Asian Hospital & Healthcare Management - Issue 53 by Ochre Media Pvt. Ltd.

I S S U E 53

2021

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Advanced Sterilization Products Successful Journey

Delivering innovative infection prevention Nilesh Shah

Vice President/General Manager Commercial Advanced Sterilization Products

Associate Partner

Outpatient Cancer Care Improving patient experience Tele-rehabilitation The time has come www.asianhhm.com

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Foreword Outpatient Cancer Care Improving efficacy and quality of life The onset of the COVID-19 pandemic resulted in increased use of telemedicine and video consultations. A majority of hospitals and healthcare facilities across the globe have become COVID care centres in the past 15 months. In several countries, lockdowns have meant that non-COVID patients with an emergency and those undergoing critical illness were allowed to be inpatients while there were restrictions on outpatient visits as well for initially. As a result, patients with chronic conditions such as cancer have had a tough time accessing the necessary treatment. Cancer is a leading cause of death worldwide, and Asia accounts for nearly half of the global cancer patient population. Inpatient treatment remained out of bounds for cancer patients given their lowered immunity. In this scenario, outpatient cancer care has emerged as a blessing in disguise during the pandemic. While this is not a new idea, outpatient care for oncology patients has gained slow prominence over the past several years as a critical method that has become beneficial for many patients. Though inpatient hospital care remains the most critical part of some cancer treatments, outpatient care has become an effective option to help support the needs of numerous cancer patients. According to Steve Paulson, MD, president and chairman of the board of Texas Oncology in Dallas, more than 80 per cent of all cancer care is delivered in outpatient settings. Over the past decade, the shift of cancer care to an outpatient setting has actively encouraged cancer patients to participate in their care's clinical and lifestyle aspects.

Emerging therapies for cancer are expensive, driving up the treatment cost. Several private practice physician groups have now joined hospital-owned oncology clinics and managed care groups. With a variety of specialty treatment facilities available to them, patients can spend more time in the comfort of their homes while availing cost benefits. According to the American Cancer Society, outpatient treatment covered by private insurance accounts for most cancer care dollars spent each year. As cancer treatment is highly time-sensitive and quite comprehensive, initiatives or efforts to provide timely care can enhance the quality of life and improve treatment efficacy. The latest issue of our magazine covers an article on how Outpatient cancer care is improving patient experience. The author, Phoebe Ho, CEO of Integrated Oncology Centres, talks about how an integrated cancer centre is a highly efficient and effective model to serve the needs of cancer patients and alleviate the mounting cancer burden in Asia.

Prasanthi Sadhu

Editor

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HEALTHCARE MANAGEMENT

Advanced Sterilization Products Successful Journey

06 Health Challenges Facing the Youth Simon Sum, Director, Scientific Affairs, Herbalife Nutrition

10 Sustainable Healthcare Joseph Saba, CEO, Axios International

COVER STORY

CONTENTS Delivering innovative infection prevention technologies

16 Pain Management R B Smarta, Founder and Managing Director Interlink Marketing Consultancy Pvt. Ltd

22 The Pandemic's Pug-Marks Gurrit K Sethi, Strategic Advisor, Global Health Services Global Strategic Analysis

24 Single Pill Combination for Chronic Hypertension Better adherence and better control Rami Riziq Yousef Abumuaileq, Consultant Cardiologist at Palestinian Medical Services; Associate Editor at BioMed Central; Associate Editor at European Heart Journal- Case Reports

32 Greater Diagnostic and Therapeutic Precision with Technology Integrating genomic insights within healthcare workflows Joel Diamond, Co-Founder and Chief Medical Officer, 2bPrecise

Nilesh Shah

Vice President/General Manager Commercial Advanced Sterilization Products

36 Four changing paradigms of healthcare R B Smarta, Founder and Managing Director Interlink Marketing Consultancy Pvt. Ltd

INFORMATION TECHNOLOGY 46 Tele-rehabilitation The time has come

MEDICAL SCIENCES

K Ganapathy, Director, Apollo Telemedicine Networking Foundation

42 Outpatient Cancer Care Improving patient experience Phoebe Ho, Chief Executive Officer, Integrated Oncology Centres

50 Data Security in Healthcare Saket Singhi, Founder and CEO, JVS Group

54 AI to Identify Cancer Cells by their Acidity Chwee Teck Lim, Professor and Director, Institute for Health Innovation and Technology Department of Biomedical Engineering, and Mechanobiology Institute National University of Singapore Yuri Belotti, Research Fellow, Institute for Health Innovation and Technology National University of Singapore

58 Digitalisation in Healthcare Moving to the forefront of AI Kevin Chiow, Country Manager, GE Healthcare Malaysia

SPECIAL FEATURES 62 Books

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Advisory Board

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

EDITOR Prasanthi Sadhu EDITORIAL TEAM Grace Jones Swetha M

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

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

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

PRODUCT ASSOCIATE John Milton Veronica Wilson

Nicola Pastorello Data Analytics Manager Daisee

CIRCULATION TEAM Sam Smith SUBSCRIPTIONS IN-CHARGE Vijay Kumar Gaddam

Gurrit K Sethi Strategic Advisor, Global Health Services Global Strategic Analysis

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

HEAD-OPERATIONS S V Nageswara Rao

Associate Partner

In Association with

A member of Confederation of Indian Industry

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

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

Peter Gross Chair, Board of Managers HackensackAlliance ACO

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

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HEALTHCARE MANAGEMENT

Health Challenges Facing the Youth Health issues are on the rise among Asian youth with many starting to develop non-communicable diseases at a younger age. In this article, Simon Sum shares insights and recommendations on how HCPs can engage with and promote health among this age group. Simon Sum, Director, Scientific Affairs, Herbalife Nutrition

sian countries are struggling to battle health issues affecting their youth population, with non-communicable diseases (NCDs) on the rise in recent years. Based on United Nation statistics in 2019, Asia contains most of the world’s youth population (15-24 years). A report from the Population Reference Bureau has also shown that people are starting to develop NCDs at a younger age. The four main NCDs defined by the World Health Organisation (WHO) are cardiovascular diseases, diabetes, cancer, and chronic respiratory diseases. The main risk factors – unhealthy diet, physical inactivity, tobacco and harmful alcohol use – are typically established during adolescence

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and young adulthood. The recent rise in these risk factors among youths in Asia indicate the region’s uphill battle to improve health outcomes for this group. Common health challenges affecting the youth

Diet shifts and sedentary lifestyles have contributed to the rapid increase in obesity rates. Economic growth in Asian countries over the years has led to diet changes from healthier traditional diets to an over-dependence on convenient diets high in calories, sodium, added sugar and fats. Such diets increase the risk of obesity for Asians, including the youth. Moreover, studies have also highlighted that youths prefer junk

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food that is nutrient deficient. As such, malnourishment from insufficient vitamin and mineral intakes have also become an issue along with overweight and obesity – the double burden of malnutrition. In addition, there is some evidence suggesting that the lack of physical activity, other than the consumption of high-fat foods, is also a significant cause of obesity. Decreased physical activity due to occupational and recreational changes is hence viewed as a major contributor to the growing health crisis. A study discovered high prevalence of physical inactivity (80.4 per cent) and sedentary behaviour (33.0 per cent) among school going youths (13-15

HEALTHCARE MANAGEMENT

years) in the Association of Southeast Asian Nations (ASEAN) countries. Unfortunately, this trend has been aggravated in the past year, as countrywide measures like lockdowns and school closures have been implemented in response to the ongoing COVID19 pandemic. A report has shown that these circumstances resulted in decreased physical activity, increase in sedentary lifestyle and screen time for youths. During this period of uncertainty, youths may also engage in stress-induced indulgence such as high-calorie foods containing fats and added sugars. As a result, Asia is currently facing increased challenges in controlling youth obesity. Statistics showed that among 13-to-15-year-old boys in secondary schools, 32 per cent in Taiwan, 25 per cent in Malaysia, and 24 per cent in Thailand are either overweight or obese. The rates are lower for girls in most Asian countries, though they are also increasing. Many low- and middleincome Asian countries are also facing the double burden of an emerging epidemic of overweight and obesity added to persistent undernutrition. Obesity is strongly linked to diabetes, as reports suggest that obesity is believed to account for 80-85 per cent of the risk in developing type 2 diabetes. In the last three decades, we have seen an epidemic level rise in the number of people diagnosed with the disease. In South Asia, the rise of type 2 diabetes is estimated to be more than 150 per cent between 2000 and 2035. Statistics also show that over 60 per cent of the people with diabetes live in Asia, with almost one-half in China and India combined. Furthermore, Asian people tend to develop diabetes at a younger age. A review study showed that Asians have a strong ethnic and genetic predisposition for diabetes and have lower thresholds for the environmental risk factors. The reasons are likewise linked to socioeconomic changes, urbanisation and lifestyle changes as the major factors.

Improving youth health through nutrition

Many of the health challenges faced by youths today can be mitigated with the right diet consisting of the necessary nutrients. Eating habits and preferences developed during adolescence and young adulthood can have a big and long-term impact on the health and fitness for individuals. Therefore, it is essential for youths to improve their nutrition intake to help them prevent the onset of any NCDs and achieve better overall health outcomes. Some of the key nutrients required by youths include complex carbohydrates, protein and micronutrients.

Youths in Asia are facing various health issues, which pose severe challenges to countries in the region.

Complex carbohydrates are generally higher in fibre, vitamins, minerals, and lower in glycemic index when compared to simple carbohydrates. Carbohydrates are an essential source of energy for the body and the fibres in complex carbohydrates can help maintain digestive health and keep healthy blood cholesterol levels. Youths can opt for more complex carbohydrates by switching from refined grains to wholegrains and consume fibre-rich starches like peas, beans, and vegetables. Protein is essential for important bodily functions including muscle maintenance, cell renewal, wound healing and immunity. While the amount of protein needs depends on different factors like gender, age, height and weight, the general recommendation is about 52 grams for teenage boys and 46 grams for teenage girls. To add more proteins into their diets, youths can easily switch certain foods in each meal for more low-fat milk, eggs, lean meat, poultry and fish. Finally, micronutrients that include vitamins and minerals are necessary for optimal health. Micronutrient needs differ slightly according to gender and lifestyle. Young men and women who are more active may require extra

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electrolytes like sodium, potassium, and magnesium. Males require a little more of vitamins C and K, along with thiamine, riboflavin, and niacin, while females require extra iron due to menstruation. The best source of micronutrients are whole grains, fruits and vegetables such as pomelos and dragon fruit, which are vitamin-rich and spinach, long beans and broccoli which are iron-rich. Healthcare practitioners’ role in advocating youth health

AUT HO R BI O

NCD risk factors such as unhealthy diet and physical inactivity continue to be a growing health concern for the youths in Asia. To battle these health challenges, it is imperative for healthcare groups, associations and healthcare practitioners (HCPs), especially dieticians, to play a part by working together, as key stakeholders of youth health. We know that the young generation wants healthcare to be as convenient as the technology that they grow up with, and that they prefer receiving updated or even real-time health information. With patients becoming more proactive in seeking health information online, digital healthcare in Asia-Pacific is predicted to be one of the fastest-growing industries in the world and many will benefit significantly from this advancement. There are several ways that healthcare associations and HCPs can leverage technology to effectively reach out to this younger group:

Connecting through social media platforms As youths are highly active on social media platforms, these platforms have become their main source for news and information. Social media is the best avenue to share nutrition related tips and facts, and HCPs can consider posting more educational and engaging content on their social media pages. Building an online community Aside from social media platforms, microsites such as Twitter, blogs, and health forums have gained in popularity as a source for health and nutrition related content. HCPs can consider building online communities and share health and nutrition materials with their followers. Utilising technology through apps More people will turn to advanced technology to assist their weight management progress and calorie intake counting. HCPs can encourage patients to download appropriate interactive apps that can aid their weight loss programmes while also provide beneficial health contents. Installation of youth fitness and consultation booths Hospitals can make medical services more accessible by installing Youth Fitness and Consultation booths in areas frequently visited by youths, such as Universities and shopping malls. The booths can have trendy decorations and include virtual kiosks where youth

can spend time to find out more health information about their age group and get practical diet and nutrition tips. Taking consultations online The pandemic has led to patients turning to telehealth platforms and applications more in the Asia Pacific region with the increased adoption of digital health tools. Asia Pacific consumers are also increasingly interested in preventive health, convenience and ownership of their healthcare with digital health platforms in countries like Singapore, Indonesia and Australia. As millennials and Gen Z like to have choices and prefer convenience, telehealth continues to be an increasing alternative method for HCPs to provide consultations. HCPs can consider setting up telehealth consulting services for ongoing nutrition, diet and weight management recommendations. These can also involve assessment of nutritional intake, monitoring changes in lifestyles and providing personalised dietary counselling. To conclude, youths in Asia are facing various health issues, which pose severe challenges to countries in the region. To prevent the detrimental impacts of poor health among youths, healthcare groups and HCPs will have to rethink how information can reach and be received by the younger generation. This will be a first step towards combating an impending health crisis affecting this age group. References are available at www.asianhhm.com

Simon Sum is a Clinical Nutrition Doctor and a Registered Dietitian Nutritionist. He is currently the Director of North America Scientific Affairs at Herbalife Nutrition. His primary role is to ensure the safety and scientific integrity of Herbalife products in North America and lead the personalized nutrition initiatives. He is also a member of the Dietetic Advisory Board of Herbalife Nutrition. Prior to joining Herbalife Nutrition, Simon was the clinical nutrition manager at Alhambra Hospital Medical Center in California, where he managed clinical dietitians, dietetic technicians and interns, and provided nutrition care process to patients with different health issues. He holds his Doctorate degree in Clinical Nutrition from Rutgers University and both Master degrees in Medical Research and Nutritional Sciences from The University of Hong Kong and California State University, Long Beach, respectively. He is also an American College of Sports Medicine’s Certified Personal Trainer and a Fellow of the Academy of Nutrition and Dietetics.

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SUSTAINABLE HEALTHCARE Joseph Saba, CEO, Axios International

1. Dr. Saba, with your extensive experience in the healthcare sector, spanning over 30 years, what are your views about building sustainable healthcare access within Southeast Asia? Health management and building healthcare access have been my passion and foremost priority through the 30 years of my professional experience. In the early stages of my career, as part of the Joint

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United Nations Programme on AIDS (UNAIDS), I worked extensively on the prevention of mother-tochild transmission of HIV and on establishing the first HIV/AIDS antiretroviral drug access programme in some of the emerging economies of the world. I worked with several healthcare stakeholders during this initiative, which helped me understand access deeply, and the need to build sustainable healthcare management

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for vulnerable populations across the world. Healthcare access has definitely evolved over the past few decades in Southeast Asia, led by shifts in disease patterns, population trends, an improvement in universal healthcare plans and a rise in scientific breakthroughs. But healthcare actors haven’t leveraged technological advances to better follow patients with chronic diseases which became the bulk of

HEALTHCARE MANAGEMENT

patients. The ongoing pandemic has further highlighted some of the glaring gaps in healthcare systems. Without addressing them, healthcare access cannot be made sustainable for populations within the region. It is important to understand that healthcare access needs a multisectoral, multi-dimensional approach, especially when it comes to management of chronic diseases. Without collaboration between different stakeholders and across areas of healthcare delivery, healthcare systems cannot be made robust. Access needs to be viewed as a long-term solution rather than a shortterm strategy and should be made more integral to overall healthcare delivery. This will help build solutions which will allow patients to have longterm access to treatment plans leading to optimum health benefits. Also, sustainable access can only be built through a unified healthcare system. We need the public and private sectors to come together including governments, pharmaceutical companies, physicians, and access specialists like us so that our combined strengths can be leveraged to build efficient and resilient healthcare systems. Such systems will have the ability to withstand any public health emergencies and deliver under the most challenging of circumstances. 2. Access to hospitals around the world has been limited due to widespread lockdowns and the fear of people contracting the Covid-19 virus while visiting healthcare facilities. How can people continue to have access to healthcare services in such a scenario? COVID-19 has caused unprecedented challenges within the healthcare sector, and patients having reduced access to healthcare facilities is one of them. Countries need to start looking beyond hospitals and put in place complementary, proactive mechanisms

in order to reach patients wherever they are so that treatment schedule and medication can be continued without any interruption or delays. This can be achieved through tapping into existing channels, such as partnering with private entities, and through deploying digital technologies for consistent engagement between patients and healthcare stakeholders, as well as reaching out to patients within their homes, thus ensuring the same care delivery but without exposing patients to any kind of health risks.

