If you think about food, while we all enjoy a fancy meal every now and then — and gosh, are we spoiled for choice here in the UAE — it definitely is not what most of us want to cook (or eat) on a daily basis. In fact, most would prefer a simple, high quality, seasonal meal that satisfies our palate, pocket and nutritional needs.

In the same way, cutting-edge drugs, surgical breakthroughs and the latest specialised medical equipment might garner the majority of attention-grabbing media headlines when it comes to healthcare, but it’s really the quality of the basic underlying system that makes a tangible difference to improving and maintaining long-term wellness. It may be more mundane and less discussed, but primary care really matters.

Changing the narrative

That being said, primary care is sometimes seen as an unwanted gatekeeper, a place you have to go before you can get through to the specialist you think you really need. In fact, during these days of choice, demand and immediate access — particularly here in the UAE — people often bypass a GP and go straight to a specialist.

However, when you break it down, it’s actually primary care that enables the sustainability of health care systems, contains extortionate cost inflation over time, safeguards responsible medical practice and ensures coordination across a range of medical conditions. In fact, it's a crucial first check mechanism before people get into secondary care. That's why we're now seeing primary care having its resurgence. And COVID-19 is showing us how.

Virtual healthcare

Quality primary care has long been associated with a strong physical infrastructure, and with good reason. How can you fully examine a patient, take blood or administer injections unless that person is in front of you? Nonetheless, there is an argument that advocates against the vast over-provision of the physical infrastructure that we currently have — and it’s a compelling one.

The social distancing and self-isolation that we are enduring as a result of COVID-19 has brought a paradigm shift to many behaviours. One of which is in how we choose to interact with doctors. Virtual care has had its ‘black swan’ moment, and the world has opened its eyes to a new way of medical consultation. Here in the UAE, the DHA and many healthcare providers are offering virtual COVID-19 consultations, while some insurers are offering such services as a new or extended benefit in their insurance package for members. As a consequence, digital consultations have gone up 100s of percentage points, consumers have quickly adapted to the change, and even the medical fraternity has embraced a new way of working. COVID-19 has done for digital health in a month what CTOs, CEOs and entrepreneurs have been trying to do for a decade.

Away from coronavirus, if you cast your mind back 20 years, you may remember that GP appointments were only available Sunday through Thursday, 9am to 5pm. This made life very difficult if you were a full-time employee, a working parent or simply needed a doctor out of hours.

Now consider that more than 60 per cent of primary care can be done without physically touching the patient. Taking a good history, getting vital sign readings and/or conducting a virtual examination can be exactly what is needed for an effective consultation.

It, therefore, makes sense to incorporate more accessible, cheaper, lighter models of delivery into the traditional system, which is precisely what the digital environment enables us to do. In 2020, technological advances mean the potential to access a GP virtually — any time, any day, any place — opens up significantly.

Location, location, location

On occasions when physical provisioning is needed, a second issue to contemplate is where we should be offering it. Again, medicine needs to move with consumer demand. As people increasingly look to home delivery in their shopping, it’s time for us to be thinking about similar models for the delivery of primary care.

For a start, it’s simply no longer practical for primary care to be restricted to limited hours at clinics. Instead, we need to think about expanding the infrastructure to include the most accessible prime retail locations, places with good footfall and extended opening times. As a result, we’re going to increasingly see a real push towards supermarkets and pharmacies offering GP units where you can go in and be diagnosed, treated or be given a prescription for minor illnesses. It’s something that is already widespread in the U.S., for example, where CVS already provide retail clinic services, staffed by nurse practitioners and physician assistants who specialise in family care. These are open seven days a week, and no appointment is needed, offering maximum convenience.

Another strategy is having the capacity to consult digitally but to have an UberEats-type network of technicians to take blood and deliver medicines where it’s convenient for patients. Combining this with the latest digital capabilities such as booking a consultation online or via an app can greatly reduce waiting times for patients.

