Asian Hospital & Healthcare Management - Issue 63 by Ochre Media Pvt. Ltd.

ISSUE 63

2024

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Vy Tran President of Asia Pacific and Japan, Siemens Healthineers

Future of Healthcare in Asia Pacific Sponsor

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AI and the Future of Healthcare

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The Impact of Wearable Technologies in Global Healthcare www.asianhhm.com

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Foreword

Exploring the Artificial intelligence (AI) and Technology Frontier A journey through the modern era

In the dynamic realm of healthcare, technology has emerged as the driving force behind unparalleled advancements. The digitization of patient records and the revolutionary applications of Artificial Intelligence (AI) are transforming the landscape, ushering in an era of efficient, personalized, and easily accessible healthcare that has reached unprecedented heights. As we delve into the contents of this magazine, we are poised to witness the profound impact of these transformative forces. In the cover story ‘Healthcare Trends-Future of Healthcare in Asia Pacific’ of Asian Hospital & Healthcare Management, Vy Tran, President of Asia Pacific and Japan, Seimens Healthnieers writes on how the global landscape of healthcare is undergoing a remarkable shift due to the pervasive influence of digitalization and automation. Some key highlights in this edition encompass articles delving into contemporary nursing approaches amidst the era of digital progress, alongside with expert interviews offering insights into the transformative impact of Artificial Intelligence on the healthcare landscape. In the pages ahead, you will find thought-provoking articles, expert insights, and real-world examples that showcase the incredible potential of technology and AI in reshaping healthcare. Join us on this exhilarating journey as we navigate the complex intersection of healthcare technology, where fusion of healthcare innovation and human expertise gives rise to a healthier, more connected future. This edition invites you to explore not only the latest developments in the healthcare sector but also the broader considerations of increasingly digitalized healthcare landscape. Stay Connected!

Medi Swetha Editor

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CONTENTS HEALTHCARE MANAGEMENT 05 Bridging the Gap: Strategies to Combat the Nursing Shortage

COVER STORY

Dr. Harish Pillai, CEO, Metro Pacific Health

09 Patient Experience and Efficiency – A Strategic View Gurrit Kaur Sethi, Healthcare Management Expert

High Value Care and High Value Tasks in Nursing Dr Tan Hui, Managing Director, Bagan Specialist Centre and Oriental Melaka Straits Medical Centre

MEDICAL SCIENCES 21 Fostering collaboration to prioritize women’s cancers and minimize cervical and breast cancer burden in Asia Pacific Deepti Saraf, General Manager, Roche (Malaysia) Dr Heather White, Executive Director, TogetHER for Health

29 Mechanical Circulatory Support – A new way of life for end-stage heart failure Dr. Nandini Nair, Medical Director, Milton S Hershey Medical Center

Future of Healthcare in Asia Pacific Vy Tran President of Asia Pacific and Japan Siemens Healthineers

EXPERT TALK 33 Advancing the Power of Diagnostics, Now and Into the Future Anand Pande, Vice President of Asia Pacific & Japan, QuidelOrtho

40 AI and the Future of Healthcare: Opportunities, Risks, and the Imperative of Building Trust Dr. N. Adam Brown, Founder and Principal, ABIG Health

SURGICAL SPECIALITY 44 Personalized Surgical Management of Severe and Complex Spinal Deformity Yong Hai, Professor and Chairman, Beijing Chao-yang Hospital

TECHNOLOGY, EQUIPMENT & DEVICES 49 The Impact of Wearable Technologies in Global Healthcare: A Transformative Journey Unveiled João Bocas, CEO, Digital Salutem

FACILITIES & OPERATIONS 52 Importance of driving the need for innovative and efficient solutions across the healthcare value chain John Graham, CEO, Zuellig Pharma

INFORMATION TECHNOLOGY 55 AI's Evolution and Impact in HealthcareEvolution and Impact in Healthcare Adam Tran, CEO & Founder, TG Group Inter

60 AI-Driven Healthcare Revolution: Transforming Pressure Injury Detection Yaniv Cohen, Co-Founder & Chief Science Officer of IR-MED

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Advisory Board

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

EDITOR Swetha M EDITORIAL TEAM Debi Jones Harry Callum Supraja B R

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

ART DIRECTOR M Abdul Hannan

Eiman Shafa Medical Director Spine Surgery Abbott Northwestern Hospital

PRODUCT MANAGER Jeff Kenney SENIOR PRODUCT ASSOCIATES Ben Johnson David Nelson John Milton Peter Thomas

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

BUSINESS EVENTS Sussane Vincent

Gurrit K Sethi Founder, Miindmymiind

PRODUCT ASSOCIATE Ethan Wade CIRCULATION TEAM Sam Smith

Imelda Leslie Vargas Regional Quality Assurance Director Zuellig Pharma

SUBSCRIPTIONS IN-CHARGE Vijay Kumar Gaddam HEAD-OPERATIONS Sivala VNR

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

Luzviminda Nietes Vice-President, Business Planning & Development, Metro Manila

Nicola Pastorello Data Analytics Manager Daisee

Associate Partner

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Piyanun Yenjit Founder & Managing Director APUK Co.,Ltd.

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

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

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H E A LT H C A R E M A N A G E M E N T

Bridging the Gap Strategies to Combat the Nursing Shortage

Examining the global nursing shortage crisis, and drawing from the experience in the Philippines, this article delves into factors impacting healthcare, from an aging population to the COVID generation's skills gap. It advocates for comprehensive strategies, including education reforms, community-based training, and global collaborations, to bridge the workforce gap and ensure patient care resilience. Dr. Harish Pillai, CEO, Metro Pacific Health

n the realm of healthcare, nursing professionals play a pivotal role in ensuring the well-being of patients. They are the backbone of any healthcare system, providing round-the-clock care, administering treatments, and offering emotional support to those in need. However, an ongoing challenge that healthcare organizations face, especially here in the Philippines, is the shortage of nursing staff. Given this, it is important that we turn our attention to the effects of nursing shortages on patient care and explore possible solutions moving forward.

The Nursing Shortage Crisis:

The nursing shortage crisis has been a longstanding issue in the healthcare

industry. Factors such as an aging population, an increase in the number of patients with complex medical needs, and the retirement of experienced nurses have all contributed to this challenge. A major problem I see here in the Philippines is that there is an increasing trend of enrollment in nursing schools, but a decrease in both the graduation rate and in the boards performance. In 2020, we observed a dip in the number of local board passers, which may indicate a need to focus on how to better support not only those taking the boards for the first time, but especially those repeat-takers struggling to achieve their goals. Notably, however, the production of nurses does indicate an increase. The 2023 Philippine Nursing Licensure

Exams are anticipated to produce an additional 24,000 nurses, from estimates of 32,000 Board takers this year and a projected passing rate of 75%. All this to say that while the decline is unignorable, there are some positive projections on the horizon. Another factor contributing to the nursing shortage, especially among South Asian and Southeast Asian countries, is the continued exodus of nurses outside the region. As a guidance for all, The World Health Organization (WHO) recommends a ratio of 27 nurses per 10,000 population. In the Philippines, for example, there are only 16 nurses per 10,000 right now. A Southeast Asian country like ours would need an additional 127,000 nurses to meet the WHO target—in contrast, by the end of 2021, we found that there were at least one-third of more than 900,000 registered nurses who were working outside the Philippines. The effect of this exodus was felt tremendously during the critical period of the COVID-19 pandemic. The Post-COVID Effect:

The

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experienced in recent years don’t need belabouring. The lasting effects of the COVID lockdowns are evident in the “new generation” of nursing professionals in our industry today. Having missed out on hands-on experience and on-thejob training in live environments, most of them are coming to hospital bedsides with just virtual education and simulations, leaving them grossly unprepared. We have observed a pronounced gap in nursing skills and other reallife competencies in the “COVID generation” of new nurses. Thus, there is a greater impetus for hospitals to invest in adequately training these new nurses before they can be deployed to the bedside. In addition to the skills gap, hospitals in the Philippines also grapple with competition for nurses from the business process outsourcing (BPO) industry. BPOs heavily engage in health-related services like medical transcription, resulting in them vying for the same pool of nursing candidates sought after by hospitals. A significant number of nursing graduates opt not to pursue opportunities abroad but instead choose to transition laterally into the BPO sector. While they remain within the country, they are not accessible for hospitals or healthcare positions. Only 53.5% of the nurses in the Philippines are actually active, while the rest are part of the BPO workforce, or pursuing businesses that generate more income for them. Traditional healthcare players like hospitals are at a disadvantage—unable to compete in terms of compensation, benefits, and work-life balance, they are forced to watch their nursing recruit pool dwindle. By the end of 2022, approximately 170,000 nurses in the Philippines were employed in both private and public health facilities within the nation. In contrast, over 290,000 licensed nurses had ventured into alternative career paths.

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It is a hard reality, but we need to face the fact that we don’t have enough nurses. In the Philippines, we still haven’t returned to pre-pandemic levels where one school can produce as many as 12,000 graduates. The impact of the nursing shortage therefore means not only a lack of nurses in terms of quantity, but also a maldistribution. Effects on Patient Care:

Unfortunately, the effects of a nursing shortage go far and wide. Firstly, nursing shortages often lead to an increased workload for the existing nursing staff. This can result in exhaustion, burnout, and reduced job satisfaction among nurses. When nurses are overworked, their ability to provide the best possible care to patients is compromised. This can have serious consequences for patient outcomes. A nursing shortage can also directly affect the patient’s experience when visiting a hospital. Insufficient nursing staff can lead to longer wait times for patients seeking care. Patients may experience delays in receiving essential medical attention, which can negatively impact their recovery and overall experience. A shortage of nurses can lead to compromised patient safety, lapses in monitoring and providing timely

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interventions—all of these increasing the risk of medical errors. Ensuring patient safety is non-negotiable, and nursing shortages can put patients at risk. Addressing the Challenge:

Addressing the nursing shortage, both in the Philippines and globally, is a complex issue that involves various strategies for the short-term and long-term planning: 1. Education and Training Expand Nursing Programs: Right now, one immediate measure I can see being implemented both locally and globally is increasing the capacity of nursing schools to admit and train more students. Investments must be made in strengthening nurse competency training programs, while also reversing the brain drain to ensure retention of senior nurses. This also includes hiring more faculty, expanding facilities, and developing more robust training programs. Right now, the supply side issues are aggravated by the Nurse Educator shortage. Prioritizing education will also consequentially mean higher percentages of takers also passing the nursing board exams. Community-Based Training: Another short-term solution that can be explored are partnerships between private hospitals and the government,

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2. Working Conditions and Incentives Improve Working Conditions: While this may take more time for planning, adjustments, and logistics, it is also crucial down the line to enhance the working environment for nurses by ensuring reasonable workloads, adequate staffing, and access to necessary resources and equipment. As nurse staff stability affects all stakeholders (patients and doctors) and the cost of care and legal issues, it is crucial to maintain the senior versus junior nurse ratio to address the complexity of care. Competitive Salaries and Benefits: This may also be a long-term strategy because of so many factors, but it's worth exploring how hospitals could adjust and offer more competitive salaries and benefits to retain existing nursing staff and attract new recruits. This can include health insurance, retirement benefits, and opportunities for professional development. Right now, Filipino nurses leave because salaries are not “living” wages, and do not allow nurses to meet basic needs. While it will be difficult to truly match the economic equivalent of a foreign currency, healthcare players can find ways to offer more holistic and wellrounded compensation and benefit packages to augment the monetary difference. Career Development Opportunities: It is also immensely vital that hospitals, government and even schools provide clear pathways for career advancement, including specialization options, leadership training, and continuing education. There is a need for more efficient and effective targeted on-boarding initiatives, while also streamlining on-boarding processes and enhancing nurse retention strategies.

3. Policy and Legislation Government Support: The leaders of the medical field must also all come together and advocate for governmental policies that support the nursing profession, including funding for nursing education, research, and practice. Regulatory Reforms: It may seem like an insurmountable task to do away with all the red tape, but efforts must also be made to reform regulations to streamline the accreditation of foreign-trained nurses and facilitate their integration into the local workforce. 4. Retention Strategies Work-Life Balance: For retention, I also think it will go a long way if hospitals can implement policies that support a healthy work-life balance, such as flexible scheduling and mental health support. This is made all the more important as the Millennials and Gen Z workforce are increasingly aware of the importance of mental health. Mentorship Programs: Nurses should never feel that they are alone in their work. I believe more senior members in the field can work to establish mentorship programs for new nurses to aid in their professional development and adjustment to the workplace. There should be continued efforts with Nursing Retention & Engagement Programs and determining and maintaining optimal staffing levels to achieve efficiency and growth. Recognition and Appreciation: For a good morale boost, it is also helpful to regularly recognize and appreciate the contributions of nurses through awards, public acknowledgments, and other incentives. 5. Global and Local Collaboration International Nurse Exchange Programs: I believe there can be more efforts made within the international nursing community to encourage exchange programs that allow nurses to gain international experience and bring new skills back to their home countries.

6. Technology and Innovation Leverage Technology: In the Philippines, I see this as a big room for improvement. Our hospitals must learn to utilize more advanced and developed forms of technology to improve nursing education and practice, such as through online training programs, immersive simulation labs, and telehealth services. Innovative Healthcare Solutions: Related to the previous point, I believe that it falls on us leaders in the medical field and health sector in the Philippines, to encourage innovation in healthcare delivery that can make efficient use of nursing resources, like nurse-led clinics and community health programs. In closing, we must recognize that our pursuit of solutions to the nursing shortage is not just a strategic imperative—it is a testament to our unwavering commitment to quality patient care and the well-being of our healthcare professionals that tirelessly serve our community. By exploring and championing both short-term and long-term solutions, and ensuring they are implemented in accessible and sustainable ways, we leaders have the power to shape a future where healthcare is not just a service but a beacon of hope, driven by a robust and resilient nursing workforce.

AUTHOR BIO

where both can invest more in the implementation of training programs in rural and underserved areas, encouraging nurses to work in these locations post-graduation.

Dr. Harish Pillai, Group CEO of Metro Pacific Health, brings a wealth of experience from leadership roles in healthcare giants across India, Egypt, and the UAE. Recognized as an influential healthcare leader in Asia and MENA, he serves on the Private Sector Advisory Council in the Philippines, contributing to strategic healthcare development.

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Revolutionizing MRI Innovation and the Future of Medical Imaging in software, such as image processing and artificial intelligence (AI), hold immense potential but may require further development before integration into clinical practice. The future of MRI enhancement may involve Gd-based agents while exploring new approaches.

AIM LO If we could reduce the level of gadolinium needed during MRI, what might it mean for growing children who need regular checkups in recovery? We are aiming low — for curious children, and the planet they’re discovering too.

It is time to “Aim low” – innovation of GBCA

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Magnetic resonance imaging (MRI) is a foundation of medical imaging and plays a crucial role in the diagnosis and monitoring of various diseases. With advancements in technology and medicine, MRI has become the technique of choice in evaluating many diseases due to its high spatial and temporal resolution, soft tissue contrast, and lack of ionizing radiation. To further enhance the diagnostic accuracy of MRI, several techniques are being explored, including more precise scanning technology, computer-aided analysis of scans, optimized scanning protocols, and the use of injectable contrast agents.

Needs for GBCAs Revolution Contrast agents are essential in contrast-enhanced MRI (CE-MRI) to improve resolution and enhance anatomical features. While gadolinium-based contrast agents (GBCAs) have been widely used, there is growing concern about the potential risks associated with unbound gadolinium ions. While research for alternative contrast agents is ongoing, current Gd-based agents remain essential in MRI enhancement. Technological advancements

At the forefront of MRI innovation, Guerbet recognized the importance of patient safety, sustainability, and responsible usage of contrast agents is recognized. With safety concerns raised following reports of Nephrogenic System Fibrosis (NSF) and gadolinium retention, and evidence of gadolinium in surface, ground and drinking water, we believe that that lower is better for the use of gadolinium in contrast-enhance MRI, and it is time to “Aim low”. We achieve this by creating a dedicated international educational platform for radiographers and radiologists to provide evidence-based data on patient-specific contrast media dosing protocols for all diseases.

