For some time now, consultancies and think tanks have been predicting a radical shift in healthcare. Powered by technological advances, the future is expected to be drastically different where the needs of healthcare organisations take a back seat and the patient becomes front and centre. People will demand patient-centric, preventive and precision care and expect the same level of personalisation they receive in other areas of their lives, say entertainment.
How prepared is the healthcare industry to realise this grandiose future?
Jan-Schmitz Hubsch, Partner with Strategy& Middle East, part of the PwC network, says the UAE has significant potential to offer personalised care, with many of the required enablers either already in place or being established. “One of the requirements is to have integrated and granular patient data, which has been built up over the years through electronic medical records.” He points to Department of Health — Abu Dhabi’s Malaffi, the centralised database of unified patient records that allows for real-time exchange of health information between healthcare providers. Weqaya, the comprehensive screening programme for UAE nationals aged 18 and above, and the ongoing Emirati Genome Program led by AI and cloud computing company G42 for generating genomic data are all putting together valuable information.
One of the requirements is to have integrated and granular patient data, which has been built up over the years through electronic medical records.
Although technology — especially with the power of AI and Internet of Things — has the means to “redefine healthcare from hospital-centric sick care to patient-centric health care”, Dr Satish Rath, Group Chief Officer For Innovation and Research, Aster DM Healthcare, believes it would take some time for a comprehensive, coordinated and personalised preventive care to emerge in the country.
“When we talk about coordinated care, hospitals have to build a patient profile, a predictive journey and proactively try to serve them without the need of the patient to visit the hospital, which is basically predictive, proactive primary care,” he explains. “The biggest challenge here has been the overdependence of hospitals on electronic medical records, which have been developed for intra-hospital coordination; that is, for the health workers and not the patients.”
The biggest challenge here has been the overdependence of hospitals on electronic medical records, which have been developed for intra-hospital coordination; that is, for the health workers and not the patients.
But personalised care is only possible when you understand patients’ needs and preferences along with their clinical profile, says Hubsch. That requires healthcare providers to go beyond the one-size-fits-all approach and capture all relevant patient information.
Right now that’s out of most providers’ reach. Data-sharing barriers still exist even as health information exchanges such as Malaffi and Dubai Health Authority’s Salama break them down.
Disconnect in care
Moreover, there is a disconnect between people’s health and the care they receive, says Dr Mohamed Al Rayyes, Senior Physician Executive — Middle East and Africa at Cerner.
“The health of the population is not only determined by the care provided within the four walls of hospitals and clinics but also by their social determinants of health, lifestyle and daily habits that impact the quality of their health far more than any single encounter with a clinician,” he explains. “Where does that type of data sit right now? It’s in our wearables, it’s on our smartphones, it’s in our bank accounts and spending behaviour, it’s even in our social network interactions. It is everywhere but the medical records.”
The health of the population is not only determined by the care provided within the four walls of hospitals and clinics but also by their social determinants of health, lifestyle and daily habits that impact the quality of their health far more than any single encounter with a clinician.
Talking about that data raises concerns about privacy. But Dr Al Rayyes says that technological tools are already available to anonymise personal data for strategic decision-makers. Protection mechanisms can be put in place to keep others from accessing private data while people reap the benefits of personalised insights. “While you find such practices accepted as a standard in other regional industries, like banking, we are still facing strong resistance in healthcare.”
However, many hospitals in the UAE are tapping into available data to provide coordinated care. “Data mining, robotic process automation, AI and natural language processing are areas of focus that we believe will lead to personalised care within the hospital and outside,” says Sumit Singh, Chief Information Officer at VPS Healthcare.
Meanwhile, Aster is building a databank that can provide insights on digital twin profiles of patients, which can help offer personalised preventive care. “We have a vision of being a wall-less healthcare provider without legacy complexities, where patients can access required services through a digital window — their smartphones — which will be a single window for coordinated comprehensive service,” explains Dr Rath.
Taking a cue from the US Food and Drug Administration’s advocacy for setting up centres of digital health excellence at hospitals, Aster has also established a clinical simulation lab to pilot digital health solutions and gather evidence. This is in addition to embarking on anonymising its databank, which is a resource-intensive affair. “In collaboration with big tech majors we are working on highly futuristic solutions where data can be made available for AI model development in a relatively faster manner keeping privacy intact. Regulatory authorities should look into the need of these kinds of solutions and encourage policy formation through grant and public-private participation.”
Hubsch takes it a step further and emphasises the importance of aligning and coordinating efforts of all stakeholders to advance personalised medicine — from regulators, leading providers, pharma/life sciences to medtech companies, start-ups and tech players. “To orchestrate these more effectively, a national precision medicine agenda can be beneficial, clearly laying out roles and mandates of different players. It will also be important to further build partnerships with international players, both in the life sciences industry and the academic and research space. Globally, personalised medicine is most advanced where regulation, industry and academia work seamlessly together.”
He also strikes a note of caution about expectations. Since one of the promises of personalised medicine is better patient outcomes, providers will have to be ready to accept increasingly outcome- and value-based payments, he says. This means moving away from the current model of getting paid for everything that is being provided to patients to accepting the financial risk related to clinical outcomes.
“It is also important to remain realistic about the near-term potential of personalised medicine — while breakthroughs have been made and will be made, the immediate clinical and commercial potential is not yet significant,” explains Hubsch. “Patience and long-term commitment are therefore of essence.”