Investment

The final point to consider in this brave new world is where governments and private organisations should be placing their money. The last five years have been flush with venture capitalists and private equity houses going full speed into the space, and large health corporations ringfencing funds. On the other hand, Governments have been starting to change regulation to facilitate further investment, and there has obviously been fast deregulation to meet the COVID-induced demand, most witnessed here in the Middle East.

In the future, all the signs are pointing to the fact that we’re going to see a lot more private and then public investment into getting primary care right, particularly in countries where this infrastructure has been traditionally lacking. Without this, we as a society are not going to be able to meet our own demand for health care.

In short, there is an urgent mandate to change, and all signs point to a resurgence in primary care.

A new concept bed – the disposable emergency hospital bed engineered to meet the needs of temporary quarantine centres in India – is now available in the UAE and across the GCC.

The low-cost 100 per cent recyclable bed is made from high strength corrugated board, high-performance grade craft paper and is easy to transport and assemble.

“Although the bed is only 10 kgs, it is engineered to carry 200 kgs. It is coated with a chemical that enables it to withstand liquids so the floor can be mopped, and disinfectant can be used,” says Mahesh Kumar of Regent Trading, which has imported the beds. “A lot of thought and ingenuity has ensured it meets the needs of quarantine centres in the current conditions.”

The beds are easy to assemble – the pieces fit like a jigsaw ensuring the structure is sturdy and secure. Instructions are clear and no instruments or tools are required – not even nails or hammers. The design has taken care of aesthetics as well. Varied bright cheerful colours have been used to add liveliness to quarantine centres, to lift the spirits of patients.

Recyclable hospital bed

More than 50,000 beds are in use in India today across 30 cities and over 100 facilities. The manufacturer has received enquiries for them across the world – from Europe, Australia, Africa, and the Middle East. Regent General Trading is the sole appointed agent for the region and has already imported the first consignment of 500 beds.

Recyclable cardboard is particularly relevant to COVID-19 conditions because cardboard stays infected for 24 hours only whilst the virus can stay on plastic surfaces for three days and on metal for four to seven days, according to reports. The fact that it can be easily disposed makes it effective for containing the infection.

The new concept has been recognised by the Prime Minister’s office in India for one of the top 10 innovations during the COVID-19 crisis. The originators and manufacturers of the bed, Aryan Paper Mill, located in the western state of Gujarat, have filed a patent for the product. 

In the current situation, the beds are well suited to quarantine centres and they are fulfilling demand across the world. Once work is normalised, they will be well suited to labour camp fit-outs.

It is important to remember that for consumers, healthcare is an essential need and not a discretionary service like retail goods such as clothing and dining. We can expect to see many changes due to COVID-19 in the coming weeks, months, and even years in how we deliver healthcare. The job of everyone who works in healthcare – not just physician and nurse leaders – is to recognise the need for rapid transformation and having to work tirelessly to make it happen.

Healthcare delivery

The seismic shift to telemedicine

Overnight our children, ages 5-24, from kindergarten to graduate school have become the Zoom-Generation. This is also becoming the “Zoom-Generation” of healthcare (albeit not exclusively through the Zoom platform). With Telemedicine quickly becoming preferred and one of the safest ways we can interact with patients during the pandemic, we’re seeing a rapid cultural shift in providers’ attitudes.

Patients are also embracing it. With social distancing here to stay who would want to go to a brick and mortar clinic and sit close to other patients and risk getting infected if they don’t have to?

Now imagine, a patient who under “normal” circumstances must embark on a 1-hour roundtrip journey and wait for at least another 15-30 minutes to see a provider for 15-minutes. Patients will start to ponder as to why they should go through all of that extra travel time. Telemedicine is here to stay. A certain percentage of patients in areas such as psychiatry, endocrinology (including diabetes), and dermatology are expected to drive the biggest transformation.