About Guerbet Guerbet is a leading force in the development, research, and manufacturing of contrast agents, and associated technologies. We are dedicated to taking a more responsible approach to the use of gadolinium, benefiting patients, the environment, and the radiology community. Through our commitment to innovation, we strive to improve existing products and address unmet medical needs. We invest heavily in research and development to pioneer innovations in the field. Our collaborations with partners for next-generation scanners and exploration of supercomputing and AI in image analysis demonstrate our dedication to pushing the boundaries of MRI innovation. For further information about our contributions to MRI innovation, please visit our website at https://www.innovation4mri.com/ Advertorial

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Patient Experience and Efficiency A Strategic View

Patient Experience' is the new service motto of healthcare service providers. This maps a journey from a focus on patient satisfaction to a focus on meeting patient expectations on the overall outcomes of clinical and non-clinical quality standards. This is an important factor for attracting and retaining patients. But is this all? Gurrit Kaur Sethi, Healthcare management expert

he healthcare services sector has seen unprecedented growth over the last few years. There has been a rush - in acquiring more beds, setting up differential models of care, introducing better technology – all towards reaching out to the patient, filling in the gaps in care provision, doorstep delivery of care, reach out, or bettering care provision through technology. This has been seen across primary, secondary and tertiary care models, all alike. In this trajectory, the subsidiary sectors have also gotten a big boost – the education sector, the IT sector, the travel sector, manufacturing, research, BPO outsourcing and more. A host of new payor models have also evolved through all of these – specialised insurance schemes, government welfare schemes, loans etc. The key buzzwords for almost all of these are patient care, patient experience, service delivery and most of all efficiency. The first two are focused on standards of delivery, and the latter two are focussed on resource

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utilisation – keys to a good business growth proposition with an eye on the business’s health. My last article a few issues back was on more tactical ways of handling these. Today I will focus on the strategic reasons why this is necessary today and not just an option. To drive Patient Experience, efficiency is a twin as well as a subset to achieve the right outcomes. It is no longer simply a matter of healthcare professionals’ soft skills alone. The efficiency of how the backend workings flow out to the patient-facing mechanisms with transparency and continuous communication, plays a major role in the final service delivery, delivery outcomes as well as perceptions of staff and patients alike. Many studies have shown a consistent positive association between clinical effectiveness and patient experience. How we enable the patient’s and family’s journey through the healthcare system not only underlines their

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service experience, but also showcases the efficiency with which the desired objectives are executed. Looking at this closely, these terminologies are the two ends of a tunnel. One end of this tunnel faces the industry segment, the other faces the consumer segment of these services. How does what happens inside this tunnel impact the industry and consumer segment? Consumers today have various vehicles to spread the word about their experiences – especially in circumstances where the experience is very poor or very good. Social media has simply enhanced this reach multiple times, the ease with which a review can be shared, a point of view spread is indeed immense. And since Google is our dictionary today, the reviews get researched more than what any advertisement may say. Healthcare is most susceptible to this as well as the generic flow of word of mouth, because of the very nature of the industry – health being a very personal and

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sensitive domain. This sensitivity also brings into focus the need for specificity and quality outcomes – be these clinical or non-clinical dealings. The total of this spread of small reviews and views can impact the business growth and the brand name. Therefore, managing patient experience well is a major handle on how the target market will perceive the brand over a period of time. The resultant efficient use of resources has an impeccable impact on the bottom line of the business. Most leaders mistake efficiency to be ‘cheap’ however it is not so. Be it a budget facility or a luxury one, there always needs to be a balance between the revenue and the spending. Efficiency is all about finding the best balance, it is not about being stingy on expense but rather taking a reasonable approach. Many a business are today suffering from the loss of business and opportunity because of the lack of spending on infrastructure upgrades, maintenance that did not seem necessary

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Given the fast evolving business specs on the wide spectrum of service types, this can be a key strategic initiative to expand the business, lessons from the hospitality industry can help.

AUTHOR BIO

and human resource development. Most times they realise this mistake too late while being on a brink of major losses. As a healthy business strategy, it is important to ensure a healthy spend on infra development (physical or digital) as well as human resources. All the big brands that have survived over the years have had to rehaul their business processes at critical junctures, keeping in line with the business dynamics. In healthcare, this becomes all the more critical. There are a host of organisations that have fallen prey to easy credit business and with unhealthy internal systems run into major cash flow issues. Experience and efficiency also drive a solid market value, be in terms of attracting investment, especially in today’s private equity driven businesses, and in terms of driving expansion opportunities. With investors happy to service such businesses with good

funding to fill the need gaps in the market or even to create new concepts that help in creating new service lines that can be accepted well, it is a win-win for all stakeholders. On the other side of the tunnel are the industry stakeholders – employees, good candidates seeking employment, suppliers, vendors, partners etc. This is the segment that feeds the various needs of a business to make everything happen, we may want to call them business enablers. These enablers will have a pride in their work when the interactions are good. Any efficient organisation values contributions of these stakeholders, building a strong internal branding, thus attracting the right workforce and the right enablers. These stakeholders, even when they leave the organisation subsequently, retain this pride of work and carry this strong positive message, enhancing the overall brand value and market recognition. What better advertising can any organisation get? At a more tactical level, given the need for driving value based and budget healthcare, especially with the varying government schemes offering medical coverage for the community at large, efficient delivery of healthcare services and a healthy business mix can define an organisation’s survival during tough times. Driving a low budget, largely credit business, with long payment cycles, demands a very narrow bottom line with smart spending. Given the growth of such schemes in India

especially, with coverage now reaching almost 90% of many state populations, it is imperative for the businesses to have a keen eye on the efficiency of the organisation and the experience of the patients and their families. To drive these twin-dual initiatives, the change always needs to start at the top. It is the senior business managers who need to first understand what needs to change at the top to be able to drive changes on the shop floor. Contrary to what most business leaders think, change has to start from how they run their own offices – which is always the most challenging part for any change management. Experience and efficiency are a paradigm and need a major paradigm shift in those who are driving the business, in adopting new ways of driving it.

Gurrit Kaur Sethi is a healthcare management professional with a career spanning 25+ years across different verticals and domains of services, Healthcare IT and Medical devices. Her key strengths are business process re-engineering and startup incubation. She is also the Founder of one of a kind mental fitness platform miindmymiind.com, Advisory Board member of AHHM and Board member of the Punjab Institute of Medical Sciences

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Dedalus Care-Covering the Continuum of Care Healthcare information technology will play a key role in helping healthcare organisations to overcome multifaceted operational challenges while addressing the need to improve their effectiveness and efficiency. Dedalus is helping to address these challenges and needs through the introduction of Dedalus Care which embodies a holistic approach, ensuring support for the entire patient lifespan, covering the entire continuum of care and integrating with every facet of a healthcare organisation. Nilesh Jain, Global Product Manager, Dedalus Care

Healthcare organisations worldwide are grappling with an array of challenges. The pressures of growing and aging populations are straining already limited resources. While healthcare technology advances rapidly, financial constraints are hindering its swift implementation. Empowered patients are increasingly demanding higher quality care, and clinician burnout is

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on the rise due to overwhelming workloads. Innovative models like hospitals 'without walls' are emerging, redefining and extending care delivery beyond traditional settings. In the developing world, a lack of healthcare access remains a significant issue. Adapting to these challenges requires collaborative and innovative solutions from the entire healthcare ecosystem.

Improving effectiveness and efficiency in operations is paramount for healthcare advancement. It is equally vital to elevate the quality of services delivered, with a growing emphasis on personalisation. Being faster in the execution of strategic plans and enhancing integration across healthcare services are crucial goals. There is a push to extend the reach and accessibility of services offered. The success of the healthcare sector depends on the ability to attract and retain high-calibre professionals. Embracing emerging digital technologies fosters innovation, while a commitment to sustainability is essential in delivering healthcare services. In addition to the global challenges and needs described above, healthcare organisations in South East Asia have to deal with other unique circumstances. With growing economies and maturing infrastructure, there is a need to improve the quality of healthcare while dealing with expanding volumes. This can be done by adopting world-class standard pathways and practices, but it takes a lot of time and human resource to create and mature them. Unlike in Europe where most healthcare is delivered through public institutions, private institutions are a faster-growing healthcare delivery sector in South East Asia. This is accompanied by an emerging healthcare insurance sector which is adopting practices and technologies already established in the West. Billing and revenue cycle management is at the heart of ensuring the continuing commercial viability of these private healthcare institutions. At the same time, public institutions remain a major source of healthcare delivery in South East Asia. They too require flexible billing systems as well as sophisticated means of capturing healthcare utilisation to assist with planning for short-term capacity demands and devising long-term healthcare policy initiatives.Dedalus is helping to address these challenges and needs through the introduction of Dedalus Care in South East Asia (and other parts of the globe). Dedalus Care is a comprehensive solution which seamlessly integrates every facet of a healthcare organisation. It encapsulates everything from primary to tertiary care, revenue cycle management to advanced analytics, and virtual care to home care. Dedalus Care is the embodiment of a holistic approach, ensuring support for the entire patient lifespan, and covering the entire continuum of care. Dedalus Care is underpinned by an awardwinning electronic medical record and patient administration system which removes the barriers between care settings and offers an integrated and patient-centric system to share patient clinical and

administrative information for a continuum of care within and between healthcare organisations. With over 30 years of evolution, the system is currently in its fourth generation embedding modern technologies and capabilities. It is in use at nearly 150 hospitals of varying sizes across multiple countries, ranging from small hospitals to large region-wide deployments, and it covers patient records for more than one-fifth of the population across Iberia (Spain, Portugal and Andorra). The other key component of Dedalus Care is a healthcare-focused enterprise resource planning system supporting billing, claims handling, cash management and revenue cycle management; procurement, warehousing and pharmacy; asset management, tracking and geo-location; and finance administration and accounting. It is fully integrated with the electronic medical record and patient administration system, and offers highly configurable workflows to accommodate future needs as well as a modular architecture to enable phased rollout. Many healthcare organisations around the world are using the pharmacy component in conjunction with electronic prescribing and medication administration from their electronic medical record to improve the safety, quality and efficiency of hospital medication management.

Dedalus addresses healthcare challenges with Dedalus Care, a holistic IT solution. Tackling operational issues and improving efficiency, it integrates seamlessly across healthcare organizations, supporting patients throughout their lifespan.

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Dedalus Care is a complete hospital information system through provision of key departmental systems and state-of-the-art standards-based interoperability. Dedalus Care can be complemented with optional modules to cover pre-hospital and emergency care (including ambulance and other emergency transport), telehealth (remote consultations and multidisciplinary team meetings), kitchen management, document management, and business intelligence (covering a set of Key Performance Indicators (KPIs) with dashboards to monitor them) – each of these are already proven in various healthcare settings and providing benefits to patients and clinicians. Dedalus Care has a user-friendly web-based user interface which works on all modern web browsers and hence facilitates easy end-user deployment and training, along with a clinician mobile application. Dedalus Care is designed for rapid template-driven deployment, strong user satisfaction and optimised total cost of ownership. Dedalus Care is flexible and can be easily and quickly adapted to local healthcare regulations and organisational models. Dedalus Care’s large customer base enables Dedalus to offer clinical and administrative international standard workflows to help customers on their journey to delivering high-quality cost-effective healthcare. Dedalus Care is targeted to work on public cloud infrastructure, especially Amazon Web Services, but can equally work on other public or private cloud infrastructure as well as through localised on-premise deployment. Dedalus Care can bring a number of benefits to healthcare organisations in South East Asia. It supports hospital care and extended beyond-hospital services. It enhances the productivity of healthcare providers by removing administrative burdens linked to repeated manual input. It cuts expenses by automating information transfer from clinical to financial and inventory management applications via adaptable business process models. It guarantees precision and expedites cost recovery. It frees up healthcare professionals to concentrate on patient care. It facilitates improved decision-making through immediate access to more precise data across clinical, financial, and supply chain systems. It offers the capacity to refine business processes. It lowers the overall cost of ownership by diminishing implementation duration and expenses and using cost-efficient technologies. Dedalus is a global health software company and one of the largest in the world. Working across the whole continuum of care and offering open stan-

dards-based solutions, Dedalus helps healthcare organisations to deliver new models of care. The benefit of Dedalus’ approach is enabling the delivery of better healthcare outcomes. Dedalus has over 40 years of experience of delivering healthcare software and services to over 6300 healthcare organisations and 5700 labs and diagnostic centres worldwide. Dedalus software is used widely across the world, managing each year more than 3 billion diagnostic results, serving a population of over 540 million, with 28 million inpatient and 35 million emergency admissions, and over 120 million citizens in primary care. Today, Dedalus employs more than 6600 highly skilled qualified people; it has the largest software R&D team in the industry in Europe representing 38% of the overall workforce. Dedalus’ passion and mission, expressed in its software-based solutions, is to enable healthcare professionals to build and share clinical knowledge.

Biosketch – Dr Nilesh Jain is the Global Product Manager for Dedalus Care. He has previously been the Asia, Middle East and Africa Lead for Health Care Information Systems, and also has been Product Manager for Care Suite Personas, Lorenzo and Premiere Synergy. He has over 25 years of experience in Healthcare IT across suppliers, healthcare organisations, academia and international standards. His specific areas of expertise in healthcare informatics include electronic patient records, clinical terminology, clinical decision support, clinical documentation, structured data entry, artificial intelligence, interoperability and healthcare information standards. Nilesh has a PhD in Computer Science and Medical Informatics from Washington University in St Louis, USA and a BTech in Computer Science and Engineering from IIT Bombay, India.

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H E A LT H C A R E M A N A G E M E N T

High Value Care and High Value Tasks in Nursing

With the recent nursing shortage, nursing roles and tasks need to be redesigned. Using the concept of high value tasks, nurses can contribute to deliver high value care, and with that creates more job satisfaction, advance the nursing profession and improve nursing retention. Dr Tan Hui Ling, Managing Director, Bagan Specialist Centre and Oriental Melaka Straits Medical Centre

orldwide and including Asian countries, healthcare institutions are facing unprecedented nursing shortage. Various reasons have been cited including nursing burn out, increasing healthcare demand, unsatisfactory nursing renumeration and lack of work-life balance, leading many deciding to leave the nursing workforce or migrate to developed countries like Singapore, Australia and Europe. At the same time, there are also a reduction in nursing students’ recruitment, due to lack of interest in nursing career pathway, deemed unattractive nursing renumeration, and fear of personal risk due to the pandemic. While various strategies have been proposed and implemented, most importantly there

needs to be a shift in thinking and carrying out the nursing role. How can nurses play their role more effectively, progress in their profession and give them more sense of fulfilment and achievement? Introducing High Value Care

The concept of high value care has been introduced in the US due to escalating cost in the fee-for-service model of the healthcare system. The Institute of Healthcare Improvement has delineated that high value care should achieve improved patient experience, improved provider experience, lower cost and better health outcomes. JAMA has summarized high value care as providing the best care possible,

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H E A LT H C A R E M A N A G E M E N T

and not urgent, nurses can schedule a time to do it. Tasks that are low value but urgent, nurses can designate it to non-nursing staff or healthcare assistants trained especially to perform those tasks. Tasks that have no value and are not urgent, can be considered to eliminate it from the routine nursing tasks. Hence more time, effort, and attention can be put into the high value tasks, and with that high value care can be delivered. For example, if there are 2 tasks pending - cleaning a infected surgical wound versus sending a stable patient for chest x-ray, nurse should prioritise to handle the patient with the wound, and a porter can be assigned to send the patient for chest x-ray. by efficiently using resources, and achieving optimal results for each patient. It is time for Asia to adopt the concept of high value care in our healthcare system, regardless of who the payor is. Nursing as a key healthcare provider, can play a very important role in promoting and adopting high value care in service delivery.

categorization and prioritization (Refer Chart 1: Prioritizing Nursing Tasks – High Value, Low Value vs No Value). The important tasks are the high value tasks, and the not so important tasks are the low value and no value tasks. With that, nursing tasks that are high value and urgent, nurses should prioritize and do it first. Tasks that are high value

Concept of High Value Task

Nursing needs to rethink and redefine their role and tasks from the traditional model, in order to deliver high value care in their clinical work. First and foremost, nurses have to rethink their daily tasks in the perspective of what value it brings to the patients or clinical care. Tasks can be categorized as high value tasks, low value tasks vs no value tasks. What are considered high value tasks for nurses should be tasks that have important clinical impact, affect changes in the health outcome to the patient, carry significant risk and involve complex nursing skills. The Important-Urgent Matrix for Tasks Prioritization

Using Eissenhower matrix or the Important-Urgent Matrix, nurses can adapt the matrix for nursing tasks

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The Value-Complexity Matrix for Tasks Delegation

In most Asian hospitals, traditional nursing career pathway is still the norm. Nurses are differentiated by trainee nurses, junior nurse, senior nurse, sister, matron and finally chief nursing or director of nursing. The concept of nurse clinician, nurse practitioner or nurse specialist is new. Though

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assist the doctors to educate patient, monitor patient treatment compliance and progress for inpatient as well as post-discharge, for better patient care. With this tasks differentiation and specialization, it will contribute to better AUTHOR BIO

some nurses have further training with advanced diploma or post basic, their role remains the same as other nurses and no differentiation of job scope or daily tasks. Only a handful who have done masters or degree, get to specialize to just focus on specific care and take on role such as diabetic nurse and wound nurse or go into administrative role as nurse manager or ward sister. Hence now having defined the high value tasks, complexity of nursing tasks can be further categorized using the Value – Complexity Matrix (Refer Chart 2: Value-Complexity Matrix for Nursing Tasks). Tasks with different complexities can be delegated to different category of nurses. For example, high value task and high complexity tasks can be redesignated to nurse clinician, and low value and low complexity ones tasked to the general or junior nurses. For example, a nurse trained in respiratory medicine, can be designed to be ‘’COPD or Asthma nurse’’ or a respiratory nurse clinician,

nursing productivity and efficiency, and also lead to better patient outcome. As nurses contribute to deliver high value care, it will create better career pathway options as well as job satisfaction, and with that it will also help with the advancement of the nursing profession, and nursing talent retention. Hence, all healthcare leaders should start rethinking the nursing tasks within their organization and start focusing their time, energy and effort on the high value tasks in order to contribute to high value care.

Dr Tan Hui Ling has been in healthcare leadership position for more than a decade. She is the Managing Director of Bagan Specialist Centre, Oriental Melaka Straits Medical Centre and Oriental Nilam College of Nursing, Malaysia. She volunteers in Malaysia Society of Quality Healthcare and sits in the Board of Association of Private Hospitals Malaysia.

