Smart solutions: Rapidly evolving technology presents opportunities to improve patient care and overcome challenges

Across the Gulf public health authorities and private institutions are investing in smart technologies to improve patient care. Data collection, sharing and analysis, DNA-driven research on precision medicine, and distance consultation and diagnostics are already being implemented in some areas of the GCC. The region’s hydrocarbons wealth is also being used to support the latest research and the commercial development of solutions for both medical professionals and patients.

Meanwhile, the Covid-19 pandemic will be a major factor in budgetary considerations in the short term, as GCC countries identify solutions to successfully respond to the crisis and address gaps in supply.

SPENDING: According to the most recent available data from the World Bank, in 2017 per capita health care spending in GCC countries ranged from $588 in Oman to $1529 in Kuwait, where generous government allowances have been used to fund treatment abroad for many citizens. Bahrain, the UAE and Saudi Arabia spent $1127, $1357 and $1093, respectively.

COVID-19 RESPONSE: In March 2020 the Saudi Food and Drug Authority was quick to expedite the import, approval and distribution of personal protective equipment, testing kits and N95 masks in response to the spread of the Covid-19 virus. By the end of that month the UAE’s Ministry of Health and Prevention (MoHP) reported that it had carried out more than 220,000 laboratory tests for Covid-19, or around 22,900 tests per 1m people – the second-highest testing density in the world.

In Abu Dhabi’s Masdar City, a laboratory capable of conducting tens of thousands of tests daily was built from scratch within a period of two weeks. Furthermore, in Bahrain and Dubai health care regulators introduced new rules permitting medical practitioners to practise remote, digital consultations. In Oman, meanwhile, the government created 22 isolation centres in Muskat are capable of accommodating 3000 people. By early April 2020, 583 patients in these centres had become healthy enough to return to their homes.

In Kuwait 746 citizens had been released from institutional quarantine by April 13, 2020, and were subject to a further 14 days of mandatory isolation at home. At that time Kuwait reported 66 new cases, including 26 people in intensive care with nine in critical condition. Of the 66 new cases, four were believed to have contracted the virus while travelling and 51 had been in contact with a previously infected person. By mid-April there were two fatalities and 1300 recorded cases of the virus.

TELEMEDICINE: The 2020 Covid-19 health crisis may have put telemedicine in the spotlight, but the region has long recognised the potential for remote consultation and diagnostics. In 2014 Abu Dhabi’s private investment vehicle, Mubadala Investment Company, signed an agreement with Switzerland’s Medgate to create Abu Dhabi Telemedicine Centre (ADTC). ADTC provides call centre services to two of Mubadala’s other health care investments, Healthpoint Hospital and Capital Health Screening Centre, and in early 2020 extended this offering to include the Imperial College London Diabetes Centre in Abu Dhabi. In addition, in early 2020 Mubadala’s Cleveland Clinic Abu Dhabi successfully established an online health portal that allows patients to attend virtual visits with physicians, track their prescriptions and receive information on test results.

In Bahrain licensed medical company Skype Telemedicine Solutions provides remote radiography, demonstrating how hospitals and health authorities can navigate around regional shortages of some health skills in order to improve patient services.

In neighbouring Saudi Arabia, the country’s large size makes telemedicine an attractive option. “There are various channels to cater to rural and more remote areas outside the main health centres,” Tarek Al Kasabi, chairman of Saudi Arabia’s Dallah Healthcare, told OBG. “Telemedicine has improved dramatically in recent years thanks to wider availability of a number of new technologies.”

ARTIFICIAL INTELLIGENCE: In the UAE, the telemedicine concept looks set to be taken a step further. In January 2020 at the Arab Health 2020 exhibition in Dubai, MoHP and telecoms provider du signed a memorandum of understanding (MoU) to develop the region’s first virtual hospital. The institution is set to include telemedical services, online prescriptions, remote health care monitoring and electronic claims processing.

“This is part of the ministry’s strategy to harness artificial intelligence (AI) technologies to meet the needs of patients; support decision-making processes; monitor patients’ conditions remotely; provide preventive health care; and reduce health care costs,” Mohammad Salim Al Olama, undersecretary of the MoHP, told local media in early 2020.

In February 2020 the Dubai Health Authority (DHA) opened its Smart Salem fitness screening service for expatriate workers. The service uses AI to improve and streamline its procedures, allowing the Smart Salem centre to conduct medical checks – prerequisites for work visas – in just 30 minutes, and giving it the capacity to handle up to 150 appointments daily. Each appointment includes a blood test, and chest X-rays with AI-powered analysis that can detect tuberculosis in seconds.

DATA DEVELOPMENTS: Alongside advances in diagnostic applications and screening, the digitisation of medical records and the development of secure, efficient channels to disseminate patient notes are being introduced in many parts of the GCC. For example, the Abu Dhabi Health Information Exchange, known as Malaffi, was developed as a public-private partnership between the emirate’s Department of Health (DoH) and ICT services provider Injazat, a subsidiary of Mubadala. The Malaffi system was adopted by its first four health care providers in July 2019, and in October 2019 Danat Al Emarat Hospital for Women and Children, HealthPlus speciality centres and Kanad Hospital also connected to the system. The aim is to roll the Malaffi system out to all public and private providers in Abu Dhabi, creating a centralised and secure database of patient records in the emirate. Such a database would give health care providers a clear, real-time track record of patients’ medical histories. As the number of connected providers grows, this data will become increasingly valuable.