Touchless patient interaction is the new norm in ambulatory clinics

There will still be a need and place for traditional in-person ambulatory patient visits. In the next couple of months, this will be stratified and will take shape depending on the patient’s clinical needs. There will be a further transformation in brick and mortar clinics with touchless check-in, drone medicine delivery, social distancing, and many other precautions that will replace current processes that are rapidly becoming outdated. Also, in the not-too-distant future, this will include wearable devices and smart clothing, which have receptors where patient’s vital signs can be remotely measured, and trends observed even before they come into the clinic.

Opportunity to shift inappropriate use of ERs

During the COVID-19 pandemic, most patients with emergency conditions such as stroke and heart attacks, unfortunately, avoided ERs in fear of getting infected. We witnessed ER volumes having gone down, which is a worrisome trend. However, one overlooked aspect is the inappropriate use of ERs by a subset of patients who access this as the only venue of healthcare. In previous years attempts to discourage this pattern of behaviour have largely failed. The COVID-19 pandemic has created a narrow window of opportunity to calibrate patients’ perceptions about ERs allowing us to align these patients with more appropriate venues of care. This will help our efforts for preventive care and population health while at the same time driving down healthcare costs.

The demise of inpatient acute care is overly exaggerated

Although we will be scaling up our ability to give remote care, we will also re-evaluate the decades-long drive to reduce brick and mortar acute care, including hospitals.

We will still need beds, especially in the face of unexpected events such as a pandemic. In the future, hospitals will be driving not toward reducing but toward the ability to quickly scale. Hospitals of the future will have the ability to flex up in beds and ICU capacity with less than a week’s notice. Due to already existing shortages of physicians and nurses, reliance will increase on telemedicine, advanced practitioners, and AI, which will also anticipate the length and type of acute care needed for each patient. Hospital at home concept will also start to mature as a transition from hospital to home.

Prior to this pandemic, we all have known that hospitals are full of sick people and inherently carry the risk of getting infectious diseases. These are collectively called HAIs (Hospital Acquired Infections).

In the midst of fear and uncertainty of the pandemic, however, we have seen an extreme, dangerous avoidance of seeking in-person care due to fear of getting COVID-19. Stroke, heart attack, and cancer patients, in great numbers are neglecting their care. Post COVID-19, we will need to both assure and provide the public with the cleanest and safest environment when they come into a hospital setting to alleviate their worries about getting an infection. Safety and quality of patient care given at any healthcare setting will be even more scrutinised and prised.

Precision medicine will accelerate 3D Printing

Witnessing how easily worldwide and national supply & chains can be disrupted, there will be more on-demand production of materials such as PPEs, implants, and even ventilators using 3-D printing. This will involve obtaining proprietary designs from vendors and producing them on-site. OEM’s way of doing business will change. In non-emergent times, healthcare systems will adopt being able to personalise 3D implants based on a patient’s characteristics. This will allow for the acceleration of precision medicine and even more partnerships with other previously unthinkable industries.

Having been in healthcare for over 21 years, including being on the frontlines as a Neurosurgeon and partaking in roles as a Physician Executive, the discussion here reflects the author’s personal opinions. This is a three-part series which will be followed by Industry Trends and Social Trends.

Omnia Health Live

Dr. Eskioglu will be speaking on ‘Healthcare Transformation – Post COVID-19’ at Omnia Health Live on Wednesday, June 24 at 19:00 GST.  Register for free to join his keynote session - as well as the opportunity to attend 70+ sessions from a host of other leaders in healthcare.  

Anyone hearing the term “blockchain” will be forgiven for thinking it had something to do with a cryptocurrency such as Bitcoin, or a fintech you might want to bank with. In a recent survey, healthcare professionals worldwide ranked it behind other technology trends in importance that included digitalisation, AI, big data, IoT and 3D printing.

Yet blockchain has a growing part to play in healthcare’s evolution. Edward Bukstel is the highly animated CEO of Clinical Blockchain, a Philadelphia startup focused on organising, sharing and securing patient health records through blockchain. Projects he has worked on include blockchain products for workers compensation, medical bill negotiation, and federated learning and authoritative information platforms.