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Thoracic Robotic Surgery Virtual VPP: the UK’s first virtual observership programme Guy’s and St Thomas’ Thoracic Robotics Surgery Virtual VPP, enabled by Proximie

Guy’s and St Thomas’ Thoracic Robotics Surgery Virtual VPP, enabled by Proximie, is a six-week course where observers can engage in interactive learning and gain understanding of different surgical procedures remotely. Observers will attend live surgeries virtually, interact with our expert surgeons and access an extensive library of on-demand content. Participants will also be able to remotely engage in interactive learning experiences from some of the UK’s leading Thoracic surgeons to gain a deep understanding of different surgical procedures. This will include virtually attending live surgeries and interacting with

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an expert surgical team, an online education series, and having access to an extensive video library of on-demand surgical content, which will be hosted on the Proximie platform and provided by Guys’, which has the largest robotic surgery programme in the UK. Mr Andrea Bille is a Consultant Thoracic Surgeon at Guy's and St Thomas’ NHS Foundation Trust, who – alongside colleague Mr Tom Routledge, also a Consultant Thoracic Surgeon – will be leading the virtual observership programme. “This is the first – and currently only – virtual robotic observership programme in the UK,” Mr Bille

explains. “It is aimed at all thoracic surgeons planning on starting the robotic programme, or surgeons already in the robotic programme who want more opportunities to see procedures and share their experience with us to help improve outcomes and productivity. It is also aimed at full surgical teams who are looking to upskill as a group. “The fact that the programme is virtual – thanks to live surgeries and video libraries of on-demand content made possible by Proximie’s content management system - means that overseas participants are able to attend several operations over a six-week period, while avoiding all the travel-related disruptions inherent in leaving their countries, and the negative impact this has on their clinical practice and patients. These benefits are even more pronounced for full surgical teams, who are also able to make use of multiple camera views that show what any member of the team performing a procedure is doing at any given moment.” The Robotic Surgery virtual observership programme is a six-week course, during which observers can engage in interactive learning experiences and gain a deep understanding of different surgical procedures remotely. Guy's and St Thomas' is continuing to pioneer the use of robotic technology after almost two decades. It has the largest robotics programme in the UK with six robots; five da Vinci robots and one Versius robot. The team operates across six surgical specialities – urology, thoracic, head and neck, gynaecology, transplant and gastrointestinal. In 2021, 24 surgeons from Guy's and St Thomas' carried out almost 1,300 robotic operations despite the challenges posed by COVID-19, which was the most ever in the UK for one Trust.

Dr. Bille continues: “The remote viewing of live surgery provides invaluable insight into what routinely happens in thoracic robotic theatres as well as the challenges that teams may encounter during procedures. However, participants also have access to Proximie’s video library of surgical content that enables course participants to view many different recordings of the same procedure to see first-hand if there are slightly different techniques between surgeons.” The course will invite attendees to ask questions about the ways procedures have been performed, in both live surgeries and archived ones. This creates the opportunity for participants to refine their techniques based on the wealth of expertise and information collected in the archive. “Proximie is an excellent system for recording and remotely viewing these procedures, and we have found it to be an indispensable training tool,” Dr Bille says. “The analogy I always use is sports; for every sport, there is always a huge amount of video recording that coaches carry out so athletes can review and improve their performance. One of the best features of Proximie is that you can record surgical procedures and then sit down with a fellow, trainee or colleague and go through the procedure with them, finding new ways to enhance their technique in order to increase efficiency, reduce unnecessary surgical times and improve outcomes for patients.” Using Proximie, the virtual observership programme is helping to connect surgeons from different countries to share ideas and thoughts around different surgical techniques used from different regions. This provides surgeons, both those teaching the course and those attending it, the

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benefit of being able to discuss real-world examples of where surgeries have gone well and, occasionally, where issues might have been encountered. Proximie’s extensive virtual library of surgical content, continuously populated with surgeries from Guy's and St Thomas’, will supplement the live virtual observership of surgeries taking place at Guy's and St Thomas’ state-of-the-art robotics facilities, broadcast to attendees live using Proximie’s telepresence technology. Dr Bille says: “In addition to speeding up the learning curve, Proximie can also be used as a tool to validate lower volume surgeons by sending footage of their cases to be evaluated by higher volume surgeons who can provide feedback on anything that could be improved. What’s important to highlight about Proximie, from my perspective, is that its teleproctoring, video sharing and live streaming functions aren’t about finding ways to blame surgeons, but finding ways to provide a sustainable

way for surgeons to improve their techniques and have their performance continually revalidated in the future.” Dr. Bille, who routinely uses Proximie to record all of his surgeries to allow him and colleagues to go back and review procedures – before, during and after surgery – has amassed an archive on Proximie’s content management system of over 200 individual surgeries. “Proximie’s suite of tools enable the rapid and clear exchange of knowledge. It would be incredible to invite some of the attending surgeons to the Robotic Surgery virtual observership programme to upload videos of themselves carrying out procedures during the last week of the course. I would then be able to review a video of someone carrying out a right upper lobectomy in a different country, talk to them about it and provide feedback. I might see that someone’s technique is completely different from mine, but also that it’s very efficient – and that could be a learning opportunity for me. “Before the pandemic I used to go and watch other surgeons once or twice a year, because you can always pick something up to help you slightly change or refine your techniques. So running a course like this one, when you are using a platform like Proximie, means you are sharing content and interacting – and that means it is not just one-way teaching, but an exchange of information. That has the potential to help both the teacher and the surgeon, and – better yet – to share beneficial knowledge with any surgeon in every hospital linked to this programme.”

Scan the QR code to find out more about the Thoracic Robotic Surgery Virtual VPP Advertorial 20

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MEDICAL SCIENCES

Fostering collaboration to prioritize women’s cancers and minimize cervical and breast cancer burden in Asia Pacific

With the current gaps and urgent unmet need around diagnosis and treatment of women’s cancer in Asia, members of the APAC Women’s Cancer Coalition share why there is a need for a collaborative approach to drive change to improve equitable access in women’s cancer care. Deepti Saraf, General Manager, Roche Dr Heather White, Executive Director, TogetHER for Health

t a moment when the world has coalesced around global goals to reduce breast cancer mortality and potentially eliminate cervical cancer as a public health threat, the respective burdens of these two cancers in the Asia Pacific region are currently trending in a deadly direction. Preventable disease and deaths from these two cancers needlessly tear apart family units, and their

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MEDICAL SCIENCES

progression to advanced stages often results in catastrophic out of pocket costs for individuals and families and can overburden health systems and weaken national economies. The Asia Pacific region already accounts for 45% of global breast cancer cases and 58% of global cervical cancer deaths, but without urgent action that burden is likely to grow. By 2030, breast cancer diagnoses in the Asia Pacific region are projected to rise by 20.9%, with breast cancer deaths increasing by 27.8%. In that same period, new cervical cancer diagnoses are projected to rise by 18.9% with deaths increasing by almost 25%. Unacceptably high rates of cervical and breast cancer are driven by insufficient access to care and treatment capacity, exacerbated by social stigma and low awareness around the need for prevention, early detection, and timely follow-up. Recently, Member States of the World Health Organization (WHO) ratified global goals for the scale-up of effective prevention, treatment, and care for both breast and cervical cancer which, if achieved, could save millions of lives worldwide. WHO’s 60-60-80 goals for breast cancer aim to reduce mortality though risk reduction, regular screening, and comprehensive management of invasive disease, while its 90-70-90 goals for cervical cancer are built on projections showing that global scale up of HPV vaccination, preventive screening, and safe removal of pre-cancerous cervical lesions can effectively eliminate cervical cancer as a public health threat. Countries in the Asia Pacific region stand to benefit tremendously from investing in reducing the burden of cervical and breast cancer. The moral imperative to save the lives of women is compelling on its own, preserving family units and communities alike. But these cancers also strike women in the primes of their lives, when they are most actively contributing to the financial well-being of their families – and in the aggregate, to their nation’s economies.

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Insufficient uptake of effective preventive measures such as vaccination, screening and preventive treatment for cervical cancer and early screening/ detection for breast cancer, increases the risk of late-stage diagnosis, when the costs of treating invasive cancer are significantly higher than the cost of prevention or early treatment. In Vietnam, out-of-pocket costs for breast cancer are actually 66% higher for Stage II disease and 148% higher for Stage III disease compared to Stage 0/I disease. Catastrophic out-of-pocket costs to treat invasive cancer at the individual level can create cycles of poverty and impact income levels for subsequent generations. In fact, the cost of treatment for cervical cancer patients in India results in nearly 62% of patients incurring catastrophic health expenditure. At the national level, these avoidable cancer treatment costs create a huge burden on healthcare systems while sapping a country’s economic productivity. In Indonesia alone, an estimated 246,000 years of life were lost to cervical cancer mortality in the year 2018, resulting in a total productivity cost of US$1.7 billion. It’s clear that investments in prevention, screening and timely treatment of breast and cervical cancer

We are cognizant of the intricate challenges in cancer care and are committed to forging strategic partnerships with health systems and their key stakeholders.

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save lives and preserve a country’s economic health. For every one US dollar invested in the global cervical cancer elimination targets, an estimated $3.20 is returned to the economy due to the increased participation of women in the workforce. Increased funding for these interventions must first and foremost be understood not as an expenditure but as an investment in the health and economic well-being of a country’s populace. But financial resources alone won’t put the Asia Pacific region on the path to achieving goals to reduce these women’s cancers. These investments must also be guided by situational information, including an analysis of the current status of disease burden and relevant health policies. Effective policies must be incorporated into national cancer control plans in line with global targets as well as tailored to each country’s specific context. That context should also influence programs ensuring access to these interventions as well as their affordability. Finally, collaboration between stakeholders across health systems – and even between countries – must be a core principle for promoting breast and cervical health in a holistic, and patient-centric manner to decrease stigma and improve access to effective and equitable care for all. The challenges facing us are multifaceted, with no single partner or sector capable of tackling these complex problems alone. These considerations guided this year’s launch of the APAC Women’s Cancer Coalition, a multisectoral partnership dedicated to identifying areas for collaboration to advance prevention, early detection and timely treatment in the Asia Pacific and align regional priorities with the WHO’s global targets for breast and cervical cancer, starting with six focus countries: India, Indonesia, Malaysia, the Philippines, Thailand, and Vietnam. The Coalition’s members – Roche, CAPED India, Jhpiego, Crowell & Moring International, and TogetHER

MEDICAL SCIENCES

for Health – each contribute essential perspectives and distinctive capabilities. Jhpiego leverages extensive experience in successfully implementing cervical cancer prevention projects in diverse settings, notably through the use of HPV DNA testing. TogetHER for Health brings strong global advocacy experience in aligning country policies and implementation with global goals for cervical cancer. CAPED India’s significant patient advocacy and engagement skills provide the Coalition with a strong understanding of patients’ needs. Crowell & Moring International acts as Secretariat of the Coalition and brings global government affairs expertise to the table. And Roche’s investment in strategic partnerships with health systems seeks to address systemlevel barriers and root causes that women encounter in accessing needed care. The APAC Women’s Cancer Coalition’s first order of business

involved commissioning Economist Impact tto produce the “Impact and opportunity: the case for investing in women’s cancers in Asia Pacific” report, an analysis of cervical cancer prevention and breast cancer prevention and care in the Coalition’s six focus countries that also included individual country scorecards on key activities. This in-depth report has served as a point of entry for conversations with country-level policymakers and advocates seeking to generate momentum toward improving breast and cervical cancer prevention and treatment. The report also highlights the powerful potential that a collective vision of improved control of these two women’s cancers can have in driving effective health policies across the region. A great example is the Philippines, where key stakeholders - including the Department of Health, National Integrated Cancer Control Council,

Philippine Cancer Center, Department of Labor and Employment and patient groups such as Philippine Society for Breast Cancer Care Inc. - used the report as the basis to discuss key actions toward integrating elimination and prevention of cervical and breast cancer into national health plans. Some key takeaways for next steps included the need to establish population and hospital-based registries, expanding Philhealth coverage to include reimbursement to broaden access to cervical and breast cancer patients and implementing screening campaigns in workplaces by the National Integrated Cancer Control Act (NICCA). In Indonesia, a Coalition-led workshop in Jakarta on November 8th focused on women’s cancer control in the country. The recent launch of the National Cervical Cancer Elimination Plan represents a fantastic opportunity for the Coalition to partner with the government and support

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implementation of relevant activities, such as expanding the scope of HPV DNA testing beyond ongoing efforts in Jakarta, and collaborating with civil society organizations such as Lovepink and the Indonesian Coalition to Prevent Cervical Cancer on sharing of best practices, strengthening patient advocacy and awareness efforts. The opportunity of increased regional focus to protect women in the Asia Pacific region from breast and cervical cancer isn’t just tied to global WHO goals for each cancer. Collaboration in the fight against women's cancer can also serve as a real-world example of advancing the Sustainable Development Goals, in particular Goals 3 (“Ensure healthy lives and promote well-being for all at all ages”) and 5 (“Achieve gender equality and empower all women and girls”). Rapid progress in these lifesaving cancer control efforts can position the Asia Pacific as the vanguard region in achieving global health goals and an inspiration to the entire world. The APAC Women’s Cancer Coalition is committed to supporting regionwide efforts to share resources, promote best practices, and generate the necessary leadership to change the trajectory of breast and cervical cancer rates. “We are cognizant of the intricate challenges in cancer care and are committed to forging strategic partnerships with health systems and their key stakeholders. Partnering with APAC WCC, we aim to address the structural barriers that impede women's access to the highest standard of care, ensuring they receive the best possible outcomes for their health and wellbeing.” But we can’t do it without new partners and ideas. The Coalition extends an invitation to new partners to strengthen our advocacy efforts on the ground. Join us on this journey and reinforce our collective commitment to combating women's cancer in the Asia Pacific Region.

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AUTHOR BIO

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Deepti Saraf is the General Manager of Roche, the pharmaceutical division of Roche. She is also the Vice President of Pharmaceutical Association of Malaysia (PhAMA). Deepti brings with her 19 years of experience in the pharmaceutical industry in India and Thailand. She has worked across multiple disease areas including Primary care, Oncology, Comprehensive Genomic Profiling, I2O and Nephrology. She has worked to establish a rural healthcare commercial model in India and has developed a comprehensive and integrated access strategy for Roche in India. In the APAC region, Deepti is very passionate when it comes to women’s healthcare and women’s leadership. She is a part of the APAC Women’s Cancer Coalition, where the primary objective is to advance women’s’ oncology in the APAC region. The coalition’s focus lies on enhancing breast and cervical cancer care in emerging economies.

Dr. Heather White is a global health specialist with over 20 years of experience across numerous practice areas, including non-communicable diseases, family planning, HIV, and cervical cancer prevention. Heather serves as the executive director at TogetHER for Health, a global advocacy organization dedicated to ending preventable deaths from cervical cancer. In this role, she collaborates with a global network of partners to underscore the need for innovation and financing, advocates for policies which promote equitable access to prevention and treatment, and shares stories of individuals, families and communities directly affected by this disease.

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C O V E R

S T O R Y

Future of Healthcare in Asia Pacific This interview explores the healthcare trends that are encompassing Asia Pacific in 2024 and beyond. In particular, exploring healthcare solutions in cancer care, cardiovascular, and neurovascular covering themes of digitalization, automation, personalized care, and working and being a partner of choice to customers, healthcare professionals (HCPs), and policymakers. Vy Tran, President of Asia Pacific and Japan Siemens Healthineers

1. How would you describe the current state of healthcare in the Asia-Pacific region? From your perspective, what are the key healthcare trends and innovations expected to shape the Asia-Pacific healthcare landscape in 2024 and beyond? Healthcare continues to be a key priority for many governments in the region. COVID-19 of course put the issue of healthcare top of mind and on the agenda for governments and policymakers whilst some of the existing issues such as increase in non-communicable diseases (NCDs) such as heart disease, cancer, diabetes, chronic respiratory diseases and more continues

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C O V E R

to be an area of focus for all of us in the healthcare sector. The public sector is “walking the talk” by expanding healthcare spending and we also see the private sector playing a role in introducing new care models. Medtech companies such as Siemens Healthineers are also playing a role in transforming the patient experience and meeting their healthcare needs through innovative life-changing healthcare solutions, digitalizing healthcare as well as other initiative particularly in cardiovascular, cancer and neurovascular. In terms of trends, the population is getting older, this is a known fact. According to the United Nations Population Fund (UNFPA), by 2050, one in four people in the Asia Pacific region will be over 60 years old. The population of older persons (aged over 60) in the region will triple between 2010 and 2050, reaching close to 1.3 billion. Consumers are also more digitally savvy, aware of their healthcare needs, conscious of quality of care and price sensitive which is paving way for telehealth and more personalized solutions. Thirdly is the trend around cost. No doubt healthcare is getting expensive and a growing financial burden across Asia. As people get older, they get sicker and while they may live longer, it’s also about ensuring the best possible quality of life. Naturally the cost of healthcare goes up for them. There is focus on curative care and hospital care but more needs to be done for preventive care too. It’s about helping people before they get sick and need medical intervention. Lastly is the around shortages of health care professionals (HPCs) due to variety of reasons including burn out, long hours, pay and more. According to the WHO, the largest needs-based shortages of nurses and midwives is in Southeast Asia and that the world will need an additional 9 million nurses and midwives by the year 2030. And this is not unique to nursing, there is

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S T O R Y

a shortage of radiologist, surgeons, pharmacist and more. The shortage of HCPs is critical and requires immediate action to ensure that we can continue to serve patients and those in need.

2. Digitalization and automation are transforming healthcare globally. How is your organization embracing these technologies to improve healthcare delivery? In terms of trends, digital healthcare is fundamentally changing the way healthcare is delivered and how patients receive the care that they need. Asia especially those in urban areas are predominantly a digital-centric with billions of people already using one or more digital healthcare solutions. One way to increase efficiency in the healthcare system and to make an impact is through transformative digital

In 2024, healthcare trends in Asia Pacific emphasize transformative digital solutions for cancer, cardiovascular, and neurovascular care. Automation enhances efficiency, reshaping patient journeys and alleviating system pressures.

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and automation solutions. Done well, it can bring change the patient journey as well as alleviate some of the pressures on the systems like inefficient processes, long manpower hours and more. We see three critical areas that we can play a role. 1) Innovating personalized care by promoting the health of each patient. For example, by digitally connecting precise diagnosis with precise treatment. 2) Striving operational excellence by augmenting capabilities and simplifying the work of care teams so they can focus on creating value. This means with the help of AI based clinical decision supports tools, even automation tools for some routine tasks. 3) Transforming systems of care, enabling for instance smart care delivery models, like the hub and spokes model and hospital at home by seamlessly connecting stakeholders, bringing specialized knowledge closer to patients and providing access to equitable care. Take imaging for example, our aim is to automate and streamline operations along the value chain. Our broad portfolio includes enterprise imaging IT, AI-powered decision support, as well as eHealth and patient engagement solutions. It comprises business intelligence, performance management tools and tele operations solutions, innovative cardiology IT, digital pathology as well as diagnostics IT and lab automation. Another area that we are advancing is cross-border interoperability particularly within ASEAN to allow health systems, HCPs and patients to benefit from easier more efficient processes. An example would be with greater consistency in standard and platforms, the need for patient retesting can be reduced which results in cost, resource and time saving. Digitalization is an area we will continue focusing on. Earlier this year we made the announcement of investing 1,300 crore into a new campus

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in Bengaluru by 2025 to expand our digital capabilities. The campus will also house an innovation hub, R&D facility, a manufacturing centre, and design and development units for entry-level products.