Sustainable healthcare access can be built when government programmes are amply supported by private sector initiatives that keep access as one of their key priorities as part of healthcare delivery.

3. With rising healthcare expenditures and a rapidly ageing population, treatment affordability has been a significant challenge in Southeast Asia. How can healthcare access be made more widely available and affordable? In Southeast Asia, healthcare has always been a top priority. Governments have been spending big budgets to ensure that populations have access to healthcare services, and thus enjoy a good quality of life. However, most of the government programmes are designed to deliver subsidised primary care but have limited reach when it comes to chronic and Non-communicable Diseases (NCDs) that typically entail long treatment plans and expensive

specialised medication. Paying out of pocket by the public is also not a long-term solution as healthcare costs have risen significantly over the years, and a large population in Southeast Asia has been pushed into poverty because of these self-financed healthcare expenditures . I believe that sustainable healthcare access can be built when government programmes are amply supported by private sector initiatives that keep access as one of their key priorities as part of healthcare delivery. 4. Beyond affordability, healthcare outcomes are a function of treatment adherence, which is especially relevant for chronic disease patients. How can adherence be built into healthcare delivery? Yes, healthcare access has limited meaning till adherence is built-in as a crucial component. To maximise treatment outcomes, access solutions need to evolve from focusing solely on treatment affordability to offering services to support patients throughout their treatment journey – from diagnosis to treatment adherence. And since each patient journey is unique, there’s a need for customised support programmes that can comprehensively meet the patient’s underserved needs and challenges in more personalised ways – not via a ‘one-size-fits-all’ approach. Healthcare providers need to be cognizant of this fact, and design healthcare delivery systems that have adherence built into their framework. 5. Covid-19 has put a spotlight on several inefficiencies within the healthcare sector. How do healthcare systems need to evolve so that they are better prepared to address future challenges of such magnitude? Healthcare systems have evolved over the years through deployment of new modern technologies, improved healthcare infrastructure, and better

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medical expertise. But inefficiencies still exist in the systems and the ongoing pandemic has brought them to light in an urgent manner. Development of digital healthcare solutions, patient support programmes based on cost sharing models, and integration of treatment adherence into care delivery are some of the initiatives that are definitely going to improve the efficacy of healthcare systems, and their ability to offer sustainable healthcare access to people. It is vital to build a network of support for the patient that extends beyond the hospital setting to complement the efforts of healthcare professionals. This includes creating holistic patient support programmes that address challenges across the entire patient journey, establishing follow up channels for better patient management, offering remote care to reach patients wherever they are, and digital

solutions that keep the patient in mind to enhance these initiatives. Apart from these, I would like to reiterate that there’s a need for collaboration between healthcare stakeholders across the private and public domains so that we can leverage each other’s strengths and create synergistic models that will have higher reach and better impact towards achieving sustainable healthcare access. 6. Integration of technology into healthcare can create new efficiencies and improve patient journeys. What role do you think technology can play in building sustainable healthcare access within Southeast Asia? Technology is one of the important building blocks for sustainable development across sectors, and healthcare is no exception. Digital healthcare technology is one way

of strengthening healthcare access by building connected care – with patients and stakeholders all seamlessly connected, better treatment understanding, and adherence can be achieved leading to optimum health results. In addition, I see technology playing a crucial role in capturing accessrelated real-world insights (RWI) to better understand the impact of access interventions and continuously improve our support and services to the patients. It can help evaluate access solutions and re-design them for better efficacy and results. But I would like to emphasise that while digital tools are a positive force in building sustainable healthcare access, they should always be treated as enablers and not stand-along solutions. The focus should always be patient centric, and all other elements should be designed accordingly.

AUTHOR BIO Joseph Saba is Co-Founder and Chief Executive Officer of Axios International, a global healthcare access company with 20 years of specialized experience developing practical and sustainable solutions to patient access challenges in emerging markets. Under his leadership, the company has launched a number of successful drug access programs and developed innovative access strategies and new models for healthcare systems strengthening.

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A leap in cancer care A leap in impact

Siemens Healthineers and Varian share a vision for shaping the future of healthcare and creating a world without fear of cancer, thereby strengthening its position as a holistic partner in healthcare. The combined company is creating a unique, highly integrated portfolio of imaging, laboratory diagnostics, digital and AI offerings, radiation therapy, interventional oncology and surgery for the global fight against cancer with significant potential for increased value creation.

Together a step ahead They divide uncontrollably, tapping into blood vessels and invading neighboring tissues. The malignant cells spread into the body’s organs, bone marrow, or lymphatic vessels, causing one of humanity’s greatest scourges – cancer. Just a few generations ago, doctors and patients were defenseless against its ravages. Today, thanks to modern medicine, cancer treatments are getting better all the time, and many cases can even be cured. Still, of all the lives lost to cancer globally, about a third of them could be saved each year by better prevention, early detection and treatment.

Siemens Healthineers and Varian have recently joined forces. What is the vision of this combination? ELISABETH: Siemens Healthineers and Varian came together as one united company on April 15th this year. We are now combining our strengths and are taking a leap in cancer care, and a leap in the impact on healthcare overall by accelerating the path from diagnosis to survivorship in one joint step. Our common goal is to ensure that every patient receives the right treatment at the right time. We want oncologists, physicians and clinicians to be supported as effectively as possible to take on the challenges caused by cancer. As combined companies, Siemens Healthineers and Varian are now teaming up to shape the future of healthcare and work toward a world without fear of cancer. Give us a little bit of background, Kenneth, what is the burden of cancer in the Asia Pacific region? KENNETH: It is estimated that there will be around 29 million new cancer cases globally by 2040 and half of those cancer cases and deaths are projected to occur in Asia1. In many countries, cancer has become 1 The Cancer Atlas, The Burden of cancer. Retrieved May 24, 2020, from canceratlas. cancer.org/the-burden/

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the second most common cause of death after heart disease. Leading causes of cancer death in Asia are lung, liver and stomach cancer and there are still stark disparities in the five year survival rate between the countries. We know about 57 per cent of the total number of cancer cases occur in low and middle income countries, yet, more than 50 per cent of those cancer patients requiring radiotherapy lack access to treatment2. Especially in India and many of the ASEAN countries, we must increase access for patients. This is where our transformative combination can make an impact to improve early diagnosis. It’s been a few months since the combination. What feedback are you getting from healthcare providers so far? ELISABETH: So far, we have received very positive feedback on our combination. What providers and clinicians are expecting is to ultimately achieve better clinical outcomes at lower cost. Considering the constant challenge to do more with less, staff shortages and increased disease burden, there simply aren’t enough 2 E.H. Zubizarreta, E. Fidarova, B. Healy, E. Rosenblatt,Need for Radiotherapy in Low and Middle Income Countries – The Silent Crisis Continues,Clinical Oncology,Volume 27, Issue 2,2015,Pages 107-114

Together we will achieve better outcomes and move even closer to living in a world without fear of cancer.

resources to take care of patients. Not surprisingly, there is the clear expectation that we will be able to create innovative solutions that result in more efficient and effective patient care leading to more precise treatments at lower costs. Also, end-to-end solutions across the continuum of cancer care are seen as a key driver for better clinical outcomes. KENNETH: Adding on to what Elisabeth has mentioned, what we aim to achieve really goes in line with what our combination is all about. We consider ourselves as global pioneers in the field of medical technology, and we are now united by a common aspiration to help people live longer and healthier lives.

ELISABETH STAUDINGER is currently President of the Asia Pacific Region within Siemens Healthineers. Leading a team of over 8000 people who are passionate about shaping the future of healthcare, is her source of inspiration.

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 can be coordinated and combined to beat cancer. How do you feel personally about this combination? This has been one of the biggest milestones for Siemens Healthineers. ELISABETH: I’ve really been personally touched by the purpose of Varian, which is to create a world without fear of cancer. I am convinced that together, we can make a difference for millions of patients and their families and loved ones. Especially in our region, there is a huge unmet need that we’ve outlined before where we can make an impact. Globally, we will now be a team of over 65000 highly skilled people that share the same vision of shaping the future of healthcare. KENNETH: This combination represents a big leap in providing quality healthcare to patients across this region. To me, it accelerates the company’s impact on global healthcare and establishes an even stronger partner for customers and patients along the entire cancer care continuum.

KENNETH TAN is the President for the region for Varian, now a Siemens Healthineers company that has been in cancer care for more than 70 years. AHHM has interviewed them together to get some insights on the recent combination of the two innovation leaders in healthcare.

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PAIN MANAGEMENT

Pain medicines and pain management are some of the emerging specialities in several Indian hospitals aiming to revitalise and improve the quality of patient’s life by relieving the pain and minimising the sufferings. For various types of pains ranging from acute pains to chronic ones, including neuropathic, nociceptive, and radicular pains, pain management practices are very crucial and mandatory as many a times ignorance, under-reporting and mismanagement can lead to undesired, unbearable circumstances in patient’s life. R B Smarta, Founder and Managing Director, Interlink Marketing Consultancy Pvt. Ltd

ain is a sensation which we all experience at various stages of our lives to a greater or lesser extent. Pain perception varies from individual to individual. Sometimes, we don’t require any medical support in order to get rid of this sensation and sometimes, when it’s unbearable and uncontrollable, medical interventions are mandatory. Such interventions are composed of

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wide range of techniques, skills and medications in hospitals. And these collaborative efforts are often termed as ‘pain management’, which is a most significant part of medicine. Unlike developed countries, pain management is still an emerging field in India. Many developed countries have specialised, well-structured pain management programmes in their

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hospitals. Several countries have already adopted the drug-free pain management approaches in order to minimise the risk associated with the opioid medications. Pain management drugs can’t be excluded from the regimen but can be partly replaced with such drug-free approaches. Due to increasing drug-free approaches, the pain management

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devices market is expected to account for US$5.97 billion by 2026, growing at CAGR of 8.5 per cent from US$3.97 billion in 2021. Rising surgical procedures in recent healthcare scenario followed by invention of new pain relief devices could be some growth boosting factors for this market. Moreover, increasing geriatric population and chronic diseases like osteoarthritis, cancer, diabetes, etc are also fuelling the growth rate of pain management devices and drugs market. Following are some promising trends which can be seen in pain management in hospitals in the recent times and the years ahead: 1. Non-addictive substitutes to narcotic painkillers Electrical stimulation devices are commonly used devices to reduce pain nowadays. As it’s a safe substitute to narcotic addictive drugs, it can be frequently seen in hospital’s pain management procedures. Low frequency impulses provided by this device predominantly reduces the activity of sympathetic nervous system

and decline pain in patients and improve blood and oxygen flow. 2. Pain moderniser Often called as spinal cord stimulator, is a device implanted below the skin which generates small electrical impulses around the spine base. As the pain moderniser used nowadays can be automated, patient can regulate the intensity of impulses based on the intensity of pain they are experiencing. Pain moderniser are still under investigation in order to establish a better and secure device which can target specific types of pains in the patient. 3. Stem cell technique It is one of the techniques in pain management in hospitals which can gain immense demand in coming years. This technique involves abstraction of our own cells and re-injecting them into our injured or painful area. These stem cells and platelet-rich plasma help in healing wounds and reducing the sensation of pain. 4. CAM Owing to the risks and adverse events associated with the conventional

medications, use of CAM (Complementary and alternative medicines) is on the rise in today’s scenario. The therapies consisting of various types of massages, acupuncture, tai chi, etc., which are the part of CAM are rooting to the greater extent in healthcare owing to their holistic approach toward overall wellbeing. Moreover, escalating use of herbal and dietary supplements accompanied with classic nutraceuticals is also one of the promising trends for overall healthcare. Such promising trend can shape the pain management programmes of hospitals in much constructive and fruitful manner. Now look at how hospitals manage pain

Pain management could be simple or complex, depending upon the type of pain and causes behind it. Ranging from acute pains to chronic pains, the way of managing each type is different. Acute pains, often cause due to clearly defined causes like injury, are managed

Restorative therapies

Medications

Treatment categories of Pain management Interventional procedures

Figure: 01

Behavioural health approaches

Source: Interlink knowledge cell

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by healing its underlying issues. Whereas, chronic pains, associated with arthritis like health conditions, require different ways of handling. Mentioned ahead are the four broad treatment categories usually used in the hospitals-(Fig-01) 1. Medications Depending upon the type of pain, mechanism associated with it and the risk associated, various classes of medications which are consisting of opioids and non-opioids are used in pain management in hospitals. Proper risk- benefit assessment through history, physical examination and appropriate diagnostic procedure is ensured before initiating the particular medication. Owing to the risks associated with opioids drugs, hospitals are now enhancing the use of non-opioids like NSAIDS, acetaminophen, antidepressants, anticonvulsant and many other drugs which can mitigate and minimise opioid exposure. Clinicians have to be very careful about the patient's medical history and also have to discuss the medications thoroughly with patients to avoid any complications associated with the lack of safety information about the drugs. In case, any emergency like

In today’s scenario, where digitalisation of healthcare is on the rise, virtual rehabilitation can be a better option and much convenient as well.

opioid overdose happens with any patient, hospital always have enough availability of opioid antagonist like Naloxone and other medications used to minimise the risk of overdose. 2. Restorative therapies Drug treatment is often followed by restorative therapies which are implemented by the physiotherapist or occupational therapist in the hospital. Like mentioned earlier, several types of pain management devices are used in hospitals. Transcutaneous electric nerve stimulation is one of the methods used in hospitals in which low voltage electric current is used to minimise the pain. In addition to this, various massage techniques like Swedish massage (deep circular moments, long

LOW COMPLEXITY

MEDIUM COMPLEXITY

HIGH COMPLEXITY

Trigger Point Injections

Facet Joint Nerve Block

Spinal Cord Stimulator

Joint Injections

Epidural Steroid Injections

Intrathecal Pain Pumps

Peripheral Nerve Injection

Radio-Frequency Ablation

Epidural Adhesiolysis

Regenerative/Adult Autologous Stem Cell Therapy

Vertebral Augmentation

Celiac Plexus Blocks

Interspinous Process Spacer Devices

Cryoneuroablation

Percutaneous Discectomy

Neuromodulation Table: 01

strokes, kneading) and shiatsu (applying pressure with thumb and fingers) and deep tissue massage focusing on deeper layers of tissues are employed. Cold and heat treatment, therapeutic ultrasounds and therapeutic exercises are also used in number of hospitals. Pain management speciality hospitals are equipped with more such therapies and techniques in to manage pain efficiently. 3. Interventional procedures These are the diagnostic and treatment procedures used in hospitals for pain management. These procedures are very important in order to decide right steps before initiating opioid medications and extensive surgeries. Depending upon the degree of complexity, following are the interventional techniques used in hospitals: (Table:01) Provided that the safety and efficacy of these therapies are extensively studied and implemented, these techniques are the attractive alternatives for lengthy opioid therapy. 4. Behavioural health approaches Behavioural, emotional and many other psychological aspects of pain can influence the results of treatment patient undergoing. To manage these aspects, certain hospitals provide

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Way forward

Owing to the history of opioid use disorder, hospitals face significant challenges in pain management. To improve patient care, extensive research can be employed in the possible areas of managing pain. Educational programmes should be launched in every hospital for

physicians, nurses and hospital staff to deal effectively with the patient in their pre- and post-operative traumatic condition. Moreover, many times, lack Being a thought leader in Pharmaceutical, Nutraceutical and wellness industry, R B Smarta has been contributing globally through Interlink Consultancy and building business performance of his clients for 33 years. Having a Master's degree (M.Sc.) in Organic Chemistry in Drugs, MMS in Marketing, PhD in Management, and FRSA (Fellow of Royal Society of Arts) London, he is-perusing his passion of converting science to Business. Besides being a consultant, he has been teaching at IIM, prestigious management institutes, Pharmacy College, Pharmacists Associations, guiding PhD students and written as many as 7 Books on Management, Pharma, Nutra, Foods domain, and many articles in prestigious journals/ magazines.