“Currently we have 53m unique clinical records in Malaffi, and that number is increasing. Applying advanced AI analytics to this data will provide insight to help Abu Dhabi’s DoH make better decisions,” Atif Al Braiki, CEO of Malaffi, told OBG. “Digitisation of the market, in the end, is inevitable.”

PRIVACY CONCERNS: However, rapid advancements in data technology can present challenges to regulators and national government agencies concerned with protecting patient privacy. For example, the UAE recently introduced Federal Law No. 2 of 2019 to regulate the use of IT and communications throughout the health care sector. According to PwC, the new law was the country’s first piece of federal legislation to directly address data protection principles, but free zones such as Dubai Healthcare City, the Dubai International Financial Centre and the Abu Dhabi Global Market had already introduced data protection regimes.

CHRONIC DISEASE RESEARCH: A number of specialist centres have been founded in the GCC to study the prevalence of specific medical conditions in the Gulf’s population. In February 2020 the DHA and researchers from New York University Abu Dhabi launched the UAE Healthy Future Study, which aims to recruit approximately 20,000 volunteers to participate in a research project focusing on some of the chronic diseases that are most common the UAE and the rest of the Arab world.

The Centre of Excellence in Genomic Medicine Research at King Abdulaziz University in Jeddah has a specific focus on genomics. Its researchers are studying areas such as infertility, congenital malformations, consanguinity and the potential to develop personalised medicine (PM). Health care providers throughout the GCC could use genetic profiling in tandem with PM to tailor treatment solutions for patients, using AI and data analysis of their genome profiles, and medical history to improve the efficacy of treatment.

MEDTECH: GCC countries are also helping to attract investments in medical solutions by continuing to support scientific start-ups. In March 2020 local media reported that precision medical company P4ML, which was offering PM solutions with a focus on the prevention of stillbirths, was one of the international companies invited to participate in the Dubai Future Accelerators Programme. The programme aims to bring new technological developments to the UAE in a number of fields every year, and the DHA has expressed interest in the work of companies participating in its latest round.

The DHA has worked in partnership with the programme since 2016, when it challenged innovators to use genomics, analytics, telepresence and personalised medicine to create solutions for Dubai’s population that would enhance diagnostic speed and effectiveness by a factor of 10. MoUs have since been signed with three companies – Dubai-based research and consulting firm Medativ, cyber industrial engineering company Honeywell, and research lab and design studio Vinaya – to proceed with the development of 3D printed medical applications, home health care solutions, and wearable technology to monitor health and wellness.

The DHA’s challenge in 2017 was for companies to find ways to use digital technology to improve patient outcomes and encourage self-management of chronic conditions. Another four companies participated in the second round of the programme: HealthShield proposed a mobile device to identify and monitor cardiovascular disease; Photothera Labs suggested solutions using photoluminescence and OLED lights to treat jaundice in newborn babies and sleep disturbance in diabetic adult patients; ArcSecond put forward technology using motion capture in wireless wearable technology to provide real-time data on motor function in patients; and ASG Medical Systems developed booths to be used for remote diagnostics and consultations.

TRAINING: Although new technologies may provide innovative treatments, some health care providers in the region caution that in the short term the most important investment will be in training more citizens to become health care professionals. In January 2020 the DoH in Abu Dhabi published its most recent Capacity Master Plan, which forecasts future demand for medical facilities and professionals in the emirate. The plan identified a significant increase in demand for a range of medical skills and specialisations in the decade to 2030. From 2020 to 2030 demand for many full-time equivalent posts is expected to grow. These include: radiographer positions, from 124 to 1856; physical therapists, from 341 to 1568; ambulance paramedics, from 431 to 979; occupational therapists, from 351 to 837; and social workers, from 428 to 817.

GULF HEALTH PROFESSIONALS: The GCC faces staff shortages in certain medical specialties due to a lack of regionally trained professionals. There is notable room for growth in the areas of physiotherapy and occupational therapy, which are lacking in professional education opportunities. An increase in the availability of continuing professional development courses for medical staff across the GCC would likely help the region begin to address these shortages over the medium term.

Nevertheless, according to Oman’s Ministry of Health, significant strides have been made in attracting national citizens to medical careers. From 1990 to 2019 Omanisation rates rose from 9% to 41% for physicians, and from 12% to 62% for nurses. In 2018 the DHA reported that 20% of doctors and 10% of nurses in the emirate were nationals, with 287 Emirati physicians and 44 Emirati nurses working in its hospitals and primary health clinics.

Data from Saudi Arabia’s General Authority for Statistics shows that in 2018 there were 27,990 Saudi physicians, representing 32% of the country’s 88,020 doctors. Around 17,820 doctors in the Kingdom were male and 10,170 were female. Meanwhile, some 38% of the country’s 184,490 nurses were Saudi, with 43,670 female nurses and 27,030 male nurses. Attracting and retaining a greater number of Saudi citizens to these roles and allied medical professions is a key area of focus for the country’s hospitals and health care authorities.

As of 2019 there were 139 schools in the GCC providing professional training in medicine, nursing, pharmacy, dentistry, midwifery and other medical professions. In addition, many students from GCC countries study abroad for medicine and health-related degrees. In 2018 there were 20,930 Saudi citizens studying medicine and health outside of the Kingdom, and around 2390 Saudis graduated from medical courses at international universities in that year. In order to successfully meet the forecast demand for medical professionals across the Gulf, the challenge will be to persuade a greater number of young people from the region to follow in the footsteps of the most recent medical graduates.

Supporting already qualified staff is the trend of technological innovation in the health care sector. Technology can automate tasks in the back office to save time and costs, while for front office tasks, technology will provide tools to assist professionals but not replace them because personal attention is regarded as key to effective care administration.