3. In the context of cancer care, what specific initiatives has your organization undertaken to provide advanced and accessible healthcare solutions? In 2020, the cancer incidence in Asia was 169.1 per 1 00 000, accounting for 49.3% of the global cancer incidence. The most common cancers included lung (13.8%), breast (10.8%) and colorectal (10.6%) cancers1. Siemens Healthineers and Varian share a vision of creating a world without fear of cancer. We do this by combining our strengths by taking a leap in cancer care, and a leap in the impact on healthcare overall to accelerate the path from diagnosis to survivorship in one joint step. Through accelerating our digital and AI-offerings, broadening the scope of our service networks and combining our technology and oncology expertise - we aim to improve how diagnostic imaging, radiation therapy, interventional oncology and surgery are delivered to fight cancer. Our work with ICON Cancer Group in Australia is an example of how we provide advanced and accessible healthcare solutions. Many cancer patients receiving treatment involved expensive, time-consuming travel and sometimes must go to multiple locations to see the doctor, get radiation therapy and visit the pharmacy. Those living outside of city areas find it difficult to come into the city center for treatments. 1 Cancer Incidence and Mortality in Asian Countries: A Trend Analysis - PMC (nih.gov)

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Icon Group was on a mission to alleviate the stress of travel by bringing all elements of diagnosis and treatment – medical oncology, hematology, radiation therapy, and pharmacy – together in its new and expanding network of comprehensive cancer centers. Siemens Healthineers and Varian worked with ICON to provide CT scanners and linear accelerators as well as associated treatment software. These systems were installed in Icon Cancer Centers across Australia and parts of Asia to increase capacity and broaden patient access. Through our products we are able to offer our customers seamless motion management with optimal accuracy whist being effective and efficient in capturing and processing images.

4. Building strong partnerships with stakeholders is crucial. Can you share examples of successful collaborations with customers, healthcare professionals (HCPs), and policymakers; how they are contributing to improved healthcare outcomes? We are convinced that, in this increasingly complex world of healthcare, close ties between stakeholders, in particular goal oriented strategic partnerships, will help to accelerate the required changes like the adoption of innovative “fit-forpurpose” technology, bold digital transformation and the transfer of worldclass healthcare management practices. An example here in Malaysia would be our value partnership with HMI Group where we provide not only technology and digital solutions but support HMI to create value through enhanced training programs and provide healthcare consulting to further develop Centres of Excellence in the areas of cancer, cardiovascular and neurology.

HMI Group and Siemens Healthineers have entered into a strategic partnership to advance healthcare delivery in Southeast Asia.

5. What challenges do you anticipate in ensuring equitable access to advanced healthcare treatments and technologies across diverse populations in the Asia-Pacific region? Asia Pacific is a diverse region with each country facing its own unique healthcare challenges. However fundamentally, it comes down to the consumer. Consumers are more health conscious, they are well informed, engaged and expect better experiences. New ways of collaboration are key. Not just within Siemens Healthineers but also with other established players in the sector so that we can solve healthcare challenges in a meaningful way. Working together, we can collectively build capabilities in areas such as AI, robotics, digital health to reduce barriers to access and make it affordable. Working with startups are also another way. We work with organisations such as Medtech Innovator to help support startups in the sector scale by building capability and providing mentorship. Healthcare is a complex sector and no one company can go at it alone. We need to be partnering up with as many stakeholders as possible to ramp up the speed of our progress, operate sustainably and reach everyone, everywhere. An example would be our work around AI and our partnership with Global Fund to accelerate the adoption of tuberculosis diagnosis which needs much needed attention particularly in Asia.

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C O V E R

6. What role do you believe regulatory and policy frameworks play in fostering innovation and ensuring positive patient outcomes in the Asia Pacific?

AUTHOR BIO

According to the Bloomberg Innovation Index, Asian countries are expected to be among the most innovative globally. However, in the field of healthcare and medtech, with the exception of Japan, the representation of Asian companies is relatively small. Governments around the region can change this by implementing regulations and policies that promote a thriving medtech innovation ecosystem. This includes robust regulatory frameworks that support expeditious access to safe and effective technologies; R&D and manufacturing incentives to increase local capabilities and meet local healthcare needs; reimbursement policies that reward innovation and provide incentives for improved outcomes; and policies that promote the adoption of digital and AI-enabled solutions to support

S T O R Y

resource-sharing and help address skills gaps. Siemens Healthineers is committed to partnering with governments around the region, partners as well as organisations such as Asia Pacific Medical Technology Association (APACMed) to improve access to early diagnosis and treatment of diseases.

7. How is your organization addressing sustainability concerns and promoting environmentally responsible practices within the healthcare sector? Siemens Healthineers underscores its commitment to sustainability with clearly defined and measurable ESG goals. With its portfolio the company contributes to improving quality of life through access to healthcare and innovation. Patient touchpoints in underserved countries are to be increased by more than one quarter by 2025. Siemens Healthineers is also strengthening its ongoing activities for

Vy Tran serves as President, of Asia Pacific and Japan, Siemens, Vy is responsible for one of the fastest growing and dynamic regions in Siemens Healthineers. She leads a passionate team of more than 4,000 employees with a strong purpose of pioneering breakthroughs in healthcare, for everyone, everywhere. Since becoming the commercial regional head in 2022, Vy has led several strategic and digital transformation initiatives with a laser focus on building a more patient and customer-centric organization that brings high value care through a broad portfolio of healthcare offerings that alleviates key disease burdens and increases access to care in the region. In addition, Vy is also responsible for the strategy, P&L, and market growth for Asia Pacific and Japan. She is also a member of the Siemens Healthineers Global Leadership Committee. Prior to this, Vy served in leadership roles at Varian including Chief Compliance Office where she led policy development and regulatory reform.

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decarbonization along the entire value chain and is thus contributing to a regenerative and healthy environment. The ESG goals also include promoting diversity, inclusion, and employee engagement. It is a set goal to increase the percentage of women in senior management to 30 percent by 2025. No doubt, while have been making progress, we need to continue this journey. Which is why recently, updating our purpose statement to include sustainably was critical. It sends a clear signal to our employees and external stakeholders that sustainability is an important area for us; we want to operate sustainably to continue serving everyone everywhere.

8. Looking ahead, what are the main opportunities and challenges your organization foresees in the AsiaPacific healthcare sector; what strategies are you implementing to address them? Data will play a critical role in influencing the patient journey and ultimately the outcome. There are substantial challenges to overcome specifically when looking at how patients experience their own health data and reports. Additionally, healthcare providers increasingly deal with multimorbidity in patients and need to find approaches to better manage chronic diseases. With interoperability as the baseline and enabler of our solutions, we work with partners such as hospitals to manage the flow of patient data which help HCPs optimize the decision-making process. By creating a holistic view of the patient, we enable HCPs to improve cooperative care and patient outcomes. As a results HCPs can collaborate efficiently and deliver high-quality patient care, resources are managed effectively, enhance access to care and critically, enable patients to engage in their own health.

MEDICAL SCIENCES

Mechanical Circulatory Support – A new way of life for end-stage heart failure patients

This article is an overview on using mechanical heart pumps in the treatment of end-stage heart failure. The article describes how technological advances are helping in extending patient lives with a good quality in the setting or organ shortage. Mechanical pumps can be a good alternative to heart transplantation in appropriate patients considering the current data on outcomes and survival. Dr. Nandini Nair, Medical Director for Mechanical Circulatory Support /Cardiac Transplantation, Milton S Hershey Medical Center

he lack of adequate donor organs for end-stage heart failure (HF) patients has led to augmented use of mechanical circulatory support in recent years for extending life with a fairly good quality in an attempt to reduce morbidity and mortality. The early beginnings of mechanical circulatory support systems in non-human systems since the 1930s led to the initial implant of pneumatic pumps in patients to prolong life in the 1960s. The first ever reported use of a left ventricular assist device in a patient was in 1963 by Liotta and Crawford published in the American Journal of Cardiology (Liotta D, Hall CW, Henly WS, Cooley DA, Crawford ES, Debakey ME.

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MEDICAL SCIENCES

Prolonged assisted Circulation during and after Cardiac or aortic surgery. Prolonged partial left ventricular bypass by means of intracorporeal circulation. Am J Cardiol. 1963; 12:399-405. doi: 10.1016/0002-9149(63)90235-2.) In 1964 the National Institutes of Health (NIH) started the Artificial Heart Program. In 1969 the first total artificial heart was used as a bridge to transplant (Denton Cooley and associates) and continued research and development in this area resulted in the first pulsatile pumps being placed since the 1980s as a bridge to transplant. Mechanical circulatory pumps have evolved rapidly as mainstream therapy over the decades with accelerated growth in the recent past. Ventricular assist devices (VADs) were initially used only as a bridge to recovery (BTR) for patients who could not be separated from cardiopulmonary bypass in the operating room but today they have become the standard of care in patients with end-stage heart failure who are refractory to medical therapy. A milestone in the development of ventricular assist devices was the development of the percutaneous heart pump at Penn State University by engineers in collaboration with industry to develop the technology for clinical use in patients. Dr William Pierce a cardiothoracic surgeon and a chemical engineer by training spearheaded the development of the first pneumatic heart assist pump called the Pierce-Donachy Ventricular Assist Device, also known as the Penn State Assist Pump which was designated an International Historic Mechanical Engineering Landmark by the American Society of Mechanical Engineers. Since then, VADs have been in different phases of development to make them more compact, less noisy, and fully internalized. Today’s most advanced heart pumps, though implanted inside the body, are still tethered to an external power source. The development of pumps for assisted circulation requires

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Blood Flow from Ventricles assisted by the heart pump (Ventricular Assist Device (VAD)

engineering technology to match human cardiovascular and circulatory physiology. The collaboration between engineers, physicians, and scientists has yielded today’s devices. Expertise in hydrodynamics to design, test, and model the devices to be physiologically compatible is a task that also requires collaborations with material scientists and physiologists. It has therefore been a truly multidisciplinary marvel to save the lives of patients with failing hearts. The use of ventricular assist devices (VADs) has slowly and steadily evolved from being temporary support to lifelong use as “destination therapy”. Initially, VADs were indicated as a bridge-to-transplant, but steady improvements in medical management and technology with newer generation devices have helped with patient outcomes, and increased use as destination therapy. Adverse events after implantation of VADs remain a significant problem and limit its use as a complete alternative to heart transplantation. All long-term pumps currently available only support the

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left ventricle and hence patients with biventricular failure do not have longterm devices as a suitable alternative to heart transplant. VADs are now being implanted globally. From 2010 to 2019 a staggering 25000 VADS were placed across the world. The evolution of VADS from large, loud, pulsatile pumps housed outside the body to small miniaturized noiseless pumps placed in the heart remains a marvel of technology. The basic structure of the VAD is shown in Figure 1. It has a simple design with a motor connected on one side to the inflow cannula and on the other side connected to an outflow graft that connects to the aorta. Hence blood flow is conducted from the left ventricle via the inflow canula, the motor, and the outflow graft into the aorta therefore unloading and by passing the entire left heart. As the field evolved the pump technology focused on continuous flow (CF)pumps. These pumps have different physiology and can be divided into axial and centrifugal pumps. The CF pumps have now become the mainstay with

MEDICAL SCIENCES

the latest being a fully magnetically levitated centrifugal CF pump which has a wider blood-flow shaft and intrinsic pulsatility. By programming the device to rhythmically decelerate and accelerate, this pump attempts to partially restore the native pulsatility to reduce bleeding and clotting-related complications. VADs come with their own set of problems in addition to advantages. One of the major problems is driveline infection which contributes to increased healthcare costs, lower quality of life, and poor outcomes. Additionally, due to the presentday continuous flow pumps lacking pulsatility, there is an incompatibility between the physiological beating of the heart and the circulatory support provided by these artificial pumps. Such incompatibility can lead to the formation of arteriovenous malformations which can cause bleeding. There is also a shear force on the blood due to the VAD which can destroy the formed elements in the blood including the von Willibrand factor (vWF). vWF is a high molecular weight multimeric protein, which binds to factor VIII to modulate hemostasis. Shear stress on blood elements speeding through the rotor causes massive degradation of vWF to yield inactive fragments of low molecular weight causing the patient to be more susceptible to bleeding especially most commonly from the arteriovenous malformations formed in the GI tract. Hence close follow-ups and surveillance are required throughout support. The management of patients on long-term support involves arriving at a fine balance between bleeding and clot formation. High VAD speeds will cause narrower pulse pressures (the difference between systolic and diastolic pressures) which will predispose to the formation of arteriovenous malformations. The patients supported on VADS require lifelong anticoagulation to prevent clot formation and therefore this has to

be finely tailored to prevent excessive clotting and bleeding. The formation of a clot can be detrimental in these patients as it will predispose them to strokes. Though strokes and neurological issues are beginning to reduce in the newer generation of VADs, gastrointestinal bleeding remains a problem in some patients most often early after implant though it can occur at any time during VAD support. Despite all the post-implant complications, the survival on VADs has increased and is comparable to that of heart transplants at 2 years. More recently 5-year survival on the newer fully magnetically levitated pump is shown to be close to 60% with a good quality of life. Quality of life on a VAD is comparable to that with a transplanted heart except for some inconveniences such as not being able to swim while supported on a VAD. Additionally, women of childbearing age may

VADs offer a better quality of life for end-stage heart failure patients as compared to medical therapy and survival is comparable to heart transplant at 2 years

be advised against pregnancy and childbirth on the pumps because this has been successful in some cases but carries a very high risk of maternal and fetal death. Pregnancy on VAD support includes hemodynamic stress, hypercoagulable events, teratogenicity due to medications, and impingement of the uterus. The use of a multidisciplinary approach highlights the rate of success in these highly complicated patients. Implementation of shared decisionmaking, cautious anticoagulation, VAD speed adjustments, and medications will help maintain hemodynamic support during pregnancy. Pregnancy brings about an increase in heart rate, blood volume, and decrease in systemic vascular resistance which can influence the efficiency of the VAD detrimentally. Some ideal characteristics of future pumps would be internalized and surface chargeable, which can be used to support both right and left ventricles. The current total artificial heart pumps are large and have drivelines. Considering the large amount of metal in the pump which has blood flowing over it, these pumps require high levels of anticoagulation. Patients on these devices are therefore prone to both hemorrhagic and ischemic strokes. Hence future pumps are moving in the direction of small, electromechanically driven; self-contained, fully implantable, with very few moving parts. The surface of these pumps which remain in contact with blood requires to be coated with pericardial or bovine tissue to optimize biocompatibility. The future holds promise in further development of these devices to support the right and left ventricles and be fully internalized with surface rechargeability and better biocompatibility. Striving to create biomaterial surfaces that effectively prevent the formation of blood clots on surfaces in contact with blood would be an optimal pursuit. Many suggested modalities are the use of physical/chemical treatment, incorporation of anti-thrombotic

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drugs, / promoting endothelialization. Hemocompatibility is an important aspect of improving pump durability. Mimicking and adopting the properties of endothelial cells will have to be achieved possibly by cell and tissue engineering using chemical adsorption, surface grafting, plasma treatment, and control of protein adsorption. Achieving such a surface topography can be very challenging when applied to VADS due to the complexity of the design of the pumps and the hemodynamics. Therefore, innovations to speed up endothelialization under different levels of shear stress could be another strategy to improve biocompatibility. In summary, mechanical circulatory support has paved the way for a new way of life. The future holds promise for more improved pumps which could someday become a complete alternative to heart transplantation with comparable survivability and quality of life for patients with end-stage heart failure.

AUTHOR BIO

MEDICAL SCIENCES

Dr. Nandini Nair is currently a Professor of Medicine, at Penn State College of Medicine, and Medical Director for Mechanical Circulatory Support /Cardiac Transplantation at Milton S Hershey Medical Center, Hershey PA 17033, USA. Dr. Nair is a cardiologist by training with a specialization in Advanced Heart failure, Mechanical Circulatory Support/Transplant Cardiology. She is board-certified (American Board of Internal Medicine) in Internal Medicine, Cardiovascular Diseases, Advanced Heart Failure/ Transplant Cardiology, Echocardiography, and Nuclear Cardiology.

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EXPERT TALK

Advancing the Power of Diagnostics, Now and Into the Future

In May 2022, Quidel Corporation and Ortho Clinical Diagnostics united as QuidelOrtho with an 80-year history of innovation. We combine industry-leading expertise in immunoassay and molecular testing with a global footprint in point-of-care settings, clinical labs, and transfusion medicine to advance critical diagnostic solutions at scale. Anand Pande, Vice President of Asia Pacific & Japan, QuidelOrtho

ur innovations have been pathbreaking. From dry chemistry that delivers testing access where there is none, to respiratory testing and tracking breakthroughs, we are at the forefront of diagnostic science and care. We introduced the first FDA-approved rapid antigen diagnostic test for influenza A and influenza B and launched the first-ever product to determine Rh+ or Rh− blood type. We also

developed the world’s first tests for the detection of antibodies against HIV and hepatitis C. We stood at the forefront of diagnostics innovation throughout the coronavirus pandemic, developing one of the earliest molecular PCR assays for SARS-CoV-2, the first FDA emergency use authorized rapid antigen test that delivers results in 15 minutes, and highvolume antibody and antigen tests for COVID-19.