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

With three decades of experience behind him - he started the business after a 30 year background in clinical data integration, data security and communications - he has a firm view of where blockchain is headed.

Bukstel will reveal more at Omnia Health Live, of course, on 24 June when he will be discussing the impact of federated learning and unique secondary medical data silo products using blockchain. 

Related: Omnia Health Live – A virtual expo for the global healthcare industry

There is also the small matter of a pandemic, and blockchain's part in its response and recovery.

Speaking to Omnia Health Insights, Bukstel pointed to telehealth’s rapid rise in recent months, propelled by the COVID-19 pandemic. BlueCross BlueShield, Tennessee’s biggest health insurer, has become the first in the state to make telemedicine permanent. It now values virtual medical consultations and in-person consultations equally - a “tipping point”.

Payers have been holding off for that reason for years, Bukstel said, but this “pushback has crumbled” and there will be a surge in telemedicine services, in mental health especially. Calls to a national mental health hotline saw an 891% increase compared to the year before. Bukstel also suggested Millennials are in favour of telemedicine, although they are more cost-conscious.

Despite this, the interoperability of systems could be a problem. There are national telemedicine platforms, such as MDLive and Teladoc Health, and local platforms. Disconnects exist between the providers and systems involved in patient care.

Bukstel would like to see greater connectivity between telehealth platforms and local providers, and offered as an example Cloudbreak Health, a unified telemedicine platform focusing on the local or rural delivery of telehealth through providing solutions to hospitals nationwide.

But having the capability to share medical records - which includes financial and personal information - between national telehealth platforms and local providers will be absolutely critical, Bukstel believes, and blockchain is the answer to this.

As a distributed ledger technology, blockchain provides the means to transport information efficiently from one telehealth platform to another. Patient control of their own data and consent authorisation will increase patient choice, and ensure that providers have a better clinical picture of the patient. It will also allow data exchanges to be conducted openly and transparently - with COVID-19 impacting many industries, transparency is especially key.

“Battle of the AIs”

Bukstel is also excited about the potential of other technologies. Once telehealth is firmly established, it will lead on to other innovations opening up  - such as the Internet of Medical Things (IoMT), a connected infrastructure of medical devices, software applications and health systems and services.

The true magic will begin when IoMT is combined with AI. Telehealth will have the ability to make “incredible” diagnoses, although how all this is reimbursed remains to be determined.

Bukstel also warned of bias. Different AIs - whether from Google, Microsoft, IBM or Amazon - will be employed by different hospitals, clinics and platforms, who will market themselves accordingly (in a way similar, he suggested, to how providers today tout their MRI as the most advanced). Doctors, too, will have their AI preferences.

For the patient receiving “encyclopaedic analyses” on their individual health conditions from multiple AI sources with built-in biases, it will be especially challenging to figure out. But with blockchain having the ability to interact with different AIs, there is an arbiter which could provide anonymity and lower the bias thresholds.

Omnia Health Live

Edward Bukstel will be speaking at Omnia Health Live on 24 June 2020 on blockchain’s role in COVID-19 response and recovery. Register for free to attend his virtual conference session, as well as hear from a host of other leaders in healthcare.  

With the world on the brink of a mental health crisis due to the COVID-19 outbreak, Synctuition, the most advanced mindfulness, and mind relaxation app backed by well-known scientists and experts, today announces that their platform will be made free to people in 14 countries.

The announcement comes as the company reports a surge in demand and usage over the past few months, becoming one of the top five highest-grossing mindfulness apps globally. The app has now been made available for free from now until 31st July 2020 to the United Arab Emirates, United Kingdom, Ireland, United States, Canada, The Netherlands, Australia, Belgium, Estonia, Finland, Sweden, Norway, and Denmark.

Related: How to protect the wellbeing of healthcare staff in the COVID-19 crisis

Led by veteran tech leaders from Estonia, Synctuition offers free access to the app at a crucial time as the COVID-19 pandemic affects the mental health of people worldwide, with federal agencies and experts warning of a wave of pandemic PTSD and other mental health issues on the rise.