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behavioural therapies, mindfulness and stress reduction therapy, emotional awareness and expression therapy and many more. Such approaches are very useful while dealing with the patients to overcome the pain more efficiently. Many health systems consider the CAM system for holistic recovery of the patients. Also, hospitals which have highly specialised system for pain management even classify the services according to the specific population (eg., Child, adults, women, pregnant women, elderly, etc.) and specific health conditions like blood diseases. Many hospitals in abroad employ best practices in risk assessment and educational programs for public and patients.

of knowledge about opioids addiction, dependence and withdrawal leads to emergency situation which require special attention. To handle such situations and to educate patients about using opioids, educational programmes are necessary. In addition to this, patient’s rehabilitation therapies play crucial role in the recovery process of the patient. In today’s scenario, where digitalisation of healthcare is on the rise, virtual rehabilitation can be a better option and much convenient as well. Virtual therapies consisting of Yoga, different types of exercises can boost the recovery and also minimise the healthcare expenditure. In this digital world, where healthcare is evolving like never before, pain management in hospital also require more attention looking at ever-growing surgical procedures and lifestyle diseases.

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MiniCollect® Capillary Blood Collection System For your most precious samples MiniCollect® offers a gentle way to collect small blood samples for a wide range of analyses. The capillary blood sample is becoming increasingly popular as specimen material due to its simpler and less invasive sampling procedure. One of the advantages is the low blood volume. Small quantities are sufficient to enable a variety of parameters to be tested. Capillary blood collection supports the PatientBlood Management approach: as little blood as possible, as much as necessary. If for some reason venous blood collection is not possible, capillary blood collection could be a promising alternative. For children and patients who require frequent sampling it is essential that the volume of blood collected is minimised.

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The MiniCollect® Capillary Blood Collection System is perfectly suited for young children, geriatric patients as well as patients with fragile veins. MiniCollect® is also recommended in situations where venous blood collection proves particularly difficult or contra-indicate. For delicate vein conditions, patients who often have blood samples taken, or people with severe burns, capillary blood collection with the MiniCollect® system offers a great alternative to venous blood collection.

MiniCollect® meets carrier tube MiniCollect® tubes can be inserted into a PREMIUM carrier tube. This combination corresponds to the dimensions of a standard 13 x 75mm tube. With the MiniCollect® Complete version, which is already irreversibly assembled with the carrier tube, the advantages particularly for automated analysis of the sample are numerous. The standardised tube size enables identification with standard tube label formats. MiniCollect® tubes in combination with carrier tubes can be processed in a standard centrifuge. The tubes have a pierceable cap whilst still closed and remain leak proof.It is not necessary to remove the cap before analysis, thus keeping the process simple and hygienic.

Wide range of safety lancets The MiniCollect® lancets are available with a wide range of puncture depths and blade sizes / needle gauges to ensure that the puncture wound can be kept as small as possible while achieving the targeted sample volume. The safety mechanism ensures that the blade/needle is automatically retracted after the puncture and is safely enclosed within the plastic housing. In particular when dealing with our youngest patients, it is imperative that the procedure beas gentle as possible to avoid causing unnecessary anxiety. The safety mechanism means that the blade/needle is hidden from view, allowing the blood collection to take place in a more relaxed atmosphere for all concerned.

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THE PANDEMIC'S PUG - MARKS Perhaps one of the most devastating effects of the ongoing pandemic is on our mental health. As we shuffle through the nitty gritties of new ways of living, and for many a bare survival, we need to cast a serious look at our psyches and re-build / re-new our coping mechanisms towards a ‘healthier living’. Gurrit K Sethi, Strategic Advisor, Global Health Services, Global Strategic Analysis

he lockdown opened a lot many different vistas for all – in different walks of life, and, within that, of different aspects of life. Professionals, Industrialists, Business people, Daily wagers, Students, Homemakers etc, each of them was affected hugely. While there was a lot of family bonding and together time that came, with this also came many fears – of illness, of death, of loosing jobs, of reduced earnings, of lost time and more. Also seen is a big rise in number of abuse cases reported of all sorts. And these negatives transcend all walks of life. The beauty and the beast stand together.

The beauty is that the pandemic brought back to life coping mechanisms in form of family bonding for many. Kids got the desired attention at home from both parents, many of the elderly living alone in their respective homes or those in assisted living centres came back together again, the importance of being together as a family was heightened. As everybody worked / studied from home, a new respect and understanding came by. Home chores got equally divided and we did see many a memes around this. For many, yes, this is the scene, a beautiful scene.

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While we understood the importance of home, there also were reported increased instances of abuse of different forms. Culturally, this is something for all of us to ponder upon. These existed earlier, however, the numbers grew as we got free-er, or is it that this is an expression of frustration, frustration of supressed emotions, unmet needs or those not recognised. These are grave issues and need to be looked at and healed. Healed not just from a perspective of the pandemic, but because this is reflective of habits of a social group. This social group needs to first address and recognise the ‘needs’ – personal needs as well as social needs that overlap and are suppressed. This suppression creates a cacophony of frustrations expressed illicitly or in

a fashion not acceptable in the realms of decency. Sex based discriminations, abuse and violence, other forms of domestic violence towards kids and elders, reflect a need to restructure the basics of our social existence. Add to this the economic frustrations. These gaps in the social existence call for a mental re-orientation and a dire need to recreate a mental wellness paradigm. This re-orientation cannot happen by enforcement of law but rather through a movement of ‘wellbeing’ of the body, mind and heart.

There are the fears, of course, which are omnipresent otherwise but brought forth with force because of the pandemic. These fears are well grounded in the need for survival and living. Daily

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Many people were of course unable to deal with these stresses. As daily living became difficult, they succumbed to suicides, to mental disorders of anxiety and depression giving in to these pressure and stress they faced in their day-today life. The incidence of suicides and disorders have gone up significantly per some local studies conducted recently across various states. Fear of the disease also took a toll. A pointer to the rising requirement for a mental and emotional support infrastructure.

On the other hand, there are the healthcare workers who only got busier with their hands over full given the pandemic’s healthcare needs. Tending to the growing load of covid patients. Saving many loosing some. And carrying the load of those who they couldn’t save, along with the loneliness of staying away from their loved ones so as not to give them infections, carrying the burden of being overworked and much more. The effects of these will be telling in the long run. Gurrit K Sethi, Strategic Advisor for Global Health Services, Global Strategic Analysis, contributes to healthcare by helping providers build and better business efficiencies and concept development, also strives to contribute socially through the Swiss Foundation, Global Challenges Forum as Strategic Advisor, through conception of sustainable health initiatives. She started her career from the shop floor working her way up to lead different healthcare businesses in different domains and verticals. Her significant achievements have been in bringing to life different SMEs and SBUs signifying a change in the Indian healthcare scenarios, as the opportunity paved the way along the healthcare growth curve in the country. With over 20 years in healthcare under her belt, she has carried transformational changes in the projects she has led, four of those being early stage start-ups. Gurrit is an avid traveller and voracious reader of varied genres, attributes which she says, provide her with incisive insights about people and systems and what drives them.

In step with the healthcare workers were the other frontline people, the policemen, the municipal workers, those ensuring the availability of essential services, and many others engaged to ensure that others were well protected and provided for. And they also continue to carry the burden of carrying infections back home or the stress of the working conditions. Amongst this pandemic, in a country where the mental health quotient wasn’t even recognised, today everyone is feeling the pinch of this. Each one of us is forced to sit up and recognise this aspect, whether faced by our fears, or the changed way of living in a new reality, be it the fears or the frustrations. The industry needs to perk up, recognise the shift and the need and step in with solutions. Of course, in the recent times one has seen increased funding for the mental health platforms but much more is needed, and proactively so, so as to cover the gap that exists. Sustainable models need to be developed, covering the entire spectrum of economic classes to enable a mentally healthy nation.

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wagers were the most affected as without savings they were at loss for covering even the basic necessities of life like food and shelter. Thousands lost jobs. Many businesses, big and small, came to a nought. Of course, there were a few that did well. Students had to change the way of studying as well as interacting. Many lost time and means to study because either there was no data connection, or devices to connect or the schools lacked the infra. As everything came to a rude standstill because of the lockdowns, our competitive spirits continued to thrive. Every walk of life has a story of fear and also how these were overcome. These fears, also found the right expression in the philanthropic actions of many members of the society who reached out to the others for support and in support of some basic needs. But a philanthropic expression is not enough. There is a much needed mechanism for coping, which needs to be enabled for each individual.

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SINGLE PILL COMBINATION FOR CHRONIC HYPERTENSION Better adherence and better control The global prevalence of chronic hypertension continues to rise. The main goals of treating hypertension are to ensure good blood pressure control and to prevent hypertension related adverse cardiovascular outcome. It is estimated that >60 per cent of hypertensive patients still have their blood pressure out of optimal control. The European Society of Cardiology guidelines have provided a strong recommendation to start anti -hypertensive medication with single pill combination as a measure to improve adherence and effective blood pressure control. Rami Riziq Yousef Abumuaileq, Consultant Cardiologist at Palestinian Medical Services; Associate Editor at BioMed Central; Associate Editor at European Heart Journal- Case Reports

t is estimated that more than 1.4 billion people are suffering from chronic hypertension in the world (two-third of them are living in low- and middle-income countries). Hypertension is still the most common modifiable risk factor for cardiovascular diseases worldwide. No significant

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improvement in the rates of hypertensive control has been observed over the last decade. Blood pressure control rates are as low as 17 per cent to 31 per cent in patients diagnosed with hypertension in high income countries, control rates are likely worse in low and middle income countries.

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High blood pressure is the leading global cause of premature death, being responsible for around 10 million deaths per year. Furthermore, the global prevalence of hypertension of at least 140 mmHg continues to rise. Hypertension also becomes progressively more common with advancing age, with a prevalence of higher than 60 per cent in people 60 years or older. Therefore, as the population ages, it is predicted that the impact of arterial hypertension will rise further, if management is not optimised. The “Build and Blood Pressure Study”, carried out on almost 5 million adults between 1934 and 1954, published in 1959, showed a strong direct relationship between high blood pressure and risk of clinical complications and death. In the 1960s, these findings were confirmed in a series of reports from the Framingham Heart Study. The first comprehensive guideline for detection, evaluation, and management of high

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BP was published in 1977. Since that, a series of Joint Committee guidelines were published to assist the practice community and improve prevention, awareness, treatment, and control of high blood pressure. According to most international guidelines, including the European Society of Cardiology (ESC)/European Society of Hypertension (ESH) 2018 guidelines for the management of arterial hypertension in adults, aged at least 18 years, hypertension is defined as a systolic blood pressure at least 140 mmHg and/or a diastolic blood pressure at least 90 mmHg. However, in 2017, joint societies in the United States of America, including the American Heart Association (AHA)/American College of Cardiology (ACC) lowered the level at which ‘hypertension should be defined, to at least 130/80 mmHg. This consequently raised the prevalence of patients with hypertension according to this updated definition. The ESC/

ESH noted during the release of their guidelines in 2018 that the majority of patients do not achieve blood pressure less than 140/90 mmHg, and therefore their focus was to improve goal attainment, rather than to lower the definition of blood pressure beyond the traditional definition of hypertension (i.e., blood pressure at least 140/90 mmHg). Normal blood pressure in persons aged less than 65 years according to both guidelines is, however, defined at a similar level, either as blood pressure 120–129/ 80–84 mmHg in ESC 2018 or as less than 120/80 mmHg in AHA 2017. Studies have demonstrated that attainment of ‘normal’ blood pressure reduces the risk of future cardiovascular adverse events. However, goal attainment remains suboptimal worldwide, even using a goal of less than 140/90 mmHg. In the past decade, guidelines provided measures to overcome the challenge of widespread suboptimal blood pressure control. Among these

measures, guidelines from the ESC/ ESH stated that the majority of patients with arterial hypertension initiate two antihypertensive agents to reduce blood pressure quickly towards the therapeutic target. Similarly, the 2017 ACC/AHA guidelines also recommend initiation of two antihypertensive therapies for patients having their blood pressure more than 20/10 mmHg above the target. The 2018 ESC/ESH guidelines identified that poor adherence to treatment and physician clinical inertia (i.e., lack of physician’s plan and action when the patient’s blood pressure is uncontrolled) are common causes of poor BP control. Overall, more than 50 per cent of patients might fail to adhere properly to their prescribed antihypertensive medications. Moreover, it is estimated that after 1 year, approximately 40 per cent of patients with hypertension may stop permanently their initial drug treatment. The relationship between poor adherence and high cardiovascular risk has been widely reported. A recent meta-analysis demonstrates that SPC therapy leads to improved adherence and persistence compared with free individual drug therapy. A recent meta-analysis, involving 18 studies and 13,56188 patients with hypertension showed that patients with poor adherence to antihypertensive medication had a significantly increased risk of stroke events compared to those with good adherence. A very recent meta-analysis of 44 studies has demonstrated that SPC therapy leads to improved adherence, persistence and blood pressure control compared with free individual drug therapy. Adherence is considered to be multifactorial. To achieve a greater adherence rate; different factors should be taken into account. These factors would include number of drugs used / frequency of daily doses and patient’s beliefs, lifestyle, personality, and comprehension. Several strategies have been proposed to improve adherence to

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antihypertensive medications like drug regimen simplification, education and counselling on home blood pressure monitoring, options to reduce costs, and use of allied health professionals and facilities. Single pill combinations (SPCs) therapy is an approach toward regimen simplification strategy. SPCs could offer a number of advantages versus free individual drug combinations given separately, as it may improve tolerability, reduce pill burden, lower medical costs and resource utilisation, reduce physician clinical inertia, and the most important advantage would be to improve patient adherence to medication. So, SPCs would have the potential to significantly improve the overall blood pressure control rates in treated patients. The ESC/ESH 2018 guidelines strongly recommend the use of a SPC to simplify drug regimen as a strategy to improve antihypertensive treatment adherence. However, 2017 ACC/ AHA guidelines recommend that the initiation of two antihypertensive drugs can be given either as two pills in a free combination or as an SPC therapy. SPC option is still not recommended at all in the National Institute for Health and Care Excellence guidelines. Of interest, recently the World Health Organization (WHO) has added, for the very first time, a SPC comprising two antihypertensive medications to the WHO Essential Medicines List, thereby acknowledging that the use of SPC is the emerging best practice for safe, effective, rapid, and convenient hypertension control worldwide The ultimate goal of antihypertensive therapy is good blood pressure control to reduce the risk of stroke, cardiovascular disease, and renal disease. Achieving good adherence in the long-term is a challenge. Different factors contribute to good adherence. SPCs should be used in combination with other strategies to improve adherence. Patient beliefs and local concepts still remain obstacles to proper adherence

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High blood pressure is the leading global cause of premature death, being responsible for around 10 million deaths per year.

in patients with hypertension. Patients often do not feel unwell and ask why it is necessary to continue taking treatment for long time. Doctors should not forget that combating/discussing patients’ beliefs and thoughts during his visits to the clinic could be an effective strategy to improve adherence to antihypertensive treatment. Other strategies to improve adherence and can be used in conjunction with SPCs, are like home blood pressure monitor, reminder pill boxes, integrated care, and patient preference and sharing in decision making. Really, reducing pill burden would motivate patients to improve their medication adherence and persistence to therapy, which in turn may have resulted in better blood pressure control and

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reducing cardiovascular outcome at long term. However, physicians might still have some concerns when prescribing SPCs therapies, including risk of treatment duplication, and the limited ability to individually titrate different components of the single pill with the incidence of any adverse event. As such, further clarification of the benefits is needed for healthcare professionals. Despite that, meta-analyses have demonstrated benefits of SPCs at achieving good adherence and better blood pressure control and the recent guidelines which recommend SPC over freely individual drug combinations. Further studies are still needed to use ambulatory blood pressure monitor and/or home blood pressure monitor to truly determine the effect of SPC therapy on blood pressure control and cardiovascular outcomes compared with free individual combination therapy. Regarding the cost issue, concerns have been raised like having multiple dosage strengths and logistic problems for pharmacies having to stock the multiple combinations of the same two drugs. Furthermore, in different countries, SPCs are still more expensive than the generic forms of the individual drugs, and the cost of medication is another important determinant of longterm adherence to therapy. Regarding this point, multiple studies showing that SPCs are linked to significant reductions in medical resource utilisation and are cost-effective when compared with free individual combinations. Mainly through reduction of long-term complications and adverse cardiovascular outcome assumed by better adherence and better pressure control by SPC. So, reductions in total medical costs associated with SPCs at long term more than offset the higher drug costs. Important points to remember:

