A new initiative to use advanced technology aims to reduce the need for patients to travel to specialised hospitals for treatment. Smart medicine encompasses a wide variety of technologies to deliver virtual medical and health services. For example, a hospital patient can consult with doctor, ask for second and third opinions from specialists located on the other side of the globe, and receive a diagnosis and medication disbursed by a robotic pharmacy. What might once have been dismissed as science fiction, became a reality in Dubai in 2017 with the adoption of many of these pioneering techniques to improve patient care, efficiency and costs.
The Dubai RoboDoc initiative is due to be rolled across Dubai Health Authority (DHA) facilities after a pilot project involving trials at Hatta Hospital’s emergency room and DHA primary health care centres in Al Barsha and Nad Al Hammar was completed in March 2017. All three departments are linked to the Rashid Hospital Trauma Centre (RHTC) and Dubai Hospital allowing quick access to specialised care and reductions in transfer time.
The technology being used by DHA has been provided by InTouch Health, a global network based in California, which supports 200,000 annual “physician encounters” with patients at 1500 medical centres and hospitals around the world.
Authorities in Dubai expect telemedicine to grow rapidly in the future, citing a study showing annual consultations for one health system in the US were expected to grow from 350,000 in 2012 to 7m in 2018, and another US clinic reporting its consultation costs had fallen from $95 to $45 following adoption of the technology. “Telemedicine is the way forward in many ways. It ensures immediate access to specialised consultation, which is particularly helpful in emergency situations. It also reduces the transfer of patients to [the RHTC] and helps enhance the functioning of other DHA emergency departments and intensive care units,” Dr Moin Fikree, medical director at the RHTC and head of the DHA’s RoboDoc Initiative, told local media.
Another effort supporting smart medicine is the advancement medical 3D-printing technology. Under its Dubai 3D Printing Strategy, the emirate aims to encourage the take-up of the technology in the medical field and promote itself as the global centre of 3D printing technology by 2030. In what was reportedly a first for the MENA region, two recent operations confirmed the possibilities for this kind of modelling as an aid to surgeons embarking on complex or unique operations.
Doctors at Dubai Hospital successfully removed a kidney tumour after having a model of the kidney and tumour created using 3D-printing technology. After examining the 3D model, the operation was completed successfully in three hours, rather than the five hours typically required for the procedure, and the patient made a full recovery.
In July 2017 surgeons once again requested a 3D model to be printed prior to a complex neurosurgery to treat a patient suffering from bleeding in the brain. An X-ray revealed the patient had suffered a cerebral aneurysm in four veins. Doctors at Rashid Hospital, said that having the 3D model was a vital resource. During the six-hour operation doctors were able to reduce the dilation in the veins after having practised on a model produced by Dubai-based 3D-printing company 3Dvinci Creations.
“Due to the complexity and rarity of the patient’s case, we needed a 3D model that would allow us to understand exactly how we could reach the arteries in a safe way.” Dr Abdullah Qasim, head of neurosurgery, told local media. “This helps us reduce risk because we [couldn’t have imagined] the problem without the 3D model,” he added.
The first of DHA’s robotic pharmacies opened at Rashid Hospital in 2017. With a storage capacity of 35,000 medicines, the automated dispensary is capable of filling 12 prescriptions per minute. The pharmacy reads electronic notes submitted by the hospital’s medical staff and selects the correct dosage and medicine using internationally recognised GS1 barcodes. The paperless system means there will be fewer mistakes caused by handwriting errors and that pharmacists will be free to give better counsel patients. All pharmaceuticals companies supplying DHA are required to provide medicine with the barcodes so that the smart pharmacy system can be implemented.
In 2017 the DHA was set to complete the transformation of the emirate’s patient records to a paperless system. “Digitisation allows for better patient experience, making it easier to be more proactive with health care services and prevent illness,” Michael Schelper, general manager of Cerner Middle East and Africa, told OBG.
The roll out of the technology began at the end of January and was due to be completed in November. More than 1.4m patient records and 112m transactions had been transferred to the Salama programme before the process of training more than 11,000 DHA staff members began.
The system bundles together 25 separate applications in one interface, enabling medical staff across different hospitals and clinics to access data quickly. It is designed to ensure there is a clear continuum of care for individual patients and to help cross-reference medication and allergy data. “Digitisation is especially important for lifestyle diseases such as diabetes, hypertension and obesity, all of which are prevalent in the region,” Schelper told OBG. The Salama system will issue real-time alerts, warnings and flags to draw attention to changes in the patient’s medication or condition.
The Network and Analysis Backbone for Integrated Dubai Health is designed to enable patient data to be exchanged between different health information systems deployed in Dubai. The wider public health awareness system currently being used by DHA is Hasana, which was designed to monitor big data and help decision-makers to control and prevent the spread of viruses and contagious diseases.
People living in Dubai are also able to use a growing number of health care apps. There is the Tifli app, which is designed by DHA to help parents make more informed choices. The app will help parents track the stages of pregnancy at weekly milestones right up to labour. Tifli also allows users to schedule or reschedule appointments with doctors, and it also enables prospective parents to access videos and articles offering advice from pre-conception, to the different stages of pregnancy, until an infant is two years old.
Other apps include the TummyFish app, which is designed to make drinking water more fun for children and uses interactive tools to help parents and children monitor their daily fluid intake; and the Hayati app, which is designed to help people with Type 1 and Type 2 diabetes monitor their condition by measuring glucose levels and monitoring medication, body mass index and blood pressure. Users are given reminders to take their medication and advice on how to keep a medication diary.
As part of Dubai’s drive for smart government, and in keeping with the innovation goals of the Dubai Health Strategy (2016-21), technology is also being used in the screening of prospective residents of the city. All expatriates applying for a visa to live, work or study in Dubai must take a medical fitness test, including blood tests and X-rays. From August 2017 onwards the certificates issued after satisfactory tests were being forwarded to customers and employers electronically from 40 different printing centres.
The system is also being implemented in phases at a number of medical fitness assessment centres. Although the number of tests taken by expatriates fell by 7.5% in 2016, DHA data gives some sense of the scale of the electronic issuance of certificates. In that year 1.9m medical fitness tests were conducted at 18 testing centres across Dubai, with one centre, Al Muhaisnah, performing half of all check-ups.
With an increasing volume of data about Dubai’s residents being gathered and shared, the emirate is also taking a number of steps to bolster cybersecurity. DHA’s Information Security project is in line with the Dubai Cyber Security Strategy launched by Sheikh Mohammed bin Rashid Al Maktoum, vice-president and prime minister of the UAE, and ruler of Dubai.
The DHA’s project includes information gathering, security analysis, risk assessment, business continuity and internal audit. The DHA’s board has created a monitoring and evaluation committee to ensure robust system-wide measures are implemented. By the end of 2017, 10,000 DHA staff will have been trained in data handling and security protocols.
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