The WHO has warned that in public mental health terms, the main psychological impact to date is elevated rates of stress or anxiety. And as people around the world endure the lasting impact of the pandemic – especially quarantine and its effects on many people’s usual activities, routines or livelihoods – levels of loneliness, depression, harmful alcohol, and drug use, and self-harm or suicidal behaviour are also expected to rise.

Related: Advance Health Webinar – The Importance of Mental Wellbeing During the Covid-19 Outbreak

“We would like to use our platform to build on to keep people feeling safe, supported, and happy. We want to make a difference and provide hope to those seeking a bit of peace, release, and mindfulness in their daily lives,” said Michael Burich, COO, and Co-founder of Synctuition.

“By making Synctuition a completely free, no-strings-attached resource for people, we are giving them a safe space in which to release anxieties and let their spirits soar above all of the daily deluge of heavy news. Studies have shown the positive impact that mindful practices can have on helping combat stress and anxiety, allowing people to focus on the present while increasing patience, tolerance, and imagination.

Developed over 10 years, Synctuition is the world’s most advanced audio relaxation program. Backed by 106 scientific studies, Synctuition has already reached 4 million users. Whilst being entirely self-funded, the platform has become the third biggest mindfulness app in the US since launching 18 months ago.

Dr. Prudence Hall, an author, and Synctuition mental health advisor, helped the development team create a rich mind relaxation and entertainment experience. She said: “Being a part of the development of Synctuition was such a unique experience — incorporating so many disciplines and striking a balance of scientific studies and mindfulness modalities. For listeners to be completely transported to a different world in just 25 minutes could truly transform their state of mind and improve mental health. Personally, integrating the program’s journeys into my own self-care regimen has brought me peace and serenity throughout the current lockdown on numerous occasions.”

Urmas Reinsalu, the Estonian Minister for Foreign Affairs, sees Synctuition as a vital tool for the current time. He said: “I’m proud that Estonia is leading the way in developing so many different technologies to combat the challenges of the current time, and one of the most pressing of these challenges is the mental health crisis. People are struggling to cope with the effects of staying indoors, and people are worried about spreading the virus if they do go out, and their recent research has shown that people are very concerned about their loved ones and their friends. It is vital that people are given all the available materials to help them deal with the stress and anxiety they are currently feeling, which is why Synctuition’s global announcement today is so important.”

You can find out how to download the app for free here: https://synctuition.com/24hpositivity/uae

Pharmax Pharmaceuticals and Cipla Limited have established the UAE’s first state-of-the-art inhaler and nasal spray testing laboratory at Dubai Science Park to increase the availability of asthma medication in the local and regional markets.

The launch of the pMDI (pressurised metered-dose inhaler) centre is in line with the directives of His Highness Sheikh Mohammed bin Rashid Al Maktoum, Vice President and Prime Minister of the UAE and Ruler of Dubai, to build a post-COVID-19 economy focused on sectors such as healthcare and pharmaceutical manufacturing.

Related: Marwan Abdulaziz, the catalyst putting Dubai on the healthcare innovation map

The cutting-edge centre will carry out sophisticated testing, providing the UAE and the wider region with access to locally-produced, high-quality medical products for respiratory diseases from Dubai Science Park – a hub for medical innovation that is home to over 350 companies and 3,600 professionals across the life sciences, energy and environmental sectors.

With respiratory diseases considered among the ‘big four’ health burdens in the UAE that have been exacerbated by the onset of COVID-19, the exclusive partnership is timely and relevant.
 

Related: Advance Health Webinar – The Importance of Mental Wellbeing During the Covid-19 Outbreak

Marwan Abdulaziz Janahi, Managing Director of Dubai Science Park, said: “We are pleased to see our business partners Pharmax Pharmaceuticals and Cipla leverage the advanced infrastructure within our community to establish a world-class testing facility to develop affordable medication for respiratory diseases.