1. Evidence favours SPCs as initial treatment for hypertension based on advantages of efficiency, adherence, persistence and safety. ESC/ESH

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as a general first-line treatment for hypertension. However, beta-blockers are recommended at any treatment step for hypertensive patients with specific indications including heart failure, angina, post-myocardial infarction, atrial fibrillation, or younger women with, or planning, pregnancy. The combination of a beta-blocker with a thiazide diuretic was criticised previously because of the increased risk of developing diabetes. However, combining a beta-blocker with a dihydropyridine CCB is a logical approach in patients for whom betablockers are indicated. 7. The 2018 ESC/ ESH guidelines recommend the combination of CCB and thiazide/thiazide-like diuretic for initial antihypertensive treatment in black patients, and it may be a good choice in other patients with low renin hypertension. Furthermore, both CCBs and diuretics have been recommended individually as preferred treatments for isolated systolic hypertension in the elderly and both drug groups have shown benefits in reduction of cardiovascular events in older patients. The first SPC of CCB and diuretic to become available was the fixed doe combination of indapamide sustained release (SR) 1.5 mg with amlodipine 5 mg, which is effective with once daily dosing. 8. Thiazide-like diuretic outperformed thiazide diuretic in terms of significant reduction in cardiac event

AUTHO R BI O

guidelines strongly recommend SPCs over individual free multi daily dose regimen. 2. The 2018 ESC/ ESH guidelines recommend the combination of a drug that blocks the renin-angiotensin system (RAS) with a calcium channel blocker (CCB) or a thiazide/thiazidelike diuretic. For the RAS inhibitor, the choice is between an angiotensin converting enzyme inhibitor (ACEI) or an angiotensin receptor blocker (ARB). 3. SPCs are going to stay as a preferred approach to treat arterial hypertension. The physicians (cardiologists, family medicine, primary care doctors etc…) should be aware about different components of SPCs forms (advantages and precautions or contraindications) and their different doses available. 4. Importantly, each component of the SPC should have a sufficient duration of action to provide 24-h blood pressure lowering activity to ensure once daily dosing is effective. Furthermore, it would be an advantage if the two components of the dual combination SPC were also available in a triple pill combination, which would facilitate subsequent up-titration of treatment if it will be necessary. SPCs are clearly here to stay, and they offer appropriate firstline anti-hypertensive treatment for the majority of patients, but not for all. 5. While the net clinical benefit supports an initial two-drug therapy, physicians should be vigilant in relation to vulnerable patients and individualise therapy accordingly. In vulnerable patients (e.g., elderly, frail patients) a more cautious or individualised and stepwise approach with a higher emphasis on safety should be implemented. Even though guidelinesdirected medical therapy is the principle of treatment, individualised treatment and expert advice are still needed in areas of uncertainty. 6. In contrast to the 2013 ESH/ ESC hypertension guidelines, the 2018 European guidelines no longer recommend beta-blockers

and stroke. Based on 19 randomised trials, the recent 2020 International Society of Hypertension guidelines supported the use of thiazide-like diuretic (e.g., indapamide and chlorthalidone) rather than thiazide diuretic (e.g., hydrochlorothiazide). 9. There are several alternative options for two drug combinations in SPCs to use as first-line anti-hypertensive therapy. Individual patient characteristics may help in deciding which one to choose. The SPC of an ARB with a CCB has emerged as a popular choice, despite the lack of evidence from a clinical outcome trial with this combination. The use of this combination is supported by effective reductions in blood pressure, good tolerability, and the benefit of improved drug adherence with a single tablet. 10. During each visit to the clinic, medical doctors should ensure patient's good adherence. Initiate short discussion, explore obstacles towards good adherence and take patient's preferences into consideration. The final aim is to ensure good adherence and good blood pressure control. 11. Always, evaluate the overall cardiovascular risk level/profile of hypertensive patient and take measures for proper control of his major risk factors (e.g., diabetes mellitus, dyslipidaemia, kidney disease, obesity, smoking, sedentary life style, etc…).

Rami Riziq Yousef Abumuaileq. Consultant Cardiologist (M.D., Ph.D.) at Palestinian Medical Services- Gaza. Doctorate Degree of Cardiology at Cardiology Department of University Hospital of Santiago de Complostela- University of Santiago de Compostela- Spain. Active member of the European Association of Preventive Cardiology. Associate Editor at European Heart Journal- Case Reports (official journal of European Society of Cardiology). Editor at BioMed Central (BMC Cardiovascular Disorders). Expert and recognized reviewer in several highly qualified and official international journals of Cardiology.

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Nilesh Shah

Vice President/General Manager Commercial Advanced Sterilization Products

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Advanced Sterilization Products Successful Journey Delivering innovative infection prevention technologies 1) Advanced Sterilization Products has a long history of planning and conveying innovative infection prevention solutions. How do you think this would raise the level of healthcare and safety? Every day, millions of people around the world visit a healthcare facility. It may be a mother giving birth, a grandfather receiving routine treatment, or a parent visiting a sick child. What they all have in common is a desire to leave the hospital as healthy or healthier than when they arrived. The care and handling of instruments used to treat patients is vital to their health outcome and there is no room for error. But sadly, hundreds of millions of patients are affected by healthcare-associated infections worldwide each year, leading to significant mortality and financial losses for health systems1. And COVID-19 only exacerbated an existing sterilisation and disinfection problem, with a recent poll indicating nearly 80 per cent of responders spend over 75 per cent of their time on COVID-19 infection prevention efforts2. 1 WHO, Health care-associated infections fact sheet, www.who.int/gpsc/country_work/ gpsc_ccisc_fact_sheet_en.pdf 2 Stevens MP, et al. Impact of COVID-19 on traditional healthcare-associated infection prevention effort. Infect Control Hosp Epidemiol 2020. Apr 16, doi: 10.1017/ ice.2020.141

At Advanced Sterilization Products (ASP), we are dedicated to designing and delivering innovative infection prevention technologies to protect patients during their most critical moments. In addition to healthcare professionals, we work with additional bodies in Asia Pacific that support the prevention of hospitalacquired infections, to work towards better access and reduced infection-related burdens. For example, in Hong Kong, we partner with the Hong Kong Sterile Supplies Management Association and Infection Control Nurses’ Association to organise conferences and educational seminars.

2) Could you tell our readers how the medical equipment is processed in Advanced Sterilization Products Systems? Sterilisation offers the greatest margin of safety to device reprocessing, yet conventional high-temperature methods such as steam are not suitable for all devices. The materials that comprise some advanced surgical instruments, and their complex design, necessitates the use of Low-temperature Sterilisation (LTS) to maintain device integrity. The STERRAD® by ASP exploits the synergism between hydrogen peroxide and low temperature gas plasma (an excited or ionised gas) to rapidly destroy microorganisms. At the completion of the sterilisation process based on this technology, no toxic residues remain on the sterilised items3. 3 STERRAD 100NX Sterilizer with ALL Clear™ Technology, FDA Indications for Use, ASP, 2017 www.asianhhm.com

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We are dedicated to designing and delivering innovative infection prevention technologies to protect patients during their most critical moments.

3) With the best technology available, how would you simplify buying and operating infection prevention products and services for medical facilities globally? ASP offers the ASP ACCESS® Technology – an informationsharing technology that empowers an ecosystem across ASP devices. It is designed to enhance compliance, automating the documentation of the sterile process, and integrate with leading Instrument Tracking Systems. This greatly improves efficiency as it enables real-time access to sterilisation records that can be used within different departments in a healthcare institution.

4) Can you throw some light on STERRAD® Systems and how they are useful to the current situation prevailing today? Busy medical facilities need to maintain stringent sterilisation protocols and the current pandemic placed people and resources under extra pressure across the health systems. COVID-19 also caused numerous product shortages and delay in supply chains in the beginning, and possibly affected medical device sterilisation between patients. When facilities and operators are overwhelmed, there is a risk that they may feel rushed to return medical devices to service with an elevated possibility of skipping or forgetting steps necessary for complete sterilisation. Similarly, issues may arise if people do not have enough resources to engage in the proper sterilisation protocols.

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Hence, the pandemic spotlighted the need for sustainable solutions for disinfection needs with shorter turnaround times. STERRAD® Sterilisation Systems enable faster instrument turnover, as they do not require lengthy aeration and offer a rapid sterilisation cycle (24–60 minutes), saving time and increasing efficiency. This means that instruments can be re-used much sooner, alleviating the costs associated with holding a large number of instrument sets in inventory. STERRAD® Sterilisation Systems rapidly and safely sterilise medical devices and materials, avoiding exposing users and patients to unnecessary health risks by utilising a combination of H2O2, which is non-carcinogenic, and gas plasma, which eliminates H2O2 residues to leave only water and oxygen. With no toxic emissions or byproducts result, because hydrogen peroxide breaks down to water, STERRAD® avoids the need for expensive abatement systems, and adherence to strict regulatory guidelines associated with preventing and detecting exposure, such as for EtO and FO.

5) With the COVID-19 pandemic affecting millions of people around the world, what role does Advanced Sterilization Products have in protecting patients and healthcare workers? ASP is committed to protecting patients and healthcare workers with infection prevention solutions. Our products are highly involved in disinfection & sterilisation practices and our teams are doing what is humanly possible, to make them broadly available where needed. For example, we created an online Coronavirus Resource Center on our website to help our EMEA healthcare communities navigate the significant challenges they are facing in this time of great uncertainty.  With important facts and information that is updated, we want to become a resource in combatting COVID-19 and other infections. Under what the World Health Organisation has called ‘force majeure’, hospitals are looking for solutions outside the ordinary to protect their medical staff and patients. On the quest to find ways to sterilise single use Personal Protective Equipment (PPE) or other materials currently in shortage due to the extreme demand, our STERRAD® low temperature sterilisation systems have been involved in several locally initiated & executed studies. All sterilisation systems and disinfectant solutions that ASP provides have been tested against enveloped viruses, the family of viruses that includes coronavirus. Furthermore, some of our products, including CIDEX® OPA, have been directly tested against coronavirus, and have been demonstrated to be efficacious. The pandemic offers huge opportunities to learn lessons for health system preparedness and resilience.

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Success of infection prevention and control in health facilities is always due to multiple factors. ASP has a history of innovation in High Level Disinfection and Low Temperature Sterilisation. ASP developed and introduced CIDEX® OPA to the market over 20 years ago and created the first hydrogen peroxide terminal sterilisation system, STERRAD®.

7) Could you tell which medical device types are at high contamination risk of coronavirus and why? In a hospital or the course of healthcare set-up, medical devices and instruments will encounter patients infected with coronavirus. To prevent patient-to-patient transfer of the coronavirus, reusable medical devices must be sterilised or thoroughly disinfected between uses. Devices such as bronchoscopes, ENT flexible endoscopes and laryngoscopes are used for the diagnosis and treatment of patients with advanced coronavirus infections. These devices are reusable and must be disinfected or sterilised between uses. A high number of patients needing advanced care for coronavirus could result in a single device being used multiple times a day. Medical devices such as blood pressure cuffs, thermometers, monitoring equipment and ventilators, which are used at the bedside will also need to be disinfected or sterilised between uses.

8) How is Advanced Sterilization Products partnering with global regulators, logistics professionals and healthcare providers to expedite products to the field? ASP is actively working with regulators and healthcare providers across the world to provide products that can aid in reducing or preventing the spread of infection. In 2020, to mitigate the impact of the COVID-19 pandemic, the Chinese FDA announced it would have a temporary program in place to fast-track devices that assisted in the fight against COVID-19. We were able to satisfy the requirements to bring the AEROFLEX™ Automatic Endoscope Reprocessor (AER) to market early. The AEROFLEX AER has a built-in function to check minimum concentration levels of solution prior to every scope being processed.

9) Which product of Advanced Sterilization Products as per you is effective against Coronavirus and its significance? Although ASP has not specifically conducted testing of CIDEX® OPA Solution against 2019-nCoV, CIDEX® OPA Solution has been tested for efficacy against human coronavirus. Testing was performed using the United States EPA Virucide Assay Method. Testing was also completed using a diluted strength CIDEX® OPA formulation to present adequate challenge to CIDEX® OPA. The results showed that even at a diluted concentration, CIDEX® OPA Solution inactivates Human Coronavirus. Additionally, coronaviruses such as SARS-CoV 2 are lipid viruses (enveloped viruses). Lipid viruses are typically, susceptible to various low and medium disinfection modalities according to the guide of the hierarchy of biocide resistance published by the Centers for Disease Control and Prevention (CDC).

Nilesh Shah is the Vice President/General Manager Commercial of Advanced Sterilization Products and is responsible for growth worldwide. Nilesh brings over 20 years of global experience in P&L management, marketing, new business model innovation, engineering and product management. Nilesh has a strong track record of global leadership in the healthcare industry. AUTHOR BIO

6) What is Advanced Sterilization Products focused on when helping to provide the safest possible environments for patients and healthcare individuals worldwide?

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GREATER DIAGNOSTIC AND THERAPEUTIC PRECISION WITH TECHNOLOGY Integrating genomic insights within healthcare workflows

Precision medicine has gained momentum ever since the human genome was mapped in 2003. However, patient genomic data can be difficult to access at the point of care with its complex vocabularies. This is where cloud-based technology can step in, to strengthen and empower the delivery of healthcare that can better place genomic insights at its core Joel Diamond, Co-Founder and Chief Medical Officer, 2bPrecise

ur healthcare environment today is made up of complex health needs and healthcare systems which are often put to the test. Generally, there are underlying expectations placed on the medical industry about what would dominate the next era of healthcare. Even before the pandemic brought into the spotlight the sustainability of healthcare delivery, there has been a gradual paradigm shift towards patient-centred and personalised care, where individuals themselves are more involved than ever in the treatment and services that they receive.

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One such practice the evolution of healthcare has brought about, which puts patient-centricity at its core, is precision medicine. It is an emerging approach to medical care that integrates unique genetic make-up, lifestyle and environmental factors to determine the best medical strategy(ies) to use for a health condition. While the term precision medicine is relatively new, one component – the concept of understanding a person’s genetics to determine the best approach to prevent, diagnose and treat disease – is not. Blood type, for example, is coded in one’s DNA,

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and for decades has been key to ensuring that an individual who needs a blood transfusion can receive blood safely from a matching donor. Identifying select gene mutations in one’s DNA, can also show if an individual has a likely genetic predisposition to skin conditions such as eczema or other diseases including cancer, haemochromatosis and sickle cell anemia. The aim with precision medicine is to provide personalised treatment that is more likely to improve effectiveness and patient outcomes for each patient, compared with reactive cookie-cutter or sluggish trial-and-error approaches.

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The place of precision medicine in healthcare

Since the human genome was successfully mapped in 2003, the movement to accelerate the transition of precision medicine from science and research to practical application at the point of care has gained momentum, albeit decades in the making. This has followed years of technological advancements and breakthrough discoveries in the field of genomics, and physicians across most specialties are now equipped to order a genetic test and gather genomic profiles of their patients. They can then use the results to pinpoint highly accurate diagnoses and optimal treatments for cancer, cardiovascular diseases, reproductive health, psychiatry, neurology, orthopaedic pain and countless other conditions. Building onto precision medicine is also the field of pharmacogenomics (PGx) – where genetic variations can reveal how a person’s genes affect his / her response to medications – which has garnered huge interest in the past few years. Simply put, PGx enables clinicians to treat patients with medications that are tailored to their genes. The application of PGx can help physicians make more informed decisions about treatment involving medications, potentially increasing effectiveness and lowering the number of incidents of adverse reactions to it. Moreover, testing of a gene panel for a range of medications need not be repeated, as the results apply through patients’ lifetimes, which also eliminates duplicative testing and reduces cost. In Singapore, precision medicine has been identified as a potential solution that can help contribute towards its long-term goals for the sustainability of its healthcare sector and transform healthcare for locals. Its National Precision Medicine (NPM) Strategy – a ten-year plan to put in place the healthcare framework and infrastructure needed to bring precision medicine to fruition – is currently in its second phase, where it will study the genetic makeup of 100,000 healthy Singaporeans and up to 50,000 people with specific diseases. It will also work with the healthcare ecosystem to run a precision medicine pilot, translating research findings into standard clinical practice.