We have well-established track records for providing high-quality products and services to the global clinical laboratory and immunohematology communities. Hospitals, hospital networks, clinical laboratories and blood banks around the world depend on our innovative technology and tools (including our exclusive dryslide technology) to help ensure test results are fast, accurate, and reliable. Our customized solutions deliver affordability, efficiency, and automation – all supported by an award-winning service and support program that provides best-in-class technical, field and remote service in more than 130 countries and territories around the globe. Spanning the full spectrum of customers and care – from the largest labs and hospitals to the smallest clinics and in our homes – our diverse

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EXPERT TALK

suite of diagnostic solutions expands access to reliable answers, providing critical information when and where it is needed most.

1. Could you provide us with a comprehensive overview of the merger between Quidel Corporation and Ortho Clinical Diagnostics, now operating as QuidelOrtho, and the strategic vision behind this union? QuidelOrtho Corporation (Nasdaq: QDEL) unites the power of Quidel Corporation and Ortho Clinical Diagnostics behind a shared mission of developing and manufacturing innovative technologies that raise the performance of diagnostic testing and create better patient outcomes across the entire healthcare continuum. Ranked among the world’s largest in vitro diagnostics (IVD) providers with more than 120 years of collective experience, we combine industry-leading expertise in immunoassay and molecular testing with a global footprint in clinical labs and transfusion medicine. Our company’s comprehensive product portfolio delivers accuracy, speed, automation and access, providing critical information when and where it is needed most. Inspired by a spirit of service, the QuidelOrtho family is committed to enhancing the well-being of people worldwide and happy in the knowledge we are making a difference. • Balanced and diversified product portfolio across diagnostic instruments and assays: The companies’ highly complementary, world-class product and service offerings provide opportunities to capture significant growth globally while enhancing cross-selling opportunities across a diversified customer and channel mix • Highly synergistic opportunities create significant shareholder value creation • Complementary cultures with a

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commitment to providing world-class products and services: Combined, our talented and experienced employees share a commitment to customers, patients and the communities the companies serve • Robust, more diverse product pipeline and enhanced R&D capabilities: The combined product portfolio, supported by an established global commercial infrastructure and distribution footprint, positions QuidelOrtho to capitalize on strong secular growth drivers

While growth is a good indicator of our success, a more satisfying indicator is the number of lives touched. We are proud that our products and services are not just limited to the affluent strata of the society through corporate hospitals, but also include many government hospitals that cater to every section of society in developing countries.

2. How has the merger affected the company's position in the global diagnostic solutions market, particularly in terms of research and development capabilities and market reach? The Asia Pacific region is a growth engine for most of the healthcare companies and it is no different for

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QuidelOrtho. Our strength in the region is our people, who are our biggest asset. It is because of our people that we are growing faster than the market in almost every geographic region consistently for the last few years. While growth is a good indicator of our success, a more satisfying indicator is the number of lives touched. We are proud that we have been consistently exceeding our own expectations. What makes us feel proud is that our product and services are not just limited to the affluent strata of the society through corporate hospitals, but also include many government hospitals that cater to every section of society in developing countries. We are consciously working on increasing access to enhance and extend our services. While access and awareness are the two important factors in developing markets, we cannot ignore awareness and adoption of the newer technologies. There are multiple awareness programs that we run in each country for all the stakeholders, not just limited to our products but more focused on improving patient care. As an organization, our focus is on providing services to our customers to make them a partner for life to improve and save lives with diagnostics, thus creating a healthier future for all.

3. The company has a rich history of groundbreaking innovations. How does QuidelOrtho continue to foster a culture of innovation and what are the key areas of focus for future technological advancements? Building upon our legacy of groundbreaking innovation, we partner with customers across the healthcare continuum and around the globe focusing on building a new diagnostic frontier, one where insights

EXPERT TALK

and solutions know no bounds, expertise seamlessly connects and a more informed path is illuminated for each of us. Our innovation strategy is grounded in a customer-centric, global perspective. We seek growth investments with a positive return on investment while endeavoring to reduce our environmental impact. We integrate customer feedback into actionable improvements, with the goal of keeping our solutions attuned to the real-world needs of healthcare providers. Strategic investments in R&D allow us to expand our diagnostic testing platforms and foster improved healthcare access. Near-term, mid-term and longterm strategies are aimed at fulfilling unique market needs, increasing healthcare accessibility and revolutionizing the delivery of healthcare. Our innovation is not just limited to products but also the processes and partnerships. Our ValumetrixTM Consulting use Lean and Six Sigma tools and effectively work with laboratories and blood banks to help and support them in optimizing their testing workflow to improve their service delivery.

4. In light of the recent advancements, what significant contributions has QuidelOrtho made to the field of diagnostics, and what specific measures are being taken to maintain a leading edge in the industry? As we continue to innovate and significantly differentiate ourselves in the market, we are focused on developing assays and panels that address unmet clinical needs. As an example, we have added syphilis to our Molecular Diagnostics POC STI panel. Syphilis is one of the fastest growing sexually transmitted infections (STIs), with a 74% increase in cases since 2017. And among those cases, newborns have surged with a 203% increase. The lack of sufficient diagnostic test methods for primary syphilis compounds this problem and those numbers are likely underestimated because of this. This is just one example of how diagnostic testing can provide unique

solutions to help combat devastating but easily treatable bacterial infections. We expect several planned panels to be de novo and to be differentiated as well. While we continue to expand our suite of products and capabilities, we are steadfast in driving our next phase of integration to create a highly efficient, agile organization rooted in operational experience. We know more today than we did previously and are aggressively focused on reducing complexity in the business, enhancing our culture and improving capital allocation and portfolio management and upgrading our global manufacturing operations and supply chain capabilities. At QuidelOrtho, we envision a world where individuals, families and communities have the insight and clarity to spot trends sooner, respond quicker and confidently chart their course to better health; a future where we foster lifelong well-being in real time, disease is predicted and prevented before it takes hold, communities can anticipate, prepare and protect the health of their populations, and diagnostics

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EXPERT TALK

solutions are readily accessible here and when they are needed most. And while our individual solutions continue to advance diagnostic care across the continuum, this is just the beginning. We are forging a new diagnostic frontier where our capabilities converge, experts and expertise build and invent together, and systems seamlessly connect. Changing lives one test at a time. While our services are focused on providing diagnostic solutions, we also understand our responsibilities towards our environment. Our VitrosTM Systems are unique in the diagnostics arena. They do not require water and they do not contaminate the environment with biohazardous liquid waste effluents, making Vitros analysers environmentally friendly.

5. Could you elaborate on the role QuidelOrtho has played in addressing critical global health challenges, particularly during the COVID19 pandemic? How has this experience shaped the company's long-term strategy for handling future health crises? Our point-of-care portfolio remains a cornerstone for managing a range of respiratory infections such as flu, RSV, COVID-19 and Strep A, and as we reflect on the COVID-19 pandemic, we played a critical role in the public response to contain the spread of this deadly virus. With the initial launch of the COVID-19 vaccine and subsequent booster shots over the last two years, there has been a shift away from asymptomatic testing and the necessity to produce a negative PCR test. However, the public has taken greater responsibility for their individual health and understanding of

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how viruses spread. We are seeing a considerable volume from patients and influenza-like illness symptoms, turning to their medicine cabinet to self-administer our QuickVue® At-Home over-the-counter (OTC) COVID-19 test or asking their doctor for a test in the clinic. Further strengthening our position as a leader in COVID19 testing capabilities, we recently received a CLIA waiver in the U.S. for our new Sofia® 2 SARS Antigen+ FIA in September. This is the first rapid antigen test that detects COVID-19 to be awarded FDA market clearance through the agency's De Novo process. It is also now the first rapid antigen test to receive a CLIA waiver. In addition to our CLIA waiver, we were honored to receive an award from the U.S. government to provide the government with at-home COVID-19 tests that will be provided for free to American households. The top-line impact from this $29 million award commences in the fourth quarter and is expected

While our services are focused on providing diagnostic solutions, we also understand our responsibilities towards our environment. Our Vitros™ Systems are unique in the diagnostics arena. They do not require water and they do not contaminate the environment with biohazardous liquid waste effluents, making Vitros analysers environmentally friendly.

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to continue over 18 months and was not included in our 2023 financial guidance. We were also among the first to receive the EUA for the COVID-19 Antibodies & Antigen tests on our fully automated Vitros analysers.

6. What key lessons have been learned from the development of the SARS-CoV-2 tests, and how is this knowledge being applied to other areas of diagnostic research and development? We believe we're doing what we can to help the government be prepared for another pandemic-level threat. COVID19 has clearly moved into an endemic state. However, we expect it to remain a persistent respiratory pathogen for many years to come. Our testing capabilities allow patients and providers to be informed both quickly and accurately.

7. How does QuidelOrtho ensure the delivery of highquality products and services across a global network of clinical laboratories and healthcare facilities? QuidelOrtho has developed an integrated Quality Management System (QMS) that encompasses our commitment to manufacturing quality, operational excellence, customer engagement and continuous improvement initiatives. To establish a more globally consistent QMS across the company, we have defined and implemented a shared Quality Manual and Quality Policy Statement, objectives and management review processes. We also maintain ISO 13485 certification, an international standard for medical device QMSs. This certification signifies our dedication to producing safe and effective devices across all

EXPERT TALK

stages of production, from design and development to distribution and customer feedback. Our QMS is built on stringent testing and validation of materials, helping to ensure we embed quality into our products from the outset. Through this meticulous focus on quality control, we maintain a high level of confidence in our product performance, providing our customers with safe and reliable diagnostic solutions. In addition, our QMS incorporates continuous improvement systems, including the monitoring of product performance, regular audits, inspections and management reviews. In our pursuit of operational excellence, our QMS supports us to achieve our quality metrics and key performance indicators. Through transparency and responsiveness within this system, we foster continuous improvement in our processes while upholding high standards of safety and quality. As part of our customer engagement strategy, we actively monitor the performance of our products and solicit feedback from our customers. Our customer hotlines are open to address concerns, provide guidance and facilitate the optimal use of our diagnostic solutions. This engagement enables us to deliver better support and continuously enhance our offerings. Regular inspections and audits at our manufacturing sites further enhance the safety, efficacy and reliability of our products. By tracking complaint rates and nonconformances and timely reporting nonconformance disposition requests, we demonstrate our ongoing commitment to improving product safety and quality. We employ a hybrid approach to auditing, incorporating electronic and paper-based inspections for enhanced efficiency. This comprehensive approach fosters an efficient QMS that enables us to deliver high-quality and reliable healthcare solutions.

8. In what ways does the company plan to expand its reach in underserved regions and communities, and what initiatives are being implemented to ensure the affordability and accessibility of diagnostic solutions in these areas? Our mid-term strategy focuses on developing lower-cost platforms for emerging markets and introducing additional immunoassay products. These innovations are expected to further increase healthcare accessibility in underserved communities, breaking down barriers to quality care. QuidelOrtho recognizes that democratizing healthcare plays a vital role in improving patient outcomes and advancing global healthcare. By improving the accessibility and affordability of our diagnostic solutions, we strive for a healthier world. We recognize that the democratization of healthcare is essential for advancing equitable access, particularly in underserved communities. The onset of the COVID-19 pandemic accelerated the demand, acceptance and adoption of POC diagnostic solutions, further underscoring the need for accessible and affordable healthcare. Our progress toward democratizing healthcare consists of the following initiatives such as low-cost platforms: We invest in the development of affordable diagnostic platforms and recertification and refurbishing, empowering underserved communities and emerging markets to improve overall health outcomes. We are proud of the fact that the same high quality and reliable technologies and products that are used for diagnostic testing in developed markets like U.S., Japan, Australia, etc., are also accessible to patients in Tier 2/3 & 4 towns in India, Thailand, Philippines, etc.

9. Could you shed light on the strategies employed by QuidelOrtho to maintain strong customer relationships and ensure customer satisfaction? How does the company adapt its services to meet the diverse needs of clients worldwide? QuidelOrtho’s services and informatics program is the evolution of how service, expertise, technology and data-driven solutions come together to create a more effective, efficient lab, so labs can focus on improving patient outcomes. Superior partnership and after sales service and training

support are more important than ever as labs experience greater demand for more complex testing, challenging budgets and a workforce shifting from more specialists to more generalists. With QuidelOrtho solutions, labs get the partnership they need, along with next-level data services to continually improve the speed and quality of care. Our award-winning service and support program is one of the key reasons, our customers choose us and contribute to our 99% customer retention rates in Asia Pacific region. Our ValuMetrix consulting services use proven and globally recognized techniques of Lean Six Sigma thinking, design and process excellence to evaluate and optimize laboratory workflow and

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processes, helping customers do more with less. QuidelOrtho in Asia Pacific region offer curated online as well as offline training and certification programs for various stakeholders like technologists, lab supervisors, quality managers, doctors, nurses, purchase heads and Chief Experience Officers.

10. What specific steps are being taken to further enhance the service and support program, especially considering the company's operations in more than 130 countries and territories globally? The QuidelOrtho Global Service Organization is investing in digital transformation and building a nextgeneration customer experience program. Our approach is to create delightful customer experiences

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throughout our customers’ journeys. It starts with our employee philosophy to invent ways to make our customers’ businesses more intelligent and their operations easier. Our exciting nextgen customer investments result in solutions that bring our customercentric thinking to life, so customers and employees have the freedom to focus. Our award-winning field service leverages Smart Service remote diagnostics. Our comprehensive customer service offering includes: • Highly responsive team of experts available 24/7/365 • Flexible training programs and robust educational resources available in multiple languages • E-Connectivity™ Technology to remotely monitor instruments in real-time to ensure they are running efficiently at optimal performance • Smart Service, QuidelOrtho’s innovative mobile app, assures a datadriven, proactive review is part of

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every customer service visit and ensures maximum uptime. 89% of issues are resolved the same day, thus reducing the need for on-site visits and greatly reducing delays in testing due to instrument downtime. • ValuMetrix consulting, which advises customers on Lean process engineering and reimagines the lab as a more efficient value driver for the hospital • The Voice of Customer program, which takes action on customer feedback and supports an environment of continuous improvement

11. What are the primary goals and aspirations of QuidelOrtho for the coming years, and how do you envision the company's role in shaping the future of diagnostic solutions? At QuidelOrtho, we’re advancing the

EXPERT TALK

nostic care across the continuum, this is just the beginning. Together we are forging a new diagnostic frontier where our capabilities converge, experts and expertise build and invent together, and systems seamlessly connect.

12. How does QuidelOrtho plan to leverage emerging technologies and industry trends to continue making a significant impact on global healthcare and diagnostic capabilities? We are committed to advancements in dry-slide technology, launching additional immunoassay products and developing modular solutions. These long-term goals have the potential to revolutionize the delivery of healthcare by making diagnostic tools more accessible across various settings, benefiting a wider range of people.

13. How does QuidelOrtho envision its role in shaping the future of global healthcare, and what key initiatives will the company

AUTHOR BIO

power of diagnostics, now and into the future. We envision a world where individuals, families and communities have the insight and clarity to spot trends sooner, respond quicker and confidently chart their course to better health. This is a future where: we foster lifelong well-being in real time; disease is predicted and prevented before it takes hold; communities can anticipate, prepare and protect the health of their populations; and diagnostics solutions are readily accessible where and when they are needed most. We’ve relentlessly pursued the unknown for many years, blazing trails in testing, tracking and analysis. Today, we are one of the world’s largest pure-play diagnostics providers, driving better health for more people in more places. And while our individual solutions continue to advance diag-

prioritize to ensure its continued impact and leadership in the field of diagnostics? At QuidelOrtho, we’re advancing the power of diagnostics, now and into the future. We envision a world where individuals, families and communities have the insight and clarity to spot trends sooner, respond quicker and confidently chart their course to better health. This is a future where: we foster lifelong well-being in real time; disease is predicted and prevented before it takes hold; communities can anticipate, prepare and protect the health of their populations; and diagnostics solutions are readily accessible where and when they are needed most. We’ve relentlessly pursued the unknown for many years, blazing trails in testing, tracking and analysis. Today, we are one of the world’s largest pure-play diagnostics providers, driving better health for more people in more places. And while our individual solutions continue to advance diagnostic care across the continuum, this is just the beginning. Together we are forging a new diagnostic frontier where our capabilities converge, experts and expertise build and invent together, and systems seamlessly connect.

Anand Pande, Vice President of Asia Pacific & Japan for QuidelOrtho, responsible for commercial operations in the region. Mr. Pande has more than two and a half decades of experience, both in developed and developing markets. Prior to his current role, he was Ortho’s managing director of India, where he successfully stood up the country’s operations after Ortho became an independent company in 2014. He previously worked for Johnson & Johnson as Ortho’s country manager for Korea and filled various roles in Ortho’s regional marketing function. He holds a master's degree in physics from Agra College in India and a business management degree from the Indian Institute of Management

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EXPERT TALK

AI and the Future of Healthcare Opportunities, Risks, and the Imperative of Building Trust

1. How do you perceive the current state of AI adoption in healthcare, and what significant barriers do you see hindering its widespread implementation and integration into clinical practice?

Artificial Intelligence (AI) is poised to revolutionize clinical practice. Many believe that this technology has the potential to improve operational efficiencies and clinical workflows, reducing errors and costs, and decreasing clinician burnout through automation, predictive analytics, and enhanced decision support systems. While AI may be a gamechanger in healthcare, it faces challenges from data privacy, trust, government regulations, and ethical considerations. Our interview will highlight the challenges and AI's potential role in healthcare. Dr. N. Adam Brown, Founder and Principal, ABIG Health

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Artificial Intelligence (AI) has long played a role in healthcare, aiding in tasks like radiology dictations, lab result analysis, and EKG interpretations. However, the broader potential and public awareness of AI's promise in healthcare are now coming into sharper focus. AI promises to improve clinical workflows, reduce documentation burdens, and enhance clinical decision-making, offering significant benefits for clinical operations and the potential to address clinician burnout. Yet, the widespread adoption of AI in healthcare will be gradual, with several substantial barriers to overcome. Among the primary challenges is the need for trust among end-users, particularly clinicians. They must have confidence that AI technology will save time and deliver accurate results. Additionally, administrators, while

EXPERT TALK

valuing trust, are also concerned about the substantial costs associated with implementing these technologies. The investment required for AI adoption is a significant consideration that healthcare organizations must navigate carefully.