The decision supports the vision of the UAE leadership to enhance the healthcare industry’s competitiveness and productivity through improving the quality of existing systems and deepening our expertise in areas such as pharmaceutical manufacturing. It will also elevate Dubai Science Park as a regional hub for medical innovation, and significantly increase our ability to attract talent and investment as we work together to build a sustainable post-COVID-19 economy.”

Nishant Saxena, CEO, International Business (Europe & Emerging Markets), Cipla, said: “We are pleased to collaborate with Pharmax Pharmaceuticals to reinforce the UAE’s respiratory health ecosystem, and provide patients with access to best-in-class medication and medical equipment. This development emphasises our commitment to introducing first to market technology to the UAE.

At Cipla, it is our constant endeavour to leverage our expertise in the respiratory and lung domain to serve unmet patient needs globally. In the context of the COVID-19 pandemic that has highlighted the urgent need to strengthen the healthcare infrastructure, we will continue to explore multiple avenues through which we can improve the quality of respiratory care available in the UAE.”

For his part, Madhukar Tanna, CEO of Pharmax Pharmaceuticals, said: “Under the prevailing circumstances, a lab of this kind, accredited by the Ministry of Health and Prevention, will significantly expand the UAE’s capability and credibility to localise the manufacturing of high quality affordable products for respiratory diseases. This has been made possible through our active synergies with Cipla and as a result of the Ministry’s pragmatic and enabling policies.

I am pleased to share that we have also invested in a sterile testing facility that will oversee the formulation of respules to treat asthma and similar respiratory conditions. This will help both companies offer the most advanced treatment options to respiratory physicians and patients in the UAE and the wider region.”

The UAE Ministry of Health and Prevention awarded the fully equipped pMDI laboratory the Good Manufacturing Practice approval that enables both companies to commence testing immediately.

Under the agreement, Cipla will transfer its expertise in the respiratory disease space to Pharmax Pharmaceuticals. The companies will jointly work to launch respules that can be used to treat asthma and other respiratory diseases.

Glaucoma is the second leading cause of blindness worldwide and the number one cause of irreversible blindness. It is a chronic eye disease in which increased pressure in the eye can lead to damage of the optic nerve resulting in gradual loss of vision – it accounts for more cases of irreversible blindness than any other eye disease.

However, the condition is treatable, and blindness can be prevented through early diagnosis. Although children and young adults can be affected by glaucoma, high-risk groups include people over 40, diabetics and those with a family history of glaucoma.

“Glaucoma is one of the UAE’s leading causes of blindness,” says Dr. Mohammed Sohaib Mustafa, who is a consultant ophthalmic surgeon and specialist in glaucoma and cataract surgery at Moorfields Eye Hospital Dubai.

Diabetes and risk of glaucoma

Among many factors, age, genetics, and uncontrolled diabetes, which is quite common in the UAE, are leading risk factors for glaucoma. Old age is not only a risk factor for the diagnosis of glaucoma but also its progression. Patients over 60 years old are six times more likely to develop glaucoma. Additionally, genetics is a considerable risk factor for glaucoma. Some patients are predisposed to certain kinds of glaucoma, which can increase their risk of developing the disease by about 45 per cent. Among these factors, diabetes is the most manageable factor.

“Uncontrolled diabetes puts added pressure on your eye, which can damage the retina and the optic nerve, the main eye nerve for sight, doubling your odds of developing glaucoma,” Dr. Sohaib explains.

The main type of glaucoma associated with diabetes is Neovascular glaucoma, a severe form of acute glaucoma attack, which arises when poor circulation related to diabetes causes abnormal blood vessels to grow inside the eye.

“Our team in Dubai and abroad are working diligently on breakthrough technology and research to help better understand the development of glaucoma - its symptoms and the risks associated with it. However, our key recommendation for patients is to receive regular eye checks, as early detection can prevent vision loss and reduce the progression of the disease,” he adds.