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Singapore’s way forward in precision medicine follows its research efforts into Asian genomes, which are considered largely underrepresented in genetic databases next to Caucasian counterparts. While developing a solid and extensive genomic foundation is crucial, it is also important to address the other gaps that remain and may hinder successful application of precision medicine at scale. Patient genomic data can be difficult to access at the point of care, especially where healthcare workflows are not optimised to analyse genomic results. For example, test results are typically returned in genetic science vocabularies, and not the vernacular that clinicians are more familiar with. Genomic data are also not currently stored holistically with data in electronic health records (EHRs), where there is a lack of robust functionality required to process and contextualise it next to existing clinical information about the patient. Think of it in a way where physicians are having to decipher code before being able to add to current health records and making an informed assessment for their patient care after. Even though genomic results can have a significant impact on health outcomes, the reality is still miles away, where data

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has yet to be used meaningfully at the point of care. Additionally, there is also a lack of trained personnel to support the deployment and integration of precision medicine into traditional healthcare set-ups. A comprehensive education programme will also be needed to help physicians and healthcare providers embrace an integrated information system that places genomic insights at the heart of decision-making on patient care.

The changing dynamics of healthcare delivery marks the pivotal note for the sector to embrace precision medicine, from the inside (of its ecosystem) out, to truly enable positive health outcomes at scale.

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Helping the healthcare sector keep pace with the technological advances in precision medicine, enabling safer and more effective patient care

For precision medicine to be effectively integrated into clinical use at scale, new technologies and informatics must be introduced. This begins with the foundation of deep capabilities that can process and store genetic data of populations safely and securely. As genomic data are not yet presented in a format suitable for real-time use, it is necessary for healthcare institutions to enhance their IT infrastructure to accommodate the complexity of delivering precision medicine insights, where clinical workflows would need to incorporate specialised sequencing technologies and enhanced health IT solutions for the interpretation and generation of data. For example, using a cloud-based platform that combines clinical information from a separate EHR system with data from any testing lab for a clinical-genomic ontology, which is also easily and directly accessible within the workflow. By setting in place the fundamental infrastructure needed to keep up with the continuously evolving precision

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medicine approach, physicians across the healthcare sector, be it in any specialty or department, can take the actionable steps towards doling out personalised care for their patients. After all, genomics- informed decisions, which in turn result in improved patient outcomes and satisfaction, can be made only through the implementation of an advanced data-driven healthcare approach. A case in point would be the Murfreesboro Medical Clinic and SurgiCenter (MMC) in Tennessee, which focused on leveraging PGx to provide better and safer therapy for its patients. Earlier this year, MMC conducted a comprehensive chart review of patients for whom providers had ordered PGx tests. Clinicians were prompted to make medication changes in 74 per cent of these patients, as the test results had indicated the medications that had been prescribed put the patient at risk for toxicity, adverse reactions or were unable to be processed by the patient to deliver the intended therapeutic results. Following the medication changes, 98 per cent of the affected patients reported improvement thereafter. This was done simply by integrating PGx test results, within their clinical workflow and EHR, which empowered physicians to prescribe medication that would most likely yield the best response in patients, based on the lab’s evaluation of medication benefits against genetic profiles.

and insights would be a critical link to achieving precision medicine’s promise of better care and greater efficiency. The changing dynamics of healthcare delivery marks the pivotal note for the sector to embrace precision medicine, from the inside (of its ecosystem) out, to truly enable positive health outcomes at scale. The technology and know-how are already here today, and the future of healthcare is really about putting the power of precision medicine to work. Combining the strides in technology, and the shift towards patient-centred care, the impact of these changes will be felt by the healthcare sector in accelerated fashion in the years ahead.

Joel Diamond is a Co-founder and Chief Medical Officer of 2bPrecise, a wholly-owned subsidiary of Allscripts, is a Diplomat of the American Board of Family Medicine and a Fellow in the American Academy of Family Physicians. He cares for patients at Handelsman Family Practice in Pittsburgh.

Much has been said about the array of benefits that comes from the applications of precision medicine, especially in optimising diagnostic methods which can create a ripple effect and enhance screening, detection and treatment methods. Providing a level of access for physicians and healthcare providers to their patients’ genomic data

AUTHOR BIO

The next era of healthcare; moving precision medicine beyond being an afterthought

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FOUR CHANGING PARADIGMS OF HEALTHCARE World is understanding the role of pro-active and preventive health in this era of pandemic. The need for nutrition, preventive medicines and nutraceuticals is becoming a focal point of better health. On the other hand, there is a thought of making Indians healthy and not just disease free. Hence, the number of govt. initiatives are aiming at a Pathy-agnostic approach of integrated medicines. Pharma and nutrition from plants, herbs as well as classical nutraceuticals will pave the way for health and wellness in recent times. R B Smarta, Founder and Managing Director, Interlink Marketing Consultancy Pvt. Ltd

nown as the year of uncertainties, 2020 was a rollercoaster for the healthcare industry as it was forced to adapt a number of new approaches which may well turn out to be blessings in disguise. The sector is evolving at a greater pace and trying to future-proof itself to the extent possible. The focus has drastically shifted toward advance research in medicines and vaccines to fight the ongoing pandemic. Moreover, the synergistic fusion of herbal and conventional medicines is a trending practice. In addition to this, the approaches are patient-centric now-a-days as personalisation of healthcare is on the rise. So, looking at the fruitful transition in actions, better healthcare can be expected in coming years even in the developing countries like India. Discussed ahead are four changing paradigms of healthcare-

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PARADIGM 1 Easier and advanced access to healthcare through IT

Unequal access to the healthcare facilities is one of the major concerns when it comes to availability of these facilities to different groups in the society. People living in rural areas, where the healthcare services are inadequate and biased, are described as the unhealthy part of the population. However, due to pandemic, telehealth practices in the healthcare are on the rise, barriers are decreasing and access to public health facilities is increasing. Rising digitalisation in healthcare is resulting in increased efficiency, patient engagement and personalisation of health solutions. Several interventions like teleappointments, real-time interactions, telediagnosis, tele-patient monitoring, and much more, are possible due to virtual assistance.

1 2

Moreover, owing to this IT- based approaches, health professional who are based abroad, can efficiently guide surgical procedures and other interventions virtually. Due to increasing acceptance of telehealth, rural population can enjoy better and advanced healthcare in the coming years. PARADIGM 2 Proactive patient care

Due to late diagnosis of health condition, there was always a risk of highly advanced disease stage leading to unmanageable consequences. However, as the healthcare structure is evolving, proactive patient care gaining traction. Early diagnosis is essential for managing deadly diseases like cancer and other chronic health conditions. Utilising early detection and preventive measures can lead to improved survival rate in the future.

Easier and advanced access to healthcare through IT

Changing Paradigms of Healthcare Proactive patient care

Fig. 1: 4 Changing Paradigms of Healthcare

While reshaping and reimagining healthcare, affordable healthcare cost should also be taken into consideration.

In recent scenario, the preventive healthcare approaches surging with the interventions of nutraceuticals, traditional medicines and herbal

Integrative approaches

Technological headway

Source: Interlink knowledge cell

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PARADIGM 3 Integrative approaches

The concept of holistic wellness is establishing in the population like never seen before. Government actions are also inclined toward increased acceptance of Ayurveda and other integrative medicines. In pharmaceuticals, Drs’ prescriptions have increased for plantbased nutrition products along with vitamins and minerals as supplementary prescription which is evident from IMS. org or IVAC reports. In comparison to overall growth of pharmaceutical industry, the nutritional products, vitamins and minerals as nutrients, are going faster than the total market. The pandemic has shifted people’s focus from cure to prevention. Along with this, role of spices, ayurvedic kadhas (drinks) and other traditional medicines have emerged as alternatives in the minds of the general public. In addition, lockdowns and work from home policies have further fostered the use of such remedies — although their efficacy remains unproven as yet. Similarly, there has been a growing awareness about therapies like acupuncture, massage therapies, meditation, etc., which, the author believes, healthcare can adopt as they are holistic in nature. Patient’s rehabilitation is also one of the matters of concern as many a times, post-surgery care is important in order to restore a healthy lifestyle. Looking

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at the better approaches toward today’s healthcare, rehabilitation centres can become prevalent in coming years. Paradigm 4- Technological headway

The days when surgeries were not so precise and unassured are fading away. Increasing technological advancements in healthcare at various levels are effectively future-proofing the entire sector and billions of lives. Artificial intelligence (AI), one of the highly trending topics today, is making great moves in healthcare industry. Several advanced interventions which are not only timesaving but also very

Being a thought leader in Pharmaceutical, Nutraceutical and wellness industry, R B Smarta has been contributing globally through Interlink Consultancy and building business performance of his clients for 33 years. Having a Master's degree (M.Sc.) in Organic Chemistry in Drugs, MMS in Marketing, PhD in Management, and FRSA (Fellow of Royal Society of Arts) London, he is-perusing his passion of converting science to Business. Besides being a consultant, he has been teaching at IIM, prestigious management institutes, Pharmacy College, Pharmacists Associations, guiding PhD students and written as many as 7 Books on Management, Pharma, Nutra, Foods domain, and many articles in prestigious journals/magazines.

AU THO R B IO

supplements. Along with classic nutraceuticals, one of the most in-demand nutraceutical formulations are ‘natural immunity boosters’ which have gained a good traction in pandemic. Moreover, In India, Ministry of AYUSH has led down a platform for immunity boosting traditional medicines during COVID. Contesting about tested or untested formulation are going on and there are certain natural products like Bacopa monnieri, for which enough clinical trials are available. However, claiming for corona on immunity, it definitely needs trials.

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promising are empowering the current healthcare sector. AI is highly useful in the space of genomics and gene editing which can give rise to the drugs and treatments for various life-threatening diseases. While reshaping and reimagining healthcare, affordable healthcare cost should also be taken into consideration as this aspect of healthcare services is also very important. As more healthcare organisations implement tech-driven initiatives, cost factors are needed to be balanced in order to make the healthcare services approachable for the patients belonging to various levels of the society.

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UNIK Interconnected Solutions Targeted for excellence Driven by its commitment to advance radiology today and tomorrow, Guerbet has designed a portfolio of interconnected diagnostic imaging solutions to enhance decision-making at each point of the patient journey from diagnosis to treatment and follow-up, in order to efficiently improve patient outcomes. This is UNIK. A major global player in the diagnostic imaging market thanks to the established reputation of

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its contrast media products, Guerbet is much more than a mere supplier of contrast agents. Guerbet also provides a wide flexible range of injection systems, digital solutions and services. Appreciating that their customers benefit from these products and perceive their value not only as individual items but rather as forming a combination of interconnected solutions, Guerbet has introduced the UNIK solution.

What is UNIK? In modern imaging centres, busy healthcare professionals face daily complex challenges and needs. Some of these needs are shared, some are unique depending on the role and place in the organisation. However, the common needs usually are related to reducing costs, minimising time spent on imaging procedures, not only for patients but also for radiologists, radiographers and back-up staff. Challenges faced are the constant need to improve quality and ensure traceability and regulatory compliance. In short, the solution is to create an integrated delivery ecosystem combining contrast medium, injector, consumables, software and services to allow healthcare professionals to improve the workflow in the radiology centre by reducing the reporting and compliance burden via automation while providing meaningful insights. This common ecosystem of interconnected products allows noticeable productivity gains.

Challenges faced are the constant need to improve quality and ensure traceability and regulatory compliance.

trates on 4 pillars: high quality contrast media for MRI and for Xray, a large range of injectors and associated consumables covered by expert 360° technical support, and innovative digital solutions to ensure automatic traceability, improve efficiency, and heighten patient safety in the areas of contrast administration and radiation dose management. UNIK brings tangible benefits to healthcare professionals, ranging from efficiency and optimisation of workflow, patient safety, traceability and control of the injected contrast media, improved clinical performance through optimal product combination and interoperability. Another tangible benefit is cost saving, which is achieved through integration, improved workflow and smart financing services. In addition, UNIK provides the full organisation with the ability to identify areas of value creation, to improve processes and guidelines, reporting the evidence of their excellence through traceability and certifications. Necessary in the modern world of imaging, the high performances can however be challenging for each professional to maintain on their own. UNIK, within the Guerbet excellence partnership, allows the diagnostic imaging organisation to help healthcare professionals meet this challenge.

The important word is tailored. UNIK is not a collection of disparate products nor a commercial package covering aggregation of prices – it is a flexible solution designed to create value by reflecting the healthcare professional’s needs and improvement areas, targeted for excellence. UNIK concen-

Charbel Saade joined Guerbet from a very solid academic and clinical background. He was the Professor and Chair of Radiology at the American University of Beirut and still holds many Adjunct Professor roles worldwide. He has published more than 100 scientific papers and 80 conference abstracts in international congresses. He served as the APAC Clinical Applications and Education Manager and now taking charge of the APAC Digital Solutions and Technical Service. He is passionate about lifting the clinical and technical practice of Diagnostic Imaging for better patient outcomes.

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OUTPATIENT CANCER CARE Improving patient experience It is evident today that the landscape for cancer care is undergoing a dynamic change. Services and technologies like diagnostic imaging, oncology drug administration and radiation therapy have made outpatient care accessible to cancer patients. As the cancer burden in Asia continues to increase, outpatient integrated cancer centres are efficient model to serve the needs of cancer patients. Phoebe Ho, Chief Executive Officer, Integrated Oncology Centres

ancer is the second leading cause of death globally, and accounts for nearly 5.2 million lives in Asia according to a report in 2018. , This indicates that there is a pressing need to provide good quality cancer care in Asia. The question is, what is good quality cancer care in an Asian context? Cancer is a complicated disease by nature. It represents a large number of diseases in different organs with malignant cells dividing uncontrollably and potentially spreading to other organs. Cancer patients can be diagnosed at different stages of disease or at different organs. Some patients may discover the disease at health screening or from cancer symptoms. After the initial diagnosis, cancer can be treated with surgery, chemotherapy, radiation therapy. The whole process can take at least 6 to 12 months. After active treatment, the recovery process can be

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MEDICAL SCIENCES

even longer. Therefore, cancer care that is tailored to the lifestyle and cultural context of cancer patients should be the way to go. Inpatient and outpatient cancer care: the comparison

Cancer care encompasses a wide range of medical services, including diagnostics procedures, pathology tests, imaging, surgery, radiation therapy, intravenous drug administration, oral drugs and supportive treatment. Due to the complexity of some of the procedures, patients will have to be admitted to the hospitals. For example, if a pancreatic cancer patient needs to have Whipple's operation which is a major procedure of up to 12 hours, the patient will have to be admitted as an inpatient. On the contrary, for a lung cancer patient who only needs an oral targeted therapy, an outpatient consultation with a prescription is sufficient.