2. Considering the potential for AI to enhance clinical workflows and decision-making processes, what specific areas of healthcare operations and patient care do you believe AI technologies can most effectively optimize? Please elaborate on any successful case studies or pilot programs you find noteworthy. Clinicians stand to benefit significantly from AI in various aspects of their work, particularly in enhancing workflows and clinical decision-making. Notably, a prominent U.S. health system has recently harnessed Microsoft's ambient voice dictation technology, resulting in over 85% of physicians expressing satisfaction and reporting a reduction in administrative workload. Additionally, AI tools have effectively organized scattered patient data from various sources into concise patient history timelines. As a practicing physician, I recognize the transformative potential of these technologies, which could not only enhance my own experience but also contribute to improved patient care.

3. In light of the concerns surrounding data privacy and security in healthcare, how can AI-driven solutions ensure the protection of sensitive patient data while still providing valuable insights for improved care delivery and medical research?

technology users. Electronic health record (EHR) vendors have already implemented robust security and privacy features to safeguard sensitive data. Similarly, AI technologies must prioritize these aspects and seamlessly integrate into secure EHR systems. Demonstrating top-tier security measures is essential to gain the trust and acceptance of hospitals and clinical practices, ensuring the smooth adoption of AI technology in healthcare.

AI-driven recommendations, particularly in critical patient care scenarios? It is essential to recognize clinical leaders as pivotal stakeholders and involve them in every AI development and deployment stage. The invaluable input and guidance from clinicians are crucial for building trust in the technology and mitigating the risk of significant setbacks due to potential errors during adoption.

4. With the increasing reliance on AI-driven predictive analytics and decision support systems, what strategies do you suggest to maintain a balance between human oversight and

Dr. N. Adam Brown Founder and Principal ABIG Health

Security and privacy are valid and paramount considerations for AI

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EXPERT TALK

of AI integration into electronic health records for clinical documentation have yielded promising results, showcasing high success rates and widespread user satisfaction.

7. Considering the rapid advancements in AI technologies, how can healthcare organizations and professionals stay abreast of the latest developments and ensure continuous adaptation and integration of cuttingedge AI solutions into their practices?

5. Given the dynamic nature of government regulations and ethical considerations in healthcare, how can stakeholders ensure that AI technologies align with established standards and ethical guidelines, promoting patient safety, privacy, and equitable access to care?

issue stemming from the absence of regulation is the uncertainty it creates for innovators and investors. They recognize that regulation is inevitable. Consequently, investing in products or technologies that could face stringent regulation in the future raises concerns. While essential for protection and ethical reasons, regulation also provides a necessary framework and level playing field for investors and innovators alike.

There is a growing consensus that the current level of AI regulation needs to catch up to what is needed. Numerous companies have appealed to Congressional leaders, urging the establishment of regulatory standards to safeguard patients, businesses, and innovators. The concerns span from safeguarding intellectual property rights and addressing ethical considerations to combating racial bias within algorithms to safety and addressing security and privacy issues. AI has the potential to introduce significant challenges and negative impacts on both patients and businesses. However, a less-discussed

6. How do you envision AI contributing to addressing the challenges of clinician burnout and the optimization of healthcare resources, particularly in the context of improving operational efficiencies and reducing administrative burdens?

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Physicians grapple with an increasingly daunting array of administrative tasks, including heightened documentation demands and onerous prior authorization processes. Demonstrations

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Numerous news organizations diligently track advancements in AI technology, and I'm pleased to contribute to this coverage through my work with MedPage Today. I focus on exploring critical business considerations within the healthcare sector, with AI being a prominent topic of discussion. In addition to my personal channels, I stay informed by following several reputable healthcare news outlets, including Fierce Healthcare, Healthcare Dive, Axios, and Modern Healthcare. Each of these publications offers valuable updates and insights into the latest developments in the field of AI.

8. What are your thoughts on the potential ethical dilemmas that may arise with the increasing reliance on AI in healthcare, and what measures should be implemented to mitigate these ethical concerns while maximizing the benefits of AI-driven healthcare solutions? Two significant concerns are emerging in AI: the perpetuation of racial biases and data security. Recent studies have

EXPERT TALK

9. In your opinion, how can the healthcare industry foster a culture of trust and transparency around the use of AI technologies, ensuring that patients and clinicians feel confident in the reliability and accuracy of AI-driven diagnostic and treatment recommendations? Effective stakeholder engagement is of paramount importance in the realm of healthcare technology. Physicians, nurses, and other clinical team members should not experience the frustration that has often accompanied the introduction of electronic health records. They must be actively involved throughout the entire process, from the initial development stages to implementation and subsequent refinement. Furthermore, we must prioritize conducting objective research to address pivotal questions

regarding the safety, accuracy, costs, and potential operational enhancements linked to these emerging technologies. Absent such comprehensive and unbiased studies, technology initiatives may encounter significant challenges during the implementation phase. It's a collaborative effort that ensures the successful integration of these innovations into healthcare practices.

10.Looking ahead, what do you perceive as the most significant barriers and opportunities for AI in healthcare, and how can stakeholders collaborate to overcome challenges and leverage the full potential of AI for improved patient outcomes and healthcare delivery? Trust and cost. The healthcare industry faces two formidable hurdles that demand collective attention from regulators, communicators, and healthcare providers. As the pandemic illustrated with vaccine development, scientific breakthroughs and technological advancements can be revolutionary and life-saving. However, without robust stakeholder engagement and a concerted trust-building campaign, impediments may arise that hinder the successful implementation AUTHOR BIO

confirmed the apprehensions that AI is indeed amplifying racial biases, a phenomenon that aligns with the fact that we all possess implicit biases. The technology operates based on the inputs and algorithms created by fallible humans. Secondly, as AI draws data from various platforms, there's a growing apprehension regarding the safety of intellectual property and other confidential information. For instance, if I seek assistance crafting a corporate announcement involving a trade secret set to be revealed in six months and input this data into ChatGPT, could others gain access to it? The ownership of the data becomes a pertinent question, and the confidentiality of the secret may be compromised. Patients share similar concerns about the privacy of their health information and whether it may be inadvertently shared. These dual concerns demand careful consideration in the evolving landscape of AI.

of these innovations. Cost presents another formidable challenge. U.S. hospitals are grappling with substantial financial challenges, and adopting new technology is contingent on achieving a near-term return on investment. In this context, government intervention through investments and incentives could play a pivotal role in facilitating the adoption of these technologies and driving progress within the healthcare sector.

11. Is there anything else you would like to share or any additional concerns or considerations we should be aware of? Numerous narratives have explored the notion of physicians and nurses being potentially "replaced" by AI, but I believe this perspective oversimplifies the situation. Instead of framing it as an either-or scenario, we should consider AI as a valuable complement to human intelligence. AI has the potential to help address future clinician shortages and enhance operational efficiencies, thereby alleviating burnout. In essence, I view AI as "augmented" intelligence rather than purely artificial intelligence, offering a promising synergy between technology and healthcare professionals.

Dr. N. Adam Brown, is a practicing emergency physician, entrepreneur, and healthcare executive. Having risen through the ranks at Envision Healthcare, Dr. Brown became President of Emergency Medicine in 2020 and Chief Impact Officer in 2021, spearheading COVID-19 response and clinical communications. In 2022, Dr. Brown left Envision, starting ABIG Health, a healthcare growth strategy firm. He also became a professor at the UNC Chapel Hill Business School, teaching healthcare operations to MBA students. He is also co-chair of the advisory board for the Center for the Business of Health at UNC. In 2023, Dr. Brown became a Visiting Professor at ESCP Business School in London and Paris.

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S U R G I C A L

S P E C I A L I T Y

Personalized Surgical Management of Severe and Complex Spinal Deformity The rapid development of three-dimensional (3D) technology in recent years has made their integration with surgery feasible. This article introduce the application of 3D reconstruction and printing technology in personalized management of complex spinal deformities, aiming to optimize clinical decisions and elucidate the efficacy and safety of this technology. Yong Hai, Professor and Chairman, Beijing Chao-yang Hospital

n recent years, sports and health issues have gradually started affecting human well-being. With the advent of an aging population, skeletal health has become a significant factor influencing patients' quality of life. However, as the era of precision medicine unfolds, the high demands for efficacy have led treating physicians to seek advanced technological assistance for improved surgical outcomes. Spinal deformity diseases, with their diverse and highly individualized characteristics, impose substantial demands on orthopaedic surgeons' diagnostic and therapeutic skills. Due to the complexity of severe rigid spinal deformities, procedures such as screw insertion, osteotomy, distraction, and decompression significantly increase the risk of intraoperative neurological complications. Reports indicate that postoperative neurologic complications in complex spinal correction surgeries can reach as high as 4.0%-23%. The risk of

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S U R G I C A L

neurological complications is closely associated with preoperative deformity severity, osteotomy location, osteotomy type, and correction rate of kyphosis deformity. Tailoring individualized and precise surgical plannings for each patient based on their clinical and radiographic features has become a routine practice for orthopaedic surgeons. As we progress into the era of "precision medicine," the pursuit of more accurate and efficient surgical treatment strategies becomes paramount. In the field of orthopaedics, particularly in deformity cases, the three-dimensional morphological abnormalities of bones in coronal, sagittal, and axial planes result in severe loss of movement function, cosmetic deformities, and can also lead to cardiorespiratory abnormalities, significantly impacting patients' quality of life. Historically, surgical plans were often formulated based on a surgeon's personal experience and literature reports, resulting in a rudimentary assessment and prognosis of postoperative outcomes for patients, lacking visibility, specificity, and effectiveness. Several studies have reported the use of SurgiMap software for surgical simulation to predict and design osteotomy plans. While this software provides two-dimensional correction simulations based on sagittal or coronal plane X-rays, most spinal deformities are three-dimensional in nature, limiting the applicability of two-dimensional planning software. The rapid development of threedimensional simulation reconstruction and 3D printing technology as advanced technologies in recent years has made their integration with medicine feasible. In various medical fields, three-dimensional imaging techniques have been utilized to reconstruct various physiological and pathological structures, simulate surgical plans, and formulate surgical strategies, gradually becoming indispensable tools for physicians. With ongoing innovations

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in three-dimensional reconstruction and 3D printing technologies, new cases of their integration with modern medicine continue to emerge within the medical field. In the realm of orthopaedics, this technology has also seen significant advancements in recent years. For patients undergoing orthopaedic surgery, three-dimensional reconstruction based on patient imaging data is used to create visual orthopaedic models. Precise surgical plans are developed within these visualization models, enabling the formulation of personalized surgical treatment plans for enhanced surgical outcomes and efficacy.

Various 3D techniques, including spinal canal reconstruction evaluation, computer-assisted screw inserting planning and 3D surgical simulation, 3Dprinted spine model, and 3D-printed guide template of pedicle screw or osteotomy, has been applied in the personalized surgical management of severe and complex spinal deformity patients, aiming to optimize clinical decisions, efficacy and safety

While computed tomography (CT) reconstruction of the spine provides three-dimensional images, traditional medical imaging still has limitations in preoperative planning and intraoperative guidance. 3D printing technology based on CT scan data can provide surgeons with high-precision, anatomically accurate physical spine models. Recent studies have shown that these models

not only play a crucial role in educating medical students and explaining patient conditions and surgical plans but also assist surgeons by visualizing anatomical structures and tissues, ultimately reducing surgical time. Previous research has demonstrated that 3D printing technology contributes to improved accuracy of pedicle screw placement, reduced surgical time, decreased surgical blood loss, and lowered neurological complications. Some scholars have reported the combined use of digital technology and 3D printing for preoperative planning and pedicle osteotomy in complex spinal deformity surgeries. They constructed osteotomy guides and simulated the surgical process, proving that the 3D printing osteotomy guide system could effectively assist in preoperative osteotomy planning. However, this experiment was conducted in vitro, which limits the value of this personalized design and assisted surgery system. Therefore, the value of personalized digital planning combined with 3D printing technology in assisting osteotomy procedures for rigid complex spinal deformities still requires further exploration. Through three-dimensional simulation reconstruction and 3D printing technology, various preoperative data, surgical plans, and postoperative effects can be visualized, enabling surgeons to more accurately assess postoperative skeletal structural conditions. Moreover, the application of relevant internal fixation and osteotomy guides created from three-dimensional simulations can significantly enhance the surgical effectiveness and safety. Presently, this technology has yet to be fully integrated. In this article, we would introduce the application of three-dimensional reconstruction and 3D printing technology in personalized surgical treatment of complex severe spinal deformities by our team, aiming to optimize clinical decisions and elucidate the clinical efficacy and safety of this technological approach.

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The application of spinal canal reconstruction evaluation

Han et al. assessed the effects of two surgical techniques, Ponte osteotomy and posterior vertebral column resection (PVCR), on spinal cord deformation in severe and rigid kyphoscoliosis patients. A 3D model of the spine was constructed for each patient, focusing on the spinal canal between T2 and L2 vertebrae. Results revealed that Ponte osteotomy elongated the spinal canal length (SCL) at the concave side by 5.4% and at the convex side by 1.3%, while PVCR shortened SCL at the concave side by 2.3% and at the convex side by 5.2%. Both techniques significantly improved Cobb angles and patientreported outcome measures, with Ponte osteotomy primarily elongating the SCL at the concave side and PVCR causing compression at the convex side. These findings offer insights for the development of new surgical techniques that integrate the benefits of both approaches to optimally correct spinal deformities and prevent neurological complications. Also, this is the first time that the spinal canal reconstruction technique was applied in complex spinal deformity evaluation. (Figure 1)

Figure 1 The measurement of changes of spinal canal length.

The application of computerassisted screw inserting planning

Zhang et al. conducted a prospective cohort study aiming to investigate the feasibility and effectiveness of computerassisted screw inserting planning (CASIP) in treating severe spinal deformities. A total of 50 patients participated, with 25 allocated to the CASIP group and 25 to the Non-CASIP group. Pedicle screw accuracy, puncturing rates, estimated blood loss, surgical time, correction rate, and radiological parameters were compared between the two groups. The CASIP group demonstrated significantly higher pedicle screw accuracy (92.0 ± 5.5% vs. 82.6 ± 8.3%, P < 0.05) and lower puncturing rates (0% vs. 0-6.25%, P < 0.05) compared to the Non-CASIP group. Additionally, the CASIP group

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Figure 2 The application of computer-assisted screw inserting planning before surgery.

exhibited shorter surgical times (280.0 [IQR: 260.0-300.0] min vs. 310 [IQR: 267.5-390.0] min, P < 0.05). This study concluded that CASIP is feasible and enhances the accuracy of pedicle screw placement, enabling spine surgeons to create detailed preoperative personalized screw plans, resulting in improved fixation outcomes. (Figure 2) The application of ComputerAssisted Three-Dimensional Surgical Simulation

Zhang et al. assessed the reliability of computer-assisted three-dimensional

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surgical simulation (CA3DSS) for posterior osteotomies in thoracolumbar kyphosis secondary to ankylosing spondylitis (TLKAS) patients. Simulated osteotomies were conducted using Mimics and 3-Matic Medical software, and radiological parameters were measured in preoperative X-rays, preoperative original 3D spine (PreOS), simulated 3D spine (SS), and postoperative original 3D spine (Post-OS). Reliability was assessed through intraclass correlation coefficients (ICCs) and Bland-Altman analysis. The study found excellent consistency

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between preoperative X-rays and Pre-OS models. In SS and Post-OS models, global kyphosis, thoracic kyphosis, and lumbar lordosis exhibited excellent reliability (ICC 0.832, 0.773, and 0.896, respectively), while the main curve and sagittal vertical axis showed good reliability. Correction angles achieved by pedicle subtraction osteotomy (PSO) and posterior column osteotomies (PCO) also demonstrated good reliability. Bland-Altman analysis further supported the agreement between Cobb angle and distance measurements. The study concludes that CA3DSS is an accurate, reliable, and effective method for simulating correction surgery with posterior osteotomies in TLKAS patients. (Figure 3) The application of ThreeDimensional Printing Spine Model

Pan et al. performed a retrospective casecontrol study aiming to assess the utility of three-dimensional printing (3DP) spine models in the surgical management of severe spinal deformities. Patients with severe scoliosis or hyper-kyphosis who underwent posterior fixation and fusion surgery using 3DP spine models were compared to a control group that underwent surgeries with free-hand screw implantation. After propensity score matching, 35 patients were included in each group. The 3DP group exhibited significantly reduced operation time and blood loss compared to the control group. Moreover, the 3DP group demonstrated higher accuracy in pedicle screw placement

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Figure 3 The computer-assisted simulation of pedicle subtraction osteotomy for a patient with severe thoracolumbar kyphosis secondary to ankylosing spondylitis.

and a lower rate of screw misplacementrelated complications. Notably, a higher proportion of three-column osteotomies were performed in the 3DP group. This study emphasizes that 3DP spine models can enhance surgeons' confidence in executing complex osteotomies and improve safety and efficiency in severe spinal deformity correction surgery. The promising potential of 3D printing technology in spinal deformity surgery is highlighted. (Figure 4) The application of 3D-printed guide template of pedicle screw placement

Liang et al. performed a study to compare the accuracy of pedicle screw placement and surgical outcomes between the 3D-printed (3DP) guide template technique and the freehand technique in spinal deformity surgery. Through a systematic literature search, seven studies

involving 87 patients with 1384 pedicle screws placed using 3DP guide templates and 88 patients with 1392 pedicle screws placed using the freehand technique were included in the meta-analysis. The results indicated that the 3DP template technique exhibited significantly higher accuracy for placing pedicle screws, with increased rates of excellently and qualifiedly placed screws, and decreased rates of poorly placed screws. Additionally, the 3DP template group demonstrated reduced mean placement time per screw, total screw placement time, and blood loss compared to the freehand group. Notably, there were no significant differences in operation time and main curve correction rate between the two techniques. In conclusion, this study highlights the potential of the 3DP guide template as a promising tool to enhance pedicle screw placement accuracy in spinal deformity surgery,

Figure 4 The application of three-dimensional printing spine models in the surgical management of severe spinal deformities.

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Figure 5 The application of 3D-printed guide template technique in pedicle screw placement for complex spinal deformity cases.

Figure 6 The application of personalized preoperative digital planning and three-dimensional printing osteotomy templates for severe and complex adult spinal deformities, especially for revision cases.

and

The application of 3D-printed guide template for osteotomy

Ding et al. demonstrated the clinical utility of personalized preoperative digital planning and three-dimensional printing (3DP) guide templates for the treatment of severe and complex adult spinal deformities. The procedure included osteotomy. Various perioperative and radiological parameters were collected and analysed retrospectively. The technique achieved successful outcomes, with correction of main cobb angle and kyphosis and a high ratio of osteotomy execution to simulation (97.02%). Notably, three pedicle subtraction osteotomies (PSOs) and five vertebral column resection (VCR) osteotomies were conducted with the assistance of the guidance templates. The study concludes that this approach is effective, safe, and

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easily applicable, allowing for precise preoperative osteotomy simulation and reducing surgical risks and complexities associated with high-level osteotomy in severe adult rigid deformities. (Figure 6) Precision medicine's emergence has prompted orthopaedic surgeons to seek advanced technological support for improved surgical outcomes. Among the complex challenges posed by spinal deformity diseases, the demand AUTHOR BIO

warranting further adoption exploration. (Figure 5)

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for personalized and precise surgical planning has led to the integration of three-dimensional morphological assessments and 3D printing technology. These innovations enable the creation of patient-specific orthopaedic models, serving as the foundation for meticulous surgical plans tailored to individual needs. The studies presented in this collection highlight the transformative potential of advanced technologies in spinal deformity treatment. From investigating the impact of osteotomy techniques on spinal cord deformation to enhancing pedicle screw accuracy through computer-assisted planning and leveraging three-dimensional surgical simulation for complex cases, these techniques underscore the potential of computer technology in optimizing surgical interventions. Moreover, the application of 3D-printed spine models and guide templates demonstrates tangible improvements in surgical efficiency, accuracy, and safety. As technology continues to reshape the field of orthopaedics, these advancements hold promise for enhancing patient outcomes and redefining the standards of care in spinal deformity treatment.

Yong Hai is a world renowned researcher and surgeon in the field of spine surgery from Beijing, China. He is the professor and chairman of the department of orthopedic surgery, Beijing Chaoyang Hospital, Capital Medical University, and director of Center for Spinal Deformity of Capital Medical University.

TECHNOLOGY, EQUIPMENT & DEVICES

The Impact of Wearable Technologies in Global Healthcare A Transformative Journey Unveiled

In the dynamic landscape of global healthcare, wearable technologies have emerged as powerful tools, reshaping the way we approach well-being and patient care. From the bustling metropolises of New York to the remote villages of sub-Saharan Africa, the impact of wearables is not confined by borders; it's a universal transformation touching lives across continents. As we explore the global footprint of wearables in healthcare, a narrative of empowerment, accessibility, and innovation unfolds, heralding a new era in patient-centric healthcare delivery. João Bocas, CEO, Digital Salutem

The Rise of Wearable Technologies: A Pioneering Wave

Wearable technologies have indeed ushered in a transformative era in healthcare, transcending geographical boundaries with their pervasive presence. From bustling city centers to remote villages, the sight of individuals donning smartwatches, fitness trackers, and health monitoring devices has become commonplace. This ubiquity signifies a monumental shift in healthcare dynamics, reshaping the very relationship between individuals and

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TECHNOLOGY, EQUIPMENT & DEVICES

their well-being. Wearables have evolved from gadgets into guardians of wellbeing, playing a multifaceted role that goes beyond mere data collection. In the era of wearables, access to health data is no longer confined to clinical settings. Real-time health insights are seamlessly integrated into the fabric of everyday life, fostering a culture of proactive healthcare management. These devices not only monitor heart rates, track physical activities, and analyze sleep patterns but also serve as constant reminders of health goals. Through gentle nudges and personalized notifications, wearables motivate individuals to maintain healthy lifestyles, encouraging regular exercise, adequate sleep, and mindful eating. This continuous engagement transforms health from a periodic concern to a day-to-day commitment, emphasizing the importance of preventive measures over reactive interventions. Furthermore, wearables have democratized access to health data, dismantling barriers that once hindered the flow of vital information. Individuals from diverse socioeconomic backgrounds now have the means to monitor their health, irrespective of their geographic location or financial resources. This democratization of health data is not just a step towards inclusivity; it represents a fundamental redefinition of healthcare as a universal right rather than a privilege. Empowering Patients: From Passive Recipients to Active Participants

In the annals of healthcare, the role of patients has historically been a passive one, with individuals seeking medical attention primarily when faced with illness or discomfort. However, the advent of wearable technologies has heralded a transformative shift, empowering individuals to become active participants and architects of their health journey. These innovative devices have not merely disrupted the traditional patient-provider dynamic; they have redefined the very essence of

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healthcare, placing individuals at the helm of their well-being irrespective of their geographic location on the global map. Wearable technologies, equipped with an array of sensors and sophisticated algorithms, offer continuous monitoring of vital signs, physical activity, and even emotional well-being. This real-time data collection serves as the cornerstone of a proactive approach to health, enabling individuals to stay informed about their physiological states at all times. Heart rate fluctuations, sleep patterns, daily steps, and even stress levels are now accessible at the touch of a fingertip or a glance at a smartwatch screen. This constant stream of personalized health information fosters self-awareness, illuminating the intricate interplay between lifestyle choices and overall well-being. Enhancing Chronic Disease Management: A Global GameChanger

In the realm of global healthcare, chronic diseases such as diabetes, cardiovascular disorders, and respiratory ailments pose substantial challenges. These conditions, often requiring lifelong management, place immense pressure on healthcare systems worldwide. However, wearables

My vision is that wearables can change the world, certainly the healthcare world. We need to turn healthcare upside down to make it sustainable in the future, and wearables are the perfect vehicle to empower people. Furthermore, selfcare will be the healthcare of the future. Nothing will ever replace good health, that's the ultimate goal of every single human being

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have emerged as revolutionary tools in the management of chronic diseases, transforming the lives of millions. Equipped with sensors and artificial intelligence algorithms, smart wearable devices enable remote monitoring, offering real-time insights into patients' health statuses. Wearables provide personalized care plans, tailoring interventions to individual needs. Through continuous monitoring, wearables detect subtle changes in vital signs, enabling the early detection of health anomalies. This early warning system not only prevents complications but also ensures timely medical interventions. Moreover, wearables promote adherence to treatment regimens, offering reminders for medication schedules, exercise routines, and dietary plans. By empowering individuals to actively manage their chronic conditions, wearables enhance the quality of life for patients, promoting independence and reducing the burden on healthcare infrastructure. Revolutionizing Healthcare Accessibility: A Universal Solution

Accessibility to quality healthcare remains a critical challenge globally. Remote and underserved communities, whether nestled in bustling cities or secluded rural villages, often lack immediate access to healthcare facilities. Wearables act as equalizers, bridging gaps in healthcare accessibility. These devices, adept at collecting and transmitting health data, pave the way for telemedicine platforms that reach even the most remote corners of the world. Telemedicine, supported by wearables, connects patients with healthcare professionals, breaking down barriers imposed by geography. Timely consultations and medical guidance become accessible to individuals regardless of their location. Wearables facilitate remote diagnoses, enabling healthcare providers to assess patients' conditions accurately.

TECHNOLOGY, EQUIPMENT & DEVICES

This democratization of healthcare ensures that every individual, regardless of their geographic location or economic status, receives the quality care they deserve. Wearables redefine healthcare accessibility, making it a universal right rather than a privilege. The Promise of Wearables in Global Healthcare: A Glimpse into the Future

As we peer into the future of global healthcare, wearables hold the promise of further revolutionizing the landscape. Advanced innovations, including smart biosensors, wearable AI assistants, and healthcare-focused augmented reality applications, are on the horizon. Smart biosensors offer real-time, detailed health analysis, enabling users to monitor their well-being with unprecedented precision. Wearable AI assistants, powered by machine learning, provide personalized health recommendations, acting as virtual healthcare companions. Furthermore, wearables integrated with predictive analytics will not only anticipate individual health needs but also contribute valuable data to public health initiatives. By harnessing the power of big data, healthcare professionals can gain deep insights into population health trends, disease

patterns, and treatment outcomes. This collective intelligence informs evidencebased healthcare policies, ensuring proactive measures to safeguard public health. In this symbiotic relationship between wearables and global healthcare, a future unfolds where health is not just responsive but anticipatory, personalized, and truly universal. Wearables cease to be mere devices; they become architects of a future where every individual,

regardless of their background or location, experiences healthcare tailored to their unique needs. This vision represents more than a technological advancement; it embodies a paradigm shift, a transformation that transcends boundaries and ensures a healthier, more equitable world for all. Wearables, in this future, become the cornerstone of a global healthcare renaissance, ushering in an era of proactive health management and unparalleled accessibility. The shift from passive recipients to active participants, facilitated by wearable technologies, marks a pivotal moment in the evolution of healthcare. Wearables empower individuals, providing them with the knowledge, tools, and motivation to take charge of their health journey. This empowerment is not an isolated occurrence but a global phenomenon, transcending barriers and uniting individuals in a shared commitment to well-being. As wearables continue to advance, they are not just devices; they are enablers of a healthier, more engaged, and interconnected world, where every individual is not just a patient but an active participant in their path to a healthier tomorrow. AUTHOR BIO João Bocas is a dynamic and visionary healthcare entrepreneur who has dedicated his career to driving innovation and transformation in the healthcare industry. With a passion for cutting-edge technologies and a deep understanding of the healthcare landscape, João is committed to improving patient outcomes and revolutionizing healthcare delivery. With over 20 years of experience in the healthcare sector, João has become a recognized thought leader, speaker, and advisor in digital health, wearable technology, and artificial intelligence. He is known for his ability to identify emerging trends and leverage them to create impactful solutions that bridge the gap between technology and healthcare.

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FA C I L I T I E S & O P E R AT I O N S

Importance of driving the need for innovative and efficient solutions across the healthcare value chain

Change is perennial in the healthcare industry. With evolving patient needs, emerging disease areas and new innovations driving this fast-moving landscape, we need to collectively prioritise access to healthcare, affordability and sustainability to benefit the health of communities across Asia. John Graham, CEO, Zuellig Pharma

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his, alongside collaboration among key stakeholders, is key to ensuring continued access to healthcare across communities in Asia From the discovery of insulin and penicillin in the early 20th century, the pharmaceutical industry has come a long way in meeting the healthcare needs of the world’s populations. Rapid research and development of innovative drugs and therapies have countered the emergence of new diseases that threaten to have dire impacts on communities, especially those unequipped to address them. However, with every new year that brings unprecedented opportunities for the industry, the landscape also grapples with the impact that external economic forces have on delivering healthcare. Inflationary pressures, rising costs and geopolitical headwinds have all had an impact on many industries, and the pharmaceutical sector is no different. There is a need for sustainable, innovative and efficient solutions across the healthcare value chain and it is critical that the industry stays focused on the end goal of providing greater access to high-quality healthcare for the people who need it most. Complex challenges hindering access to healthcare in an evolving landscape

In a region as diverse as Asia, the challenges faced by each market in

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making healthcare affordable and accessible are as unique as the populations that live in them. With rising healthcare costs, changing regulatory and compliance standards and fragmented medical supply chains, ensuring that patients are able to access the medicines they need has been an uphill task for manufacturers, distributors, and healthcare professionals. Affordability and inequitable distribution among developing and developed nations Access to emerging innovations in the pharmaceutical space has been largely out of reach for developing nations, with reimbursement systems at varying levels of maturity in the region, placing greater burdens on the patient to pay out-of-pocket. With different levels of health financing from local governments as a result of a dependence on economic growth, the sustainability of widespread healthcare access can be challenging. During the pandemic, many discussed the delay in access to vaccines for developing nations. Countries ranking lowest in GDP per capita were found to have waited the longest for COVID-19 vaccines as opposed to those with larger economies, despite the pandemic being indiscriminate in its toll on populations. Vaccine nationalism and a lack of universal healthcare have been two of the biggest reasons for why access across Asia Pacific was disparate, and three years on from the pandemic, access to the newest drugs and healthcare innovations paints a parallel picture.

concentration and a lack of diversification of supply sources. Extensive offshore sourcing of critical materials has also made supply chains more complex and fragmented, putting critical healthcare products at higher risk of production stoppages when faced with border closures. Product availability is hindered when faced with no-fly zones during geopolitical turmoil, and natural disasters such as flash floods and earthquakes which can cause severe consequences for the ability to manufacture much needed healthcare supplies and products due to shortages in inputs. When coupled with protectionist measures and the imposition of movement limitations during exceptional circumstances, it is evident that the global medical supply chain is not prepared for long-term resilience. In order to provide the high-quality care patients need, the intricate and complex web of suppliers, distributors, regulatory bodies and local healthcare providers need to ensure that they are properly resourced, and resistant to external shocks in the event of supply deficiencies or a spike in demand. Boosting supply reliability, operational efficiencies and ensuring that systems remain agile will be crucial. Modern solutions for modern problems

From manufacturers and distributors, to healthcare providers, ensuring sustainable access to healthcare for

patients requires a collective effort. It is critical that businesses in the industry work collaboratively towards a shared goal of strengthening health systems and healthcare delivery. Rome was not built in a day, and the same applies for solutions that are geared to solve complex, evolving challenges. The importance of cross-sector collaboration and supply chain resilience In order to ensure that healthcare access is equitable and affordable, organisations in both the private and public sector need to be proactive in cultivating the right relationships, driven by shared goals. From the research and development process to the launch of drugs in far reaching markets, industry players have a hand in ensuring that the patient remains at the centre of their purpose. At both ends of the drug life cycle, strong partnerships between manufacturers, regulatory bodies and governments can help to ensure that developing nations are not left behind. For example, ensuring that the right logistics, infrastructure and processes are in place to support global clinical trials in underrepresented markets can play a critical role in ensuring diversity in the R&D process. However, with increasing complexity of supply chain management, and new emerging therapies that require specialised methods of handling, ensuring that clinical needs are compliant with both local and international regulations will involve

Gaps in global healthcare supply chains The last few years have revealed vulnerabilities in global medical supply chains, and several key challenges continue to make the delivery of healthcare less resilient to external shocks. Supply networks have become more exposed to demand and supply fluctuations as a result of production

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Introducing innovative and efficient methods of delivery As consumer behaviour evolves, this too, necessitates the need for newer methods of drug delivery. Digital solutions will support patient autonomy and the increased accessibility for personalised care, but changing regulatory landscapes will continue to shape the way businesses such as telehealth and e-pharmacies operate and grow. Governments and regulators need to work hand in hand with businesses to ensure that the potential of such solutions can be tapped for the betterment of patient access, while ensuring that they remain transparent and accountable to users and the environment they operate in.

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Patent cliffs and emerging advanced therapies have also had an important influence on the portfolios of manufacturers, and while these challenges remain for the industry to reconcile, ensuring that the supply chain evolves to encompass such changes will also be critical. Utilising new-generation technologies that go beyond traditional cold chain capabilities, that can support and monitor variable temperatures and provide real-time insights at every step of the delivery journey will have a profound impact on the supply chain. Concurrently, equipping distributors with the right expertise to make the necessary infrastructure and process shifts to accommodate such changes will have a lasting impact on ensuring the integrity of medicines to even the most remote communities. AUTHOR BIO

experience, knowledge and partnership between multiple stakeholders. On the other end of the spectrum of drug delivery, cross-sector collaboration can help to circumvent issues in access when trade grinds to a halt during border closures, or when supply chains are threatened due to geopolitical incidents. At the same time, it is important that supply chains are further strengthened with greater end-to-end visibility to adequately address risks and produce contingencies for potential shocks. Diversifying sourcing for important commodities required in production between offshore and domestic suppliers can also play a critical role in making supply chains more resilient especially during times of crises.

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It is also critical to note that as the world evolves, climate change will continue to pose greater threats to population health. While some experts have predicted the emergence of more serious infectious diseases as a result of rising global temperatures, others have also highlighted that the growing intensity of climate-related disasters and hazards will erode supply chain resiliency, causing greater disruption in an already fragile environment. With this in mind, the industry should also increasingly prioritise the deployment of sustainable solutions, leveraging digital solutions and renewable energy sources to decarbonise supply chains and reduce their impact on our world. Where the future lies for equitable access to healthcare

To ensure that high-quality healthcare continues to reach patients in both developed and developing nations, the pharmaceutical industry needs to continue to work towards holistic and comprehensive solutions that can address gaps in the ecosystem. With companies continuing to innovate for the improvement of healthcare, it is up to the collective effort of individual players, both private and public, to ensure that its benefits can be reaped by all. References are available at www.asianhhm.com

John Graham is the CEO of Zuellig Pharma, a multi-billion dollar healthcare solutions company serving 16 markets. He has over 30 years of experience in biotech, pharmaceuticals, and healthcare consulting, with a vision to transform Zuellig Pharma into an indispensable strategic partner to those engaged in the Asian healthcare ecosystem.