The oncology community globally has been working towards the direction of shifting cancer care from inpatient to outpatient as a way to deliver a better quality of cancer care. Since 2011, the American Society of Clinical Oncology (ASCO) and the Oncology Nursing Society (ONS) have included chemotherapy administration guidelines in both outpatient and inpatient facilities. With the advancing of targeted therapy and immunotherapy, the infusion duration is even shorter than chemotherapy. It makes the outpatient cancer drug treatment even more feasible. “We understand that not all treatments can be carried out in outpatient facilities, but shifting more cancer care services to outpatient can bring normalcy to patients’ lives as well as bring efficiency to cancer service delivery. Shifting cancer care to outpatient can shorten the duration of

patients staying at health care facilities. It will lower the infection risk by reducing the exposure time and the exposure of hospital acquired infections. Quality of life of patients is also greatly improved by spending more time outside of healthcare facilities and keeping the normal lifestyle,” says Ms. Phoebe Ho, Chief Executive Officer, Integrated Oncology Centres (IOC). Outpatient cancer care can also bring efficiency to service delivery. As the outpatient service focuses on only one service type, the care process can be designed in a more standardised manner. Taking outpatient chemotherapy centres as an example, as all patients attend the chemotherapy centre to receive infusions, the same workflow can be applied to all patients from consultation, blood taking to receiving infusions. All staff can be trained with the same process and deliver the process smoothly for all patients every day. Centre design can also

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be catered for this particular workflow. Alongside enhanced efficiency, service standards can also be improved with better care process design. Coordinated Cancer Care Services

While an outpatient cancer centre focuses on a number of cancer care services, it only covers part of the services in the patient journey. A typical patient journey of cancer patients starts from diagnosis, followed by treatment and recovery. Initially, cancer patients may be present with early symptoms, like weight loss and coughing with blood, or have abnormal findings in health screening. A series of diagnostic tests will be done in the hospital or in outpatient facilities. Treatment will then have to be arranged accordingly. Cancers are usually being treated with surgeries, radiation therapy and drug therapy. Traditionally, these treatments were all being done on wards. With the advancement of technology in the past decade, a substantial amount of these treatments shifted to outpatient basis. With several cancer care services shifting to the outpatient settings, coordination becomes the key to a smoother patient journey. Integrated cancer care comes to play to facilitate coordinated cancer care. Linking all facilities and services of outpatient cancer services together, patients can solve their medical needs under one shared care system. Health care professionals can also be gathered to discuss the patient case in the same location and the multi-disciplinary team will be formed naturally. Nurses and patient service advisors can also coordinate all of the outpatient appointments for the patient in the same computer system. Currently, outpatient integrated cancer centres usually provide the following services: Outpatient consultation As in most of the health care services, clinical decisions are being made by doctors at the consultations. Be it the orders of investigation based on symptoms or the order to receive

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chemotherapy, it has to start with a consultation. Outpatient consultation department is usually the centre of the service. Nurses and patient service advisors usually work closely with the doctor in the outpatient department. Appointments for further investigation, referrals to doctors of other specialties and orders for other procedures are generated from this outpatient department. Diagnostic Imaging Diagnostic imaging services are essential for cancer diagnosis. Modalities like computed tomography scan (CT scan), magnetic resonance imaging (MRI) and positron emission tomography (PET) scan are usually used in cancer diagnosis. These machines can confirm the location of the tumour and its activities. It can be used to assist further diagnostic procedures, e.g. biopsy or further surgical oncology treatment. Oncology drug administration Oncology drug treatment evolves from chemotherapy to targeted therapy and immunotherapy. Infusion duration is significantly reduced and some of the drug treatment can even be administered orally. Inpatient admission for drug infusion is only limited to a few drug protocols or the clinical condition of the patient doesn’t allow outpatient treatment. Outpatient drug administration service is now the standard of care in most of the oncology centres.

Asia, taking up 55 per cent of the world population and half of the cancer patient worldwide, requires more cancer facilities to serve patients.

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Radiation therapy Radiation therapy utilises high energy beams to kill cancer cells. The treatment is usually broken down into small fractions every day and lasts for 1-5 weeks depending on the clinical situation. The treatment time ranges from 15 minutes to 1 hour every day. It makes radiation therapy a perfect service to be delivered in outpatient centres. Patients are usually being followed up by the oncologists weekly to monitor the progress in the outpatient radiation therapy centre. Outpatient cancer care improves patient outcome

It is evident today that the landscape for cancer care is continuing to shift. Majority of cancer services can be delivered in the outpatient facilities. Inpatient services will be reserved for patients who need longer duration of treatment and more complicated clinical needs. Triaging patients with different needs will be the key to success. Frontline clinical teams should be trained to coordinate the cancer care between patients and different specialities of healthcare professionals to deliver the best cancer care. Benefit from the technology, cancer care can be delivered in a more effective and efficient manner. Longer survival and better quality of life can be achieved under a simpler clinical pathway with the support of outpatient facilities. Even if the needs of cancer patients are getting more complex, the advancement of cancer care is growing fast enough to allow complicated clinical situations to be handled in outpatient facilities with a good team support. For instance, new patients usually need a lot of tests to confirm the diagnosis. Oncologists at the outpatient consultation department can order the tests to be done in other outpatient facilities. When the reports of all these tests are available, the case can then be discussed among the healthcare team to come up with a few possible treatment suggestions. The suggestions can then be

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outpatient facility can be a cultural shock in some countries. Patients are used to receiving all high-risk procedures in the hospital with an idea that emergency service will be readily available. Some outpatient integrated cancer centres should then be built adjacent to a hospital. Emergency support can then be sought from the hospital and a sense of security can be offered to the local community. Another possible challenge is talent acquisition. Healthcare professionals, especially those who specialised in oncology, are trained in the hospitals. When a full suite of oncology services have to be set up in an outpatient facility,

AUTHOR BIO

shared with the patient at the outpatient consultation. In that case, the patient will then benefit from the expertise of the whole healthcare team without being admitted. It requires good coordination with the health care team. As the outpatient cancer care delivery model is team based, this means the team administering the treatments to patients work together with the patient to provide treatment that fits the patient best. This ensures that the patient’s care is the focus of the team. Outpatient care is said to be collaborative as it builds relationships between the patients and the multidisciplinary team that are collaborative. All these eventually lead up to dedicated and committed healthcare professionals who intend to continuously provide care that is patient centric. One example would be the IOC's approach of collaboration. “IOC emphasizes coordination of care. For example, working together, surgeons, medical oncologists and radiation oncologists address all issues affecting their patients with cancer. Together in one team, they are able to look at things from the perspective of, ‘What’s the best thing for the patient?’” says Ms. Ho.

a full team of health care professionals will have to be recruited. Not to mention the cost, willingness of health care professionals moving their practices from hospital to outpatient facilities is already a huge challenge. Despite all these challenges, more establishments of outpatient integrated cancer centres can certainly alleviate the cancer burden in Asia. With the indefatigable effort of scientists in oncology, we anticipate that more cancer services can be brought into the outpatient facilities. With an operation model as such, Better patient outcomes and a better quality of life can definitely be achieved.

Phoebe is the CEO of Integrated Oncology Centres (IOC). A pharmacist by training, Phoebe has over 20 years of experience in healthcare and has served in various senior executive positions with Fortune 500 pharmaceutical companies.

How the future looks like for outpatient cancer care

Cancer burden is increasing rapidly with more cancer patients being diagnosed annually. Asia, taking up 55 per cent of the world population and half of the cancer patient worldwide, requires more cancer facilities to serve patients. Outpatient integrated cancer centres are an efficient model to serve the needs of cancer patients. Compared to setting up a large full functioning cancer hospital, outpatient cancer centres can be set up with a relatively shorter time with a smaller capital with a more direct service model. It is a potential solution to meet the rising demand quickly. However, this is not a common model in Asia yet. A lot of challenges can be anticipated with a new model in this vicinity. Receiving cancer treatment in an

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Tele-rehabilitation The time has come Rehabilitation, the process of restoring an individual to health or normal life through training and therapy, is a major component of health sciences. Rehabilitation services have been disrupted due to the COVID-19 pandemic. Even with unlocking and post vaccination, some form of physical distancing is likely to be part of the new normal. This review suggests that Tele-rehabilitation (TR) will soon be a distinct standalone sub speciality of Telehealth and is here to stay. K Ganapathy, Director, Apollo Telemedicine Networking Foundation

lobally, 2.4 billion people would benefit from some form of rehabilitation. Rehabilitation services help maintain, restore, or improve skills for Activities of Daily Life. These could have been lost or impaired because a person was sick, hurt or living with temporary or permanent disability. Illustrations of rehabilitation include exercises to improve speech, language and

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communication after a brain injury and modifying home environment to improve safety and independence at home, thus reducing risk of falls. Other examples include exercise training and education for healthy living, making, fitting and educating an individual to use a prosthesis, reducing muscle stiffness for a child with cerebral palsy and training in use of a white cane, for a person with vision loss.

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Introduction to tele-rehabilitation Services

Digitalisation of healthcare is at an all-time high, as is the exponential growth of telehealth. TR is “the delivery of rehabilitation services via information and communication technologies”. Reduced access to in-person rehabilitation, secondary to the pandemic, is resulting in TR growing exponentially. Patients may be too ill to travel or have difficulty in mobility. Adverse weather conditions, challenges in identifying mutually convenient session times, household responsibilities and occupational commitments may make travelling difficult. TR services include evaluation, assessment, monitoring, prevention, intervention, supervision, education, consultation, and coaching. TR services can be deployed across patient populations and multiple healthcare settings including clinics,

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homes, schools and community-based worksites. A Fortune Business Insights Report estimated a market value of US$3.32 billion in 2019, with a Compounded Annual Growth Rate (CAGR) of 13.4 per cent leading to US$9.13 billion by 2027. Advantages and barriers in telerehabilitation

These include exercising from comfort of home, ability to work on one’s recovery irrespective of time schedule of health care professionals and improved quality of exercise instruction, as they are available for repeated review on video format. Access to high-quality care despite geographical isolation, reduced travel and waiting time, flexibility, and costeffectiveness are additional benefits Limited computer literacy, unreliable internet connection, language barrier, inability to perform an actual physical assessment, patient privacy, and safety concerns are challenges Some participants were enthusiastic about TR as they could be in contact with their therapist and continue training.

Tele-rehabilitation setting

Background: This should be appropriate with adequate lighting, no background noise or interruptions. Professional clinical attire is recommended. The virtual visit should begin by getting an informed consent, ensuring adequate audio visual facilities and orienting the patient for a technical set up and a remote clinical examination. The former should include reliable internet, computer, headset, speakers, microphone, familiarity with chosen virtual platform, virtual follow-up appointments and training modules. Challenges and Limitations in introducing Tele-rehabilitation In low resource settings all needs cannot be met. Access to teleservices, reduced access to smart devices, computers, difficulty in using devices /software effectively and privacy concerns are often problems. Digital access to welfare benefits/ interventions may hurt those without internet access. Face to face services help in socialisation,

building self-esteem, learning instrumental activities, mentorship and hands-on training. Non-availability of dependable power, network and, bandwidth and shortage of multimedia devices are major concerns. Insufficient training for professionals, licensing, liability, malpractice, confidentiality, cultural issues, environmental stigma, abuse, quackery, affordability, reduced intrinsic motivation, considering portal-mediated communication with HCP as ‘impersonal’and lack of physical space and rest to properly exercise at home compound the problem. Elderly require repeated instructions for TR. Suboptimal lighting, poor audibility, call drop, difficulty in remembering procedural steps, lag during conversation and difficulty in remote troubleshooting also need to be concerned. Therapists require to see the whole person on a screen, which is often difficult. Family members may find supervising home-based activities difficult.

Methods and components of Telerehabilitation

These include physical, motor therapy, occupational therapy, speechlanguage audiology, deployment of virtual reality (VR), tele-robotic therapy and gamification. Webcams, videoconferencing tools, asynchronous e-visits, virtual check-ins, remote evaluations of recorded videos or images, telephonic assessment and management services can also be used. Machines interfaced with robotic arms, robotic legs, data gloves and smart glasses in a 3D environment allow for greater sense of immersion. Defining patient’s diagnosis for a correct therapeutic programme, visualisation in video format of catalog of preloaded exercises and creation of new ones along with maximum personalisation and customisation of TR programmes is desirable.

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Clinical indications for Telerehabilitation

Clinical indications for TR include musculoskeletal disorders, low back ache, spondylosis, osteoarthritis, neck pain, frozen shoulder and post joint replacement. Neurological conditions benefiting from TR include stroke, neurotrauma, neurodegenerative disorders, cerebral palsy, Post TB Meningitis, neuro muscular disorders, Gullian Barre syndrome, deuchenne muscular dystrophy and demyelinating diseases. Chronic obstructive pulmonary disorders (COPD), post-ICU conditions, post Covid, cardiovascular disorders, visual, hearing, developmental disorders, speech and voice dysfunction, swallowing disorders and cognitive dysfunction also benefit from TR. Virtual assessments for pain, swelling, range of motion, muscle strength, balance, gait, and functional assessment demonstrated good concurrence with physical assessments. TR can provide high‑quality personalised musculoskeletal physiotherapy. Knee osteoarthritis causes musculoskeletal pain and disability affects up to one‑third of people aged over 60 years. Remote muscle strengthening exercises can significantly reduce pain, improve physical function and quality of life. TR for musculoskeletal conditions leads to reduced hospitalisation and crowding in physiotherapy departments. Musculoskeletal Disorders (MSDs) are the second commonest cause of chronic pain and physical disabilities. Physiotherapy assessments that can be done through video include evaluation of pain, swelling, range of motion, muscle strength, balance, gait and functional assessment. TR for stroke, cardiac, pulmonary afflictions, and swallowing difficulties

A study of 22 trials involving 1937 patients from systematic reviews in the Cochrane Database System on use of TR systems found moderate-quality evidence

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that there was no difference in activities of daily living between people who received a post-hospital TR intervention and those who received usual care. Significantly different outcomes between the groups, have not been found, suggesting that TR is not inferior.TR is an excellent rehab measure for COPD patients who can exercise at home, while being monitored from tertiary care centres. Recent literature has shown that TR for pulmonary afflictions is as effective as inpatient pulmonary rehab programmes. In a recent publication, follow‑up and counselling was effective through telephone and social media (Facebook, Twitter and e‑mail). Cardiac tele-rehabilitation includes bicycles with touch screens and wireless sensors to check the patients’ ECG, blood pressure, and oxygen saturation in real time. At the hospital, the supervising staff can connect remotely to the patient’s computer touch screen to customise the exercises based on previous exercise stress test and monitor patient’s health condition in real time, during rehabilitation. Exercises can be stopped if abnormal

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values are detected. The machine could be interfaced with devices such as robotic arms, robotic legs, data gloves, and smart glasses. Such smart devices are used in a 3-dimensional environment simulation, allowing greater sense of immersion in the virtual environment. A sophisticated TR application used a realtime video fluoroscopic examination via the Internet. This system enabled the capture and display of images in realtime with only a three to five second delay. There has been considerable research into assessment and treatment of dysphagia via TR, including cost analyses, leading to establishment of sustainable TR services Tele-rehabilitation for children

TR for children presupposes adequate floor space for the child to demonstrate gross motor skills, including sitting, creeping, walking, running, jumping, and / or skipping as appropriate for age and development. Technical preparation before beginning, during and closing the virtual visit is essential. Close interaction with parents is critical

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Tele-physiotherapy

A customised tele-physiotherapy (TP) programme is made by the physiotherapist who designs the exercise schedule, sets and repetitions for the patient to execute remotely. Details of exercise programme is provided through pre-recorded video material, accessed by mobile phone, tablet, computer or video calls. Traditional physical therapy involves physical touch used to guide, direct and facilitate movement. This humane factor could be reduced in TP. Incorporation of 3D VR systems with complex sensor systems help address this. Tele-rehabilitation potential in India

India now has over 100 million senior citizens. The market for geriatric rehabilitation alone is high. Confederation of Indian Industries, in a report showed that 5.5 per cent of seniors were staying at homes. 6 per cent of seniors live alone. Of the 700 million active internet users, 70 per cent access the internet daily mostly using mobiles. Interestingly communication technology is growing faster in rural rather than urban areas. They were using smartphones in 2020. 77 per cent of 500 million smartphone users were accessing broadband services. The National Institute of Mental Health and Neuro Sciences (NIMHANS), services delivered tele-mental health services during the COVID-19 crisis to ensure continuity of care for patients who were unable to avail outpatient services.. A report on 22 senior citizens from four Community Centers in Delhi showed that home-based TR could be used as an adjunct to continue follow up care thus improving outcomes Technology

In TR, technology support to ensure proper functioning is critical. User friendly technology, flexible, simple, intuitive, requiring low physical effort, with a tolerance for error and controlled remotely can do wonders. Remotely

located patient centric devices should integrate with Communication and Software system, as beneficiaries may have impairments of fine/gross motor skill, cognition, speech, language, vision or hearing. Deployment of technology and its usability should be contextual. Virtual Reality (VR) allows development of 3D virtual environments with motion technology. Wireless sensors track the patient’s wrist and finger movements. The smart glove records kinematics of the patient’s wrist and fingers and streams sensor data to the data receiver the app allows engagement through instructional material (video, image, text) and also to video record patient performance. Computer-assisted cognitive rehabilitation systems and serious games for health are increasingly available. VR can recreate realistic environments in which patients may bodily operate. Wearable sensors allow quantitative monitoring of a patient’s performance. Tele-rehabilitation: A peep into the future

TR will eventually be integrated with Smart Homes in Smart Cities. Functional monitoring with bed

sensors, activity/motion sensors and gait monitors will be a reality. This will be followed by Creating a connected home with pressure-sensing floors, smart furniture and medical sensors. Assistive robots, power wheelchairs, prosthetic limb controls, Home Automation systems and AI Chatbot companion at Home will add value providing ‘smarter care’. This will include encouraging activities and contacting caregiver/ children in emergencies. Staying@home, better known as ageing in place will lead to better health outcomes. Conclusion

Understanding who will use TR, how it will help achieve customised, well defined and changing goals is critical. Beneficiary’s goals alone matter. TR is only a tool to achieve them. The healthcare provider using TR should get into the minds of the end user. It should never be forgotten that for digital natives, an octogenarian is from another planet. ‘Customer delight’ is not a cliché used as a marketing ploy. TR is not a solution searching for a problem. Nothing can stop an idea whose time has come. Covid has ensured that tele-rehabilitation is here to stay.