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AI's Evolution and Impact in Healthcare I. Artificial intelligence (ai) is experiencing rapid growth

The article explores the transformative role of Artificial Intelligence (AI) in healthcare. It discusses AI's evolution from basic tasks to complex functions like radiology analysis and surgery assistance. The article also highlights various AI technologies, ethical considerations, and future prospects, emphasizing AI's growing significance in healthcare systems. Adam Tran, CEO & Founder, TG Group Inter

The concept of Artificial Intelligence (AI) has been around for a while since the 1990s, but it has truly gained significant attention and experienced rapid growth since the 2000s. AI started to be used in healthcare about 10 to 15 years ago, although plans to use it date back to the 1900s. In 2010, only 21 AI companies were focused on healthcare; by 2020, that number had increased to over 300. At first, it performed simple jobs to help doctors and nurses, like keeping track of patient records and assisting with billing. During this period, healthcare professionals like doctors and nurses were responsible for the majority of tasks, such as detecting disease, giving advice, providing treatments, and taking care of patients. Today, AI can do a lot more, including analyzing over 100,000 radiology images in 24 hours, which is something that would take a human radiologist much longer. It can now help doctors find diseases like cancer through X-ray analysis, and create personalized treatment plans. AI is also used in robots that can take care of patients and assist in surgeries. The growth of AI in all fields in general, and in the healthcare system in particular, has been remarkable. In just

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a short period, it has gone from a very small helper to an important part of healthcare systems. Nowadays, people often mention AI in discussions about healthcare. According to an article published in 2020 on JMIR Publications, there were 1,473 publications related to AI in healthcare from 1995 to 2019. Ii. Types of ai technologies in healthcare

In healthcare, the most common types of AI are Machine Learning, Natural Language Processing, Robotics, Computer Vision, and the Internet of Medical Things. Each type has its own special job in helping doctors, nurses, and patients. 1. Machine Learning Machine Learning is a part of AI that allows computers to learn from data without being programmed to do so. According to a study published in the Journal of the American Medical Association, machine learning algorithms correctly identified breast cancer 94.6% of the time, compared to 88.0% for human pathologists. According to the article “Smart Healthcare in the Age of AI” published on IEEE Access, Machine Learning can do many things in the healthcare system: using smartphone-based health monitoring systems to help in predictive analytics for various health conditions, analyzing sensor data and patient history to make accurate disease predictions, being included in robots, enabling robust data analytics capabilities, and making it a significant tool in the Internet of Health Things (IoHT). The importance of machine learning is growing everyday. 2. Natural Language Processing (NLP) NLP helps computers understand and respond to human language. A 2019 study found that NLP algorithms could process and analyze electronic health records 20 times faster than a human, with an accuracy rate of 99%.

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In healthcare systems, NLP is used for assisting in clinical practice, such as suggesting treatments, diagnosing diseases, scheduling, billing, and transcribing medical records. NLP can be used in wearable devices and apps to monitor health metrics, provide real-time feedback, and even offer mental health support for patients. NLP can analyze large sets of health data to identify trends for public health planning, and it can help in the drug discovery process by analyzing complex biochemical interactions. Some outstanding uses of NLP include analyzing large sets of COVID-19 data for trends and developing predictive models.

3. Robotics Robotics involves the use of robots to perform tasks. Nowadays, it is not hard to find robots in hospitals. They are there to help healthcare professionals finish tasks more easily. In 2018, robots assisted in over 1 million surgeries worldwide. These robots have a precision level of 99.8%, reducing surgical errors significantly. Robots are used as surgical assistants in the operating room, including laparoscopy. Robots assist in the rehabilitation process and appear in hospital rooms to help caregivers take care of patients. Robots can be operated remotely to carry out tasks, especially in contaminated environments. This is particularly useful in outbreaks like the Ebola virus, which reduces the time healthcare personnel need to spend in dangerous areas. Some robots are

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specifically designed to interact with humans and manipulate objects in their environment.

4. Computer Vision Computer vision is a technology that helps computers see and understand images and videos. A study in Radiology found that computer vision could detect lung cancer in CT scans with 97% accuracy, compared to 94% for human radiologists. Medical images are harder to read and analyze than other images. Therefore, computer vision in healthcare is crucial for helping doctors reduce time in diagnosing diseases and providing treatments for each patient. It is now used in radiology to read X-rays, MRIs, and other medical images. Computer vision can also monitor patient movements for safety.

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5. Internet of Medical Things (IoMT) The Internet of Medical Things (IoMT) involves medical devices connected to the internet for better data collection and analysis. IoMT plays a crucial role in the healthcare industry, increasing the precision, consistency, and throughput of electronic devices. According to a report by Allied Market Research, the global IoMT market is expected to reach $136.8 billion by 2021. IoMT devices assist in the remote monitoring of patients. Doctors, nurses, and even patients can easily monitor a patient’s day-to-day health records and alert healthcare providers in case of emergencies. Iii. Challenges and ethical considerations

However, along with the rapid growth of AI in the healthcare industry, there are issues that have been raised and need attention in the near future.

1. Safety and Evidence Standards Ethical concerns about safety and evidence standards in biomedical AI have been raised. The question is whether AI technologies are safe and whether they meet medical standards, or if they adhere to their own standards, which could be lower. 2. Informed Consent The use of AI in healthcare raises questions about informed consent, especially when automation impacts both caregivers and patients. Some patients worry that their data might be leaked for wrong purposes by AI systems. In the near future, patients need to be fully aware and agree to how their data will be used by AI. 3. Fairness and Discrimination AI systems can sometimes be biased, leading to unfair or discriminatory treatment. This is a significant concern,

especially when it comes to healthcare, where the stakes are high. Care must be taken to ensure that AI systems are trained on diverse data sets and are regularly audited for bias. Ensuring fairness in AI systems is not just an ethical requirement but also a medical necessity to provide equitable care to all patients. 4. Patient-Provider Relationship While AI has the potential to revolutionize healthcare, it's important to remember that it has no experience or emotion. An overreliance on AI could erode the essential human elements in the patient-provider relationship. Some patients are concerned that the personal touch, care, and empathy that come from human healthcare providers could be lost. Therefore, it's crucial to find a balance where AI acts as a tool for healthcare providers, not a replacement.

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Amount invested in startup and scaleups using AI 2010-2023 YTD

5. Liabilities As AI systems become more integrated into healthcare, questions about legal responsibility arise. Determining who will take responsibility in cases where AI systems are involved in medical decisions or errors is a complex problem related to legal issues. The question raised here is, should AI be involved in important medical decisions, and if so, who is accountable if something goes wrong? This is an area that will likely require new legal frameworks.

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Iv. Future prospects

Health is a subject that humans universally care about, and consequently, every country prioritizes investment in the healthcare industry. As the general investment in healthcare grows, so does the investment in AI in healthcare. According to a report by PwC, the potential economic impact of AI in healthcare could be up to $15.7 trillion by 2030. This suggests that as technology advances, AI will play an increasingly significant role in healthcare, from

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diagnostics and treatment plans to administrative tasks and beyond. (Figure1 and 2 1. Upcoming Technologies and Research Areas The future of AI in healthcare is closely tied to emerging technologies like quantum computing and blockchain. Quantum computing could drastically speed up data analysis, making it 100 times faster, which is crucial for areas like genomics and drug discovery. On the

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other hand, blockchain offers a secure and transparent way to store patient records and track pharmaceuticals. As these technologies mature, they could solve complex challenges in healthcare, enhancing the effectiveness of AI tools in medical research and patient care. 2. The Role of 5G and Other Advanced Technologies 5G and other advanced technologies are under development and expected to revolutionize industries, including healthcare. With the rollout of 5G, data transmission speeds could increase by up to 20 times, making real-time data analysis and remote surgeries more

AUTHOR BIO

Amount invested startup and scaleups in industry.

Adam Tran, with extensive experience in E-commerce, SaaS, and AI, has grown his SaaS firm to 40,000 users, garnering attention from notable media outlets. As the CEO of TG Group Inter, he's ventured into AI with AI Fire, aiding over 30,000 professionals, and AIQrArt, a platform merging art and code for unique AI-generated QR Art, enhancing brand engagement.

feasible. In the future, 5G may provide the necessary speed and connectivity for AI technologies to function more efficiently in healthcare.

V. Conclusion

The use of AI in healthcare has come a long way and is set to become an even more integral part of global healthcare systems. While challenges remain, the numbers indicate a promising future, backed by significant investment and technological advancements. References are available at www.asianhhm.com

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AI-Driven Healthcare Revolution Transforming Pressure Injury Detection

ressure injuries are a persistent healthcare challenge worldwide, causing immense suffering to affected individuals and imposing substantial economic burdens on healthcare systems. These wounds result from prolonged pressure on the skin, frequently affecting immobile or bedridden patients. Most pressure injuries occur over bony prominences, such as heels and sacrum, where there is compressed or diminished tissue. Early detection and timely intervention are critical in mitigating the impact of pressure injuries. Currently, visual inspection is used to detect and classify pressure injuries according to depth, width, degree of tissue loss and presence of granulated tissue. However, these traditional detection methods can suffer from subjectivity and error. In recent years, biotechnology and AI have emerged as potential game-changers in the realm of pressure injury management. The transformative potential of AI, along with sub-epidermal biomarker detection, can improve healthcare practices for pressure injuries, with a focus on enhancing patient outcomes, improving equitable treatment, and reducing healthcare costs.

Pressure injuries are a global healthcare concern leading to significant suffering and healthcare costs. Recent advancements in biotechnology and AI have emerged as promising tools in early pressure injury detection and The Global Burden of Pressure prevention. AI, combined with non-invasive Infra Red Injuries Pressure injuries are a global healthcare subepidermal biomarker detection, can enhance healthcare practices for pressure injuries, leading to improved outcomes. concern with a substantial incidence Yaniv Cohen, PhD., Co-Founder & Chief Science Officer of IR-MED, Inc.

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rate. According to a meta-analysis published in the International Journal

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of Nursing Studies, one in ten adults admitted to hospitals are affected. Another article published in BMJ Open Quality states hospital-acquired pressure injury incidence ranges from between 18.1% to 26%. In the U.S. alone, where 2.5 million people develop pressure injuries each year, 60,000 people die as a direct result of these injuries according to data from the National Pressure Injury Advisory Panel. Life threatening conditions resulting from pressure injuries include: Infections: Pressure injuries can become infected, leading to complications such as cellulitis, an infection of the skin and connected soft tissues, and sepsis, a potentially life-threatening infection of the blood. Pressure sores can also burrow into joints and bones, causing bone and joint infections that impact the function of the joints. Cancer: Long-term wounds that don’t heal can lead to squamous cell carcinoma. Damage to Muscle, Bone, or Joints: The damage from pressure injuries can extend to the muscle, bone, or joints. This can lead to a serious infection of the bone, known as osteomyelitis. Moreover, hospital acquired pressure injury rates are increasing while all other hospital acquired conditions are decreasing. In fact, pressure injuries occur across the healthcare spectrum in

the U.S.: 10% of patients in acute care get pressure injuries; 25% of patients in long term acute care; 12% of patients in nursing homes; and 12% of patients in rehabilitation centers, according to the National Pressure Injury Advisory Panel. These injuries are not only physically painful but also carry a significant economic burden. The Cost of Pressure Injuries

U.S. which has one of the most diverse populations on the planet. According to a study published in Wounds, Research shows that people with dark skin tones in the U.S. suffer from pressure injury more than twice as much as those with lighter skin. They have higher pressure injury rates, higher risks of mortality from pressure injuries, and more severe pressure injuries. While white patients had the lowest incidence of pressure injuries, among all racial and ethnic groups in the U.S., black patients had the highest. Underscoring the need for improved skin assessment techniques for people with dark skin tones, a study in Advances in Skin & Wound Care states the diversity index in the U.S. has increased to 61.1% in 2020 and worldwide, people with dark skin tones comprise a majority of the population. A skin-color agnostic technology that can detect pressure injuries beneath the skin’s surface, which is less influenced by the melanin content, could significantly address these challenges.

Pressure injuries exact a substantial financial toll on healthcare systems worldwide. The cost of treating pressure injuries includes hospital stays, wound care supplies, medications, and surgical interventions when wounds become severe. According to data from the National Pressure Injury Advisory Panel, the annual cost of pressure injuries in the United States alone was $26.8 billion in 2019. Patient care cost per pressure injury ranges from $20,900 up to $151,700 in the U.S. It is one of the five most common harms experienced by patients and the second most common claim for lawsuits after wrongful death. Major Healthcare Inequity Issue

Due to the current standard of care method of visual inspection of the skin, pressure injuries can be harder to detect in people who have darker skin. While this is certainly a global challenge, the disparity is perhaps most evident in the

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Figure 1 The light captured by the sensors capture bio info from targeted markers in blood and tissue.

Figure 2 Infrared light harmlessly penetrates deep below the patient’s skin in less than a second. The pattern and intensity of light is captured by miniature sensors.

Figure 3 Healthy and diseased tissue absorb and reflect light differently, allowing biomarker profiling.

AI Infra Red and Subepidermal Biomarker Detection & Analysis: A Promising Approach

AI is accelerating the pace of research, with its primary contribution being to serve as a decision support system for identification of specific disease states and their corresponding treatments. The enhanced capabilities in disease testing and the determination of their causes through biomarkers have opened up new avenues for more precise diagnoses. This includes the creation

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of noninvasive early-stage detection tools that can influence specialist decision-making, streamline medical treatments, and reduce healthcare costs. Furthermore, Infra Red & AI-driven diagnostic tools delve deep into biomaterial analysis, reaching down to the cellular level. They not only examine individual cell components but also process entire cell samples to pinpoint deficiencies and identify the most suitable treatments. This personalized approach to treatment has become a reality thanks to AI, marking an exciting development in the field of medicine. By providing objective and precise assessments of subepidermal biomarkers, AI can significantly reduce the risk of human error and improve the accuracy of early detection across numerous diseases and conditions. AI plays a central role in not only in sending but also in analyzing data from subepidermal biomarkers. The adaptability of AI to changing patient conditions enhances its predictive capabilities. (Figure 1, 2 & 3) Pressure injuries are a prime example of how AI can produce benefits in healthcare. Subepidermal biomarkers offer a promising avenue for early pressure injury detection. These biomarkers, located beneath the skin's surface, can signal tissue damage before visible symptoms appear. Emerging research in this field demonstrates the feasibility of detecting subepidermal biomarkers, thereby enabling timely interventions to prevent bedsores. One model for how this might work is the use of a handheld device that contains miniaturized electro-optics emitters and passive sensors that send and detect visible light and infrared light. The light can be used to acquire biological information by assessing light reflected from different layers under the skin’s surface down to the reticular dermis. Optical properties of biological tissue change the spectrum of reflected or absorbed light in accordance with the tissue’s structural and chemical composition including chromophore content such as water, collagen, oxyhemoglobin and melanin. Blood flow can be measured, as blood flow in pressure injuries is different from that in healthy tissues based on measures of blood cell perfusion in the microvasculature. Sensor results can then be classified and analyzed by an AI cloud-based system at the point of care into the predefined conditions. Using this kind of model, AI algorithms can swiftly identify pressure injury risk factors,

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enabling healthcare providers to formulate personalized prevention plans tailored to individual patient needs. The algorithm itself can be driven by data from the three primary sources analyzed: 1) multiple biomarkers related to pressure injury development in tissue; 2) structural changes in different skin layers; and 3) blood flow meter. Transformative Implications for Healthcare

The integration of AI and Infra Red subepidermal biomarker detection into pressure injury management holds immense transformative potential for healthcare including: Enhanced Patient Outcomes: AI-driven early detection can significantly improve patient outcomes by enabling timely interventions. The reduction in the severity and incidence of pressure injuries can lead to better quality of life for affected individuals and even save lives. Reduced Healthcare Costs: The adoption of AI in pressure injury prevention can lead to substantial cost savings for healthcare systems globally. By averting the need for costly treatments and interventions, healthcare expenditures can be minimized. Objective Assessments: AI offers standardized and objective assessments, irrespective of geographical location. This ensures consistent quality of care and minimizes regional disparities in pressure injury management.

and when needed, data sharing among various healthcare providers. Education and Training: Ensuring that healthcare professionals worldwide receive training in AI utilization for pressure injury prevention is crucial for realizing the technology's full potential. Ethical and Health Equity Considerations: Ethical considerations surrounding AI in healthcare must be addressed universally to ensure responsible and compassionate use of these technologies. In the case of pressure injuries, AI can help improve ethics in healthcare through the combination of seeing beneath the skin’s surface and being a skin-color agnostic technology, thereby addressing inequities based on

While the potential of AI and subepidermal biomarker detection in pressure injury prevention is promising, challenges must be addressed for widespread implementation: Integration into Electronic Medical Records and Data Standardization: Capturing and analyzing biomarker data using AI is a tremendous asset that needs to be integrated into patient and hospital electronic medical records. This calls for the need for data standardization

AUTHOR BIO

Challenges and Future Directions

race and skin color. It is important that such a technology be universally adopted across various socio-economic groups and geographic regions. Conclusion

Pressure injuries represent a significant healthcare challenge, causing suffering to patients and straining healthcare budgets globally. The integration of biotechnology and AI, along with subepidermal biomarker detection, holds immense promise in addressing these challenges and revolutionizing pressure injury prevention. As healthcare envisions a future empowered by AI, the focus on improving patient outcomes and reducing healthcare costs through AI-driven approaches is pivotal. The synergy of AI and Infra Red subepidermal biomarker detection offers a beacon of hope for patients and healthcare systems worldwide, ultimately leading to enhanced patient well-being and more efficient healthcare practices. Yaniv Cohen, PhD, Co-Founder & Chief Science Officer of IR-MED is a skilled scientist and entrepreneur with years of experience leading R&D development for medical device companies. His fields of expertise include electro-optics, infrared spectroscopy, AI, and medical devices using infrared light. PressureSafe™, co-invented by Dr. Cohen, is an early detection device for pressure injuries.

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