AUTHOR BIO

K Ganapathy Former Secretary and Past President Neurological Society of India, Telemedicine Society of India & Indian Society for Stereotactic & Functional Neurosurgery Hon Distinguished Professor The TamilNadu Dr. MGR Medical University.Member Roster of experts Digital Health WHO. Director, Apollo Telemedicine Networking Foundation & Apollo Tele Health Services. Website : www.drkganapathy.com E Mail : drganapathy@apollohospitals.com

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Data Security in Healthcare Data security is an often overlooked segment of healthcare IT. With more hospitals, intermediaries, and government bodies digitising their healthcare practices, the impact of this oversight can be catastrophic. An executive from one of India’s most prominent healthcare IT businesses takes an inventory of each of these challenges and recommends applied solutions. Saket Singhi, Founder and CEO, JVS Group

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he years 2020 and 2021 will be bookmarked as the years when healthcare became a central theme of concern for the entire planet. But, as one looks one layer into this ecosystem, one sees the vast, convoluted, often redundant, and inefficient network of healthcare data security practices. Each incumbent in the healthcare ecosystem – the insurance companies, data providers, hospitals, laboratories,

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pharmacies, MedTech companies, and even the patients, have different priorities. In the process of managing these priorities, healthcare data security often goes for a toss. And the world has been witnessing its repercussions for a while now. It is high time we acknowledge and address the problems in data security with respect to healthcare. The biggest challenges in healthcare data security

1. The security paradox of going digital While going digital with electronic health records (EHRs) has been a convenient exercise for the medical ecosystem, it would be inaccurate to say it is 100 per cent secure, 100 per cent of the observable time. To an uninitiated eye, it might seem like stealing data from a physical file in an old hospital was easier than breaking into a database. But, the database operates at a much larger scale. When security is breached, the loss is more significant since there is more data at risk. This does not necessarily mean the digital transition has not unfolded the way it was supposed to. It just shows that as healthcare technology providers, consumers, and enablers, we have to focus on more robust healthcare data security protocols that are updated frequently. 2. User-enabled vulnerabilities Building on the earlier point, most healthcare institutions understand the responsibility of having fortress-like

security systems guarding the patient healthcare data. However, the patients are often provided access to their personal data. Now, who is supposed to ensure that they do not open the doors to vulnerable data sharing? If one is mailing his personal healthcare data to a friend or putting it on the public cloud, who is to blame when such data is misused? Hence, while we design more secure healthcare data environments, we must also ensure that data mobility is either monitored or controlled. A possible solution can be to provide view-only access to personal healthcare data while staying compliant with the local laws and security norms. 3. Device-level security challenges As we delve into the healthcare data spectrum, we have to zoom out and see what devices have access to editing, managing, or moving patient data. If one observes the trend, over 80 1 per cent of healthcare data is projected to pass through cloud channels. That provides convenience, and with data encryption, we should be able to solve the security challenges. However, the implicit insight here is that it is often challenging to encrypt the data used by a specific application at a specific time. On top of this, some healthcare institutions, insurance intermediaries, and other incumbents of the healthcare ecosystem allow employees to use their personal devices at work. This is a pragmatic approach if you want to 1 https://www.informationweek.com/healthcare/cloudgains-traction-in-healthcare/d/d-id/1317754

control your IT overheads. But, it throws the device-level security protocols out of the window. Without establishing a comprehensive application data-access program and cloud data encryption policy, no organisation, institution, or individual must access a patient’s electronic healthcare data. 4. Legacy technology Most of us who have visited a government hospital or an old hospital in India would agree that the technology adoption rate is certainly not at par with the private healthcare counterparts. And, when you look at the budget allocations and approval hierarchy, it becomes apparent why software reaching its end of life and data infrastructure that does not match the industry security standards are is still being used across the ecosystem. You can make any number of data protection, privacy, and accessibility laws. But, if the ground-up infrastructure does not align with such initiatives, that is all they will remain – initiatives. The targeted material impact will not be realised. It would be like saying that you have to safeguard some product and then wrapping it in brown paper instead of shock-absorbing layers. 5. The priority of compliance in spirit This might seem like a lot to unpack, but governments and law enforcement systems across the globe have tried to capture the essence of data security in healthcare. It reflects in the number of laws by country, focusing on data privacy and security in the context of healthcare: 1. EU and the General Data Protection Regulation

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2. Germany and the Patient Data Protection Act 3. USA and the Healthcare Insurance Portability and Accountability Act 4. Brazil and LGPD 5. India and the Personal Data Protection Bill 6. Thailand and the Personal Data Protection Act And the list 2 goes on. The lawmakers have tried to envelop the problem with a solution they have access to – creating adoption frameworks, establishing legally binding policies, and then enforcing the laws. On paper, this should have mitigated the healthcare data security concerns across the globe. But, that would be like saying just because you have amended the accounting rules, you have mitigated accounting fraud. The world does not operate this way. If it did, the USA – which has one of the largest networks of healthcare data privacy laws both in writing and in enforcement, wouldn't have witnessed consecutive data breaches where even the smallest incidents have impacted tens of thousands 3 of patients. 2 https://www.brainlab.com/journal/patient-privacy-dataprotection-different-laws-around-the-world/ 3 https://healthitsecurity.com/news/the-10-biggest-health-

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And, to make it clearer, this is not a USA-specific problem. Every country focusing on prioritising the digitisation of its healthcare ecosystem will have to find a way of crossing this hurdle. Several healthcare institutions, for- and non-profit interests, and intermediaries take the middle-ground – complying in spirit. As far as you are checking the boxes mandated by the law, you are compliant. This is done to control the compliance overheads. But, healthcare data security has to be a central function, not a subset of compliance. If it has to be clubbed, it should be clubbed with patient experience and not some back-office process analysed only when accounting for expense line items. How can we solve the healthcare data security concerns effectively?

The first and probably the most important idea to be acknowledged is the idea of shared responsibility. Assuming that the hospitals are the ones managing the patient data and hence have to take the onus of responsibility for securing it in isolation is devoid of any material insight. If you have to visualise healthcare data care-data-breaches-of-2020

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security, you must imagine a network of touchpoints – patients, doctors, healthcare institutions, laboratories, healthcare IT platforms, intermediaries in the ecosystem, government bodies, and the employees at each of these organisations. Anyone who has virtual or physical access to such data in encrypted or unencrypted form is a part of the problem and hence has to be a part of the solution. Now, to design a solution that has a high probability of effectively mitigating the healthcare data security risks, this framework should come in handy: 1. Create institutional accountability: dedicated cybersecurity centre The major private healthcare institutions already have a dedicated IT team. But, even the smaller healthcare bodies need an agile team that can supervise the organisational scale of cybersecurity. Such an arrangement would mean added responsibilities within the hierarchy. For instance, the hospital should have a tiered governance mechanism where data requests and movement alerts are escalated in nearreal-time, providing someone with adequate authority & resources to quickly act. Just like hospitals have normalised an Ethics Committee, they should focus on a cross-functional Cybersecurity Committee. The formalisation of this system would enable interfacing required to deploy several other solutions. For instance, the IT Team can better understand the requirements of doctors & physicians while the management team can easily access the IT Team’s requests for resource allocation. 2. Allocate adequate resources with margin of safety to the IT team Following through to the earlier recommendation, the IT Team has to be empowered. The old school idea of looking at teams as profit or cost centres is broken. It does not allocate proportional resources to teams that are protecting the healthcare institution’s

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When security is breached, the loss is more significant since there is more data at risk.

filtering outlying data requests would become easier if everyone complies with the SOPs. 4. Simplifying the healthcare data value chain This should have been the very first requirement, but professionals tend to underestimate the value of simplicity. Between data entry, database management, operational process tools, compliance & administration, and IT process management – a hospital might have a dozen tools across the healthcare data value chain. Even if one deploys every recommendation given here, it might be challenging to consistently monitor data security practices for each tool. A simpler approach to healthcare IT management can open the doors to more secure healthcare data practices. At the core of the entire operation should be a singular platform that covers all the processes from the moment a patient enters the hospital to the point where she/he/they is/are discharged. This way, instead of managing tool after tool for each process, the IT Team can pay attention to ad hoc requirements that are extensions of this central platform.

AUTHOR BIO

downsides. Generally, IT Teams should be allowed deliberation on deploying a comprehensive healthcare management platform. Moreover, they should be equipped with tools that provide active visibility into data inventory, access statistics, workflow management, and governance tools. In terms of execution, hospitals, laboratories, and other healthcare bodies can focus on working with technology providers who can provide ad hoc and out-of-box solutions. This would enable them to deploy standard solutions while inspecting their requirements and adapting features unique to their workflow. 3. Provide comprehensive training to each individual No one can stress this enough – but training is critical at each level of data sharing. The training has to be two-level and divided into: 1.Understanding the data sharing and security policies: The policies must be formulated top-down and must be bridged directly with the organisation's mission. This will create resonance among the employees once they understand the priority of healthcare data protection. Much like complying with the laws in spirit, the policies must show what each employee or data user is supposed to achieve. This way, even if they have to take immediate decisions that are out of the scope of the training, their perception will be guided to uphold healthcare data security concerns. 2.Access to knowledge base for Standard operating procedures: Once the policies have been formulated, each data user should be mandated to undergo frequent and updated training for using the healthcare data. Such SOP-based training would ensure that there is consistent practice for accessing, managing, and mobilising data. If the organisation has also enacted the earlier recommendation of establishing an escalation matrix for data requests,

It goes without saying that simplifying the healthcare IT process at hospitals with a federated platform can also provide room for deliberation across the spectrum. For instance, if the hospital’s internal IT platform and the patient-facing app have the same origins, it becomes easier for the IT Team to run stress tests, manage critical changes, and plan for upgrades. In Conclusion

No singular solution or framework can solve the pressing concerns in healthcare data security. However, parallel to the development in laws across the globe, if each incumbent in the healthcare ecosystem prioritises data security and uses the recommendations provided here, we will take a collective leap. To summarise, we have to focus on: 1. Creating institutional accountability by establishing a data security escalation matrix and a crossfunctional supervisory body at each significant healthcare institution. 2. Empowering the IT Teams with adequate resources. 3. Providing comprehensive education to data users for data security policies and Standard Operating Procedures. 4. Simplifying the healthcare data value chain by using federated platforms4 that provided integrated functionalities. 4 https://www.softclinicsoftware.com/

Saket Singhi is the Founder and CEO of JVS Group, a comprehensive technology platform with offerings across healthcare, eCommerce, and several other verticals. He is a serial entrepreneur with decades of experience in founding, growing, scaling, and operating product-centric technology businesses including Quick eSelling, SoftClinic, and SoftCath.

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he ability to identify different cell types quickly, effectively, and in a minimally invasive fashion is an important goal in medicine. Immunofluorescence remains the most used method to image biological phenomena happening at the cellular and sub-cellular levels, despite drawbacks such as phototoxicity. This is due to the reactive oxygen species generated that affects cell physiology and health. Also, there is a need for cell fixation to allow antibodies to cross the

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cell membrane. The latter aspect hinders some downstream analyses that require live cells. In addition, to account for the heterogeneity of biological samples, single cell measurements are needed. Therefore, novel techniques that would allow scientists to investigate living cells in a non-invasive way at the single-cell level are required. Intracellular acidity as a biomarker

Intracellular acidity is linked with numerous biological processes such

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as migration, division and apoptosis. Deviations from the physiological intracellular pH are associated with cancer growth, invasion, and metastasis. Specifically, cancer cells have a more alkaline intracellular environment. Several methods have been developed to probe cellular acidity, which predominantly focus on fluorescence markers or functionalised nanoparticles. The former method is limited by photobleaching, while the latter one requires complex multi-step protocols.

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AI to Identify Cancer Cells by their Acidity Novel methods capable of quickly identifying single cancer cells while keeping them alive for downstream analyses would enable improved diagnostics and allow clinicians to culture them for personalised drug tests. This article highlights how combining AI and optical microscopy led to an inexpensive and accurate way to classify cancer cells based on their intracellular acidity. Chwee Teck Lim, Professor and Director, Institute for Health Innovation and Technology, Department of Biomedical Engineering, and Mechanobiology Institute, National University of Singapore Yuri Belotti, Research Fellow, Institute for Health Innovation and Technology, National University of Singapore

An interesting approach was introduced in 2017 by Hou and co-workers which described a novel simple and inexpensive single-cell pH-based imaging method that allowed for the identification of cancer cells via common pH indicators and UV-vis micro-spectroscopy. Combining pH-based colorimetric imaging and AI for single-cell classification

Recent advancements in Artificial Intelligence (AI) have enabled novel

approaches aimed at extracting information from biomedical images to identify specific phenotypes and aid disease diagnosis. We recently published a work that describes a novel approach where quantitative pH-based colorimetric imaging is combined with AI-based single cell segmentation and classification. This methodology focuses on the use of a pH-sensitive dye, Bromothymol Blue (BTB), as shown in Fig. 1. First, the cell membrane is permeabilised

by incubating the cells for 15 minutes with ethanol at 5 per cent concentration. When imaged using a standard optical microscope, upon internalisation of 0.5 mg/mL of BTB, the intracellular environment acquires a characteristic colour based on the unique physiological condition of each cell. Specifically, each type of cell was shown to exhibit a specific colour ‘fingerprint’ consisting of a unique combination of Red, Green, and Blue (RGB) components.

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Fig. 1. Workflow of the single-cell AI-aided colorimetric pH imaging. Cells are treated with Bromothymol Blue (BTB), a pH-sensitive dye. An optical microscope fitted with a colour digital camera was used to acquire RGB images. An automated single-cell segmentation algorithm identifies single cells and extracts RGB features. Finally, another AI algorithm classifies the cells based on the RGB features.

Fig. 2. Single cell computational classification. Cell lines investigated were MCF-10A, MDA-MB-231, and MiaPaCa-2 and HUVEC. On the left, examples of colour images of individual cells are shown, for each cell line. On the right, a t-distributed Stochastic Neighbour Embedding (t-SNE) plot is employed to reduce high-dimensional data in a two-dimensional map, for each cell line.

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Normal cells (HUVECs) were found to have the lowest levels of pH versus all the cancer cell lines. For example, higher pH was found in the metastatic breast cancer cell line, MDA-MB-231, as compared with the non-cancerous cell line, MCF-10A. These findings are in accordance with past studies. Moreover, each cell type exhibits a characteristic spatial distribution of the RGB values. This information was also taken into account and used as a feature to automatically identify the different cell types using AI algorithms. The computational classification was performed by comparing an increasing number of different cell types. Singlecell classification accuracy of ~97 per cent was achieved when comparing MCF-10A with MDA-MB-231. The classification accuracy reached ~92 per cent when performing the analysis on three cell lines, including the human pancreatic cancer cell line Mia-PaCa-2 to the breast cell lines previously analysed. Finally, adding a fourth cell line to the analysis – the umbilical vein endothelial cells (HUVECs) - a classification accuracy of 92.7 per cent was achieved. The demarcation between the different groups is observed in the t-SNE plot (Fig. 2). The computational classification was validated using 10-fold crossvalidation for model testing. Further validation was done using both ‘in silico’ co-cultures (where datasets are generated by randomly combining values of the colorimetric features obtained for each cell line) and actual co-cultures. After going through the analysis pipeline, cells remain viable and can be cultured for several days. Although the use of BTB led to better computational classification accuracy, this method was also successfully proven without the use of BTB, by simply capitalising on the inherent colorimetric differences between cell lines. This is promising and will enable further developments towards a label-free version of this approach. The presented technique could also be

Recent advancements in Artificial Intelligence (AI) have enabled novel approaches aimed at extracting information from biomedical images to identify specific phenotypes and aid disease diagnosis.

used for sub-cellular analyses. In fact, various cellular components have been characterised by different pH levels as reported previously. Concluding remarks and future perspectives

This method made it possible to discriminate among normal, non-tumorigenic and cancerous cells purely by focusing on their

intracellular acidity. The non-invasive nature of this single cell classification methodology makes it extremely easy and useful for identifying various cell types and can be integrated with current screening and diagnostic methodologies. The protocol takes ~35 minutes, including BTB internalisation, image acquisition, image segmentation and classification. Moving forward, a real-time version where single cells in either adherent or suspended state can be quickly detected and individually manipulated. This will offer a less expensive alternative to the current standard flow cytometry-based cell sorting, while maintaining cell viability, which can then be integrated with downstream analysis. To sum up, our method can be used as a fast, inexpensive and accurate tool to diagnose cancer, monitor cancer progression and/or effectiveness of a treatment, and even alerting the risk of a relapse. References are available at www.asianhhm.com

AUTHOR BIO

Chwee Teck Lim is the NUSS Professor at the Department of Biomedical Engineering, Mechanobiology Institute and Director of the Institute for Health Innovation and Technology (iHealthtech) at the National University of Singapore. His research interests include mechanobiology, microfluidics for disease diagnosis and precision therapy, and wearable technologies for healthcare applications. He has authored more than 400 peer-reviewed journal papers and cofounded six start-ups.

Yuri Belotti is a Research Fellow at the Institute for Health Innovation and Technology (iHealthtech) at the National University of Singapore. His research interests include the development of novel microfluidic devices for liquid biopsy and bioinformatics pipelines for early-stage cancer prognostics.

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DIGITALISATION IN HEALTHCARE Moving to the forefront of AI

COVID-19 has caused rapid digitalisation of the healthcare industry as providers seek to care for the sudden influx in patients and deliver routine critical care. One rising trend is AI as the industry moves away from a treatment and management approach to one focused on early detection and prevention. Kevin Chiow, Country Manager, GE Healthcare Malaysia

tretched, but coping. That is the stark reality today for healthcare systems around the world, that have been battling the COVID-19 pandemic for over a year with the severity and impact of the virus coming in peaks and troughs. It is undeniable that the industry has been facing unprecedented stress as providers seek ways to deliver routine critical care amidst the sudden influx in patients. Adding to this challenge are nationwide manpower shortages, lack of healthcare access in remote areas and the risk of healthcare provider burnout – a staggering 72.7 per cent of healthcare professionals in Malaysia alone have reporting systems of burnout since the start of the COVID-19 pandemic . The numbers are especially worrying when we consider the far-reaching consequences associated with burnout. These range from feeling distant toward work, a sense of resentment toward patients and the public, and overall lack of productivity, ultimately leading to decreased performance and poorer patient experiences and outcomes1. 1 Roslan NS; Yusoff MSB; Asrenee AR; Morgan K, Burnout prevalence and its associated factors among Malaysian

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INFORMATION TECHNOLOGY

Despite the constant change that is reshaping day-to-day realities of patients, health workers, healthcare organisations and providers, not all change is bad; COVID-19 has also spurred the accelerated adoption of digital technologies, leading to digitalisation of the industry. By enabling providers to achieve better outcomes at lower costs, it is no wonder digitalisation is one of the highest priorities for the healthcare industry today, touching all aspects of healthcare. Surpassing pre-pandemic levels of investment, the industry is investing more and more in digital technologies Healthcare workers during COVID-19 pandemic: an embedded mixed-method study, Healthcare 2021

used for in a variety of areas such as care coordination, telemedicine, customerengagement or enabling a remote workforce. Digitalisation has seen the rise of several key trends, one of which is AI

As digitalisation permeates across all industries globally, an increasing number of companies are using and becoming familiar with the implementation of Artificial Intelligence (AI) in their digital transformation processes – and healthcare is no exception. Building on automation, AI has the potential to revolutionise health systems and help improve the patient’s experience, while alleviating the risk of physician burnout by freeing up

manpower with the automation of repetitive tasks. Simply put, the use of AI can make healthcare systems more efficient and productive. There are a wide range of areas where AI can have an impact: from apps that help patients manage their care themselves, to virtual agents that can carry out tasks in hospitals. Some help to improve healthcare operations by optimising scheduling or bed management while others can be used to improve diagnostic procedures, develop treatment protocols and personalise medical regimes. The medical frontline also continues to be the most critical thread in the fabric of healthcare delivery. The challenges of maintaining high standards of care, despite volatile patient demand and increased infection control requirements, while also ensuring financial viability, will require solutions that go beyond simply the latest and greatest technical specifications. Southeast Asia is at the forefront of AI healthcare innovation, as growing demand for medical services coincides with a surge in health-tech start-ups and investment. Adding to the AI impetus, countries in the region are struggling with shortages of healthcare providers amid rising demand for better healthcare. Southeast Asia is well below the global average on several healthcare metrics: five largest Association of Southeast Asian Nations (ASEAN) countries by population have an average of only 0.8 doctors per 1,000 people, well below the world average of 1.5 2. In Malaysia, we are encouraged to see that public hospitals are starting to pivot towards AI-enabled software for their CT and MR machines. While automating the interpretation of images has captured the imagination, more humble applications that grant better access to quality images with faster processing time are where AI is beginning 2 https://www.mclinica.com/ai-adoption-in-southeastasias-healthcare-systems/

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INFORMATION TECHNOLOGY

to take hold and deliver transformational results today, eliminating a portion of clinicians’ manual work. AI-enabled CT machines, as recently introduced in Thailand and Vietnam by GE Healthcare, can help eliminate manual variations. Achieving a betterquality scan now no longer requires more time in the scanner or physical manoeuvring of the patient on the scanner. When connected to the right departments and devices, AI could be the invisible antidote to countless pain points physicians encounter every day, leading to more efficient and satisfied doctors, happier patients and more patient referral. Unlocking precision health

The use of AI will also be key to unlocking the next major shift in healthcare, which promises to transform how we diagnose and treat disease: precision health. Moving away from a treatment and management approach to one focused on early detection and prevention is a trend we are already seeing take root worldwide. Precision health aims to deliver the most effective treatment tailored to a specific patient at the most opportune time to achieve the best possible

result. This medical model depends on marrying a deep understanding of each person with comprehensive knowledge of all treatment options that might work for that individual, whether at the genetic, molecular or cellular level. It is thought that such tailored treatments could cure debilitating or deadly diseases with far less risk of the serious side effects often associated with more standardised treatments. While up till this point, technology limitations have stymied progress in the field of precision health, new AI tools may now allow the industry to proceed faster than ever before. Healthcare systems in ASEAN need to seize this opportunity to improve their adoption of AI in healthcare over the next three to five years to ensure that healthcare delivery levels remain on par with global standards and customers’ shifting expectations. Challenges in adopting AI

It is to be noted, however, that for an AI solution to be successful, it requires a vast amount of patient data to train and optimise the performance of the algorithms. In healthcare, getting access to these datasets poses a wide range of issues such as patient privacy and the ethics of data ownership to the quality and usability of the data itself. Technology companies, device manufacturers, and other stakeholders are thus increasingly investing in state-of-the-art technology to address this concern, where protecting patient data remains a high priority.

Moreover, there is a notion that AI may eventually replace care providers. There is no substitute for the human touch or years of medical practice. Patients also believe that their medical needs are unique and cannot be adequately addressed by algorithms. In an ideal reality, AI technology and health professionals would work hand-in-hand to create the best possible patient outcomes. To realise the many advantages and cost savings that medical AI promises, care providers must find ways to overcome these misgivings and be more informed on the benefits of AI that can help improve workflow efficiency, aggregate patient data to support their clinical decisions and diagnosis. COVID-19 has also highlighted to clinicians that using modern technology can augment the decision-making process and relieve pressure on healthcare services – something that is going to be critical if we are to bounce back from the pandemic. There are several steps that care providers can take to overcome patients’ resistance to medical Al. For example, providers can assuage concerns about being treated as an average or a statistic by taking actions that increase the perceived personalisation of the care delivered by AI . Having a physician confirm the recommendation of an AI provider can also make people more receptive to AI-based care. A recent study found that people are comfortable utilising medical AI if a physician remains in charge of the ultimate decision. Participants reported that they would be as likely to opt for cardiac surgery where an automated or robotic provider was supervised by a surgeon as they would be to utilise care provided from start to finish by a doctor3. 3 https://hbr.org/2019/10/ai-can-outperform-doctors-sowhy-dont-patients-trust-it

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The AI opportunity in a postCOVID-19 world

analytics in healthcare, it is now possible for healthcare institutions to streamline medical resources allocation4. Healthcare providers will require new solutions motivated by the principles of minimising waste for medical professionals, keeping patients safe, serving patients’ needs and managing costs. When applied in the right way, AI is set to play a key role in the toolbox of healthcare providers and the industry as a whole. From ensuring greater efficiency, better patient outcomes and a stronger healthcare infrastructure, the potential for AI looks bright. The best opportunities for AI in healthcare over the next few years are hybrid models, where clinicians are supported in diagnosis, treatment planning, and identifying risk factors, but retain ultimate responsibility for the

patient’s care. This will result in faster adoption by healthcare providers thereby mitigating perceived risk and starting to deliver measurable improvements in patient outcomes and operational efficiency at scale. True, sustainable digital transformation goes beyond adopting new tools and technologies. It requires a culture change and re-orientation around more data-driven care models. Simply digitalising current processes and procedures won’t be enough; healthcare providers, med tech companies, government agencies, payors and patient advocates will have to work together to sustainably deliver seamless digitally enabled care across a wide variety of care settings. Realigning organisations around data-driven, digitally enabled processes and care models is paramount to the long-term success of healthcare enterprises.

4 https://www.mpo-mag.com/contents/view_onlineexclusives/2020-10-30/how-ai-is-improving-predictiveanalytics-in-healthcare/

AUTHOR BIO

On a larger scale, AI can also provide us with foresight of what is to come, flagging potential healthcare issues early so that countries can take adequate steps to prepare and prevent. Years ago, it would have been impossible to even think of predicting an epidemic before it began, but with predictive analytics, this can be achieved. It is now possible for health organisations to predict infectious disease outbreaks using data such as population density, economic profile, reported cases, and weather reports. With the ever-rising world population, there is also an increasing importance for medical authorities to track the general well-being and health of the population to take timely steps to prevent the rise of chronic diseases when necessary. With the use of advanced algorithms, IT systems, and data processing capabilities, it is possible to produce predictions driven by data within a few seconds without human intervention. AI can be used to reveal patterns across huge amounts of data that are too subtle or complex for people to detect. It does so by aggregating information from multiple sources that remain trapped in silos, including connected home devices, medical records and, increasingly, non-medical data. By comparing an individual’s healthcare records against a database of millions of other anonymised patient records, clinicians have more information to help inform their and their patients decision making and personalise treatment plans. In many regions across ASEAN, especially, the major problem healthcare organisations face – and one of the reasons they suffer poor healthcare delivery in that region – is an imbalance in the distribution and allocation of healthcare facilities and resources, especially across urban and rural areas. With the help of artificial intelligence-driven predictive

Kevin Chiow is responsible for driving the overall go-to-market strategy, growth and profitability for Imaging, Ultrasound, Life Care Solutions and Services in those markets. Kevin joined GE Healthcare in May 2017 as Channel Sales Manager for Malaysia, Myanmar, Cambodia, Singapore, Laos & Brunei. He subsequently took on the Commercial Director role for Imaging portfolio in the same territories.

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BOOKS

Lange: Understanding the Standard of Critical Crisis Care, A clinical approach Author: Ronaldo Collo Go No of Pages: 768 Year of Publishing: 2022 Description: Understanding the Standard of Critical Crisis Care is organized into four sections, covering critical care changes associated with crisis standard of care; health and management issues of specific populations; infectious agents WHO has identified as those that can cause pandemics; and trauma and warfare. You’ll learn how hospitals are transformed to accommodate surges in patients, while dealing with shortages in staffing, medications, mechanical ventilators, and personal protective equipment and get an invaluable look at how real-time critical decision were made during the height of the pandemic. healthcare applications.

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Cognitive and Soft Computing Techniques for the Analysis of Healthcare Data (Intelligent Data-Centric Systems: Sensor Collected Intelligence) Author(s): Akash Kumar Bhoi, Victor Hugo Costa de Albuquerque, Parvathaneni Naga Srinivasu, Goncalo Marques No of Pages: 370 Year of Publishing: 2022 Description: Cognitive and Soft Computing Techniques for the Analysis of Healthcare Data focuses on the cross-disciplinary mechanisms and ground-breaking research ideas on novel techniques and data processing approaches in handling structured and unstructured healthcare data. It also gives insight into various information-processing models and many memories associated with it while processing the information for forecasting future trends and decision making.

IS S UE - 53, 2021

Best Practice in Health Care (Advances in Experimental Medicine and Biology, 1335) Author: Mieczyslaw Pokorski Year of Publishing: 2021 Description: This book aims to disseminate and review the latest interdisciplinary medical knowledge to provide information on best clinical practice for difficult-totreat conditions. The book is dedicated to expanding knowledge in medical care by facilitating communication and discussion across medical disciplines. It is intended for clinical specialists, general practitioners, researchers, and members of all healthcare professions.

Intelligent Systems for Sustainable PersonCentered Healthcare

Assistive Technology Intervention in Healthcare

The Helpers: Profiles from the Front Lines of the Pandemic

Author (s): Dalia Kriksciuniene, Virgilijus Sakalauskas

Author(s): Shruti Jain, Sudip Paul

Author: Kathy Gilsinan

No of Pages: 288

Year of Publishing: 2022

Description: Assistive Technology Intervention in Healthcare focuses on various applications of intelligent techniques in biomedical engineering and health informatics. It aims to create awareness about disability reduction and recovery of accidental disability with the help of various rehabilitative systems. Novel technologies in disability treatment, management and assistance including healthcare devices and their utility from home to hospital is described. It deals with simulation, modeling, measurement, control, analysis, information extraction and monitoring of physiological data in clinical medicine and biology.

Description: Book Description: In The Helpers, journalist Kathy Gilsinan profiles eight individuals on the frontlines of the coronavirus battle: a devoted son caring for his family in the San Francisco Bay Area; a not-quite-retired paramedic from Colorado; an ICU nurse in the Bronx; the CEO of a Seattle-based ventilator company; a vaccine researcher at Moderna in Boston; a young chef and culinary teacher in Louisville, Kentucky; a physician in Chicago; and a funeral home director in Seattle and Los Angeles. These inspiring individual accounts create an unforgettable tapestry of how people across the country and the socioeconomic spectrum came together to fight the most deadly pandemic in a century.

No of Pages: 150 Year of Publishing: 2022 Description: This open access book establishes a dialog among the medical and intelligent system domains for igniting transition toward a sustainable and cost-effective healthcare. The book discusses intelligent systems and their applications for healthcare data analysis, decision making and process design tasks. The measurement systems and efficiency evaluation models analyze ability of intelligent healthcare system to monitor person health and improving quality of life.

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Asian Hospital & Healthcare Management - Issue 53

Articles inside

AI to Identify Cancer Cells by their Acidity

Books

Digitalisation in Healthcare

Data Security in Healthcare

Single Pill Combination for Chronic Hypertension

Pain Management

Tele-rehabilitation

Outpatient Cancer Care

The Pandemic's Pug-Marks

Sustainable Healthcare

Greater Diagnostic and Therapeutic Precision with Technology

Health Challenges Facing the Youth