- February 23, 2024
Digital Health in the GCC
I- Overview
- Presentation
E-health, fusion of technology and healthcare, is transforming the way we approach prevention, diagnosis, treatment, and management of diseases. By benefiting from developments in information technologies (IT), e-health includes a wide range of innovations such as mobile health applications, wearable devices, telemedicine, medical data analysis and storage. It eases access to care, personalizes treatment based on individual data, improves communication between patients and healthcare professionals.
However, this digital transformation raises crucial questions about ethics, data confidentiality and safety. It may also cause reluctance from patients or healthcare professionals. Its future is promising, however, if this technology is used wisely within a moral, ethical and legal framework. Technology is valuable as it does not replace healthcare professionals but rather let them focus on higher value-added tasks.
Progress in artificial intelligence (AI) and medical data analysis should enable not only more accurate diagnoses, but also proactive and personalized disease management. Healthcare systems could become more efficient thanks to a better care coordination and the digitalization of administrative processes.
- Aims of the current insight
This article is deliberately brief. It presents an overview, with no in-depth analysis at this stage. Examples are presented in a purely descriptive manner. Aims are therefore :
- General presentation of e-health
- Presentation of some applications
- Presentation of e-health in the Gulf region and its potential
- Opportunity presentation: matching specific regional problems with new technology solutions
- The eight pillars of e-health
- Electronic Medical Records (EMRs) are real-time, patient-centric records that provide immediate and secure information to authorized users. These folders can be stored locally or in the cloud.
- Telehealth (t-Health) or telemedicine involves health services provided remotely – as remote diagnosis, clinical monitoring and operations.
- M-Health is the use of mobile technologies to support health information and medical practices. It is a key point to improve access to care for all, especially when combined with t-health.
- The Internet of Medical Things (IoMT) is a set of connected devices dedicated to the continuous monitoring of patients and healthcare facilities.
- E-learning refers to the use of technology and electronic media for training and education. It facilitates access to learning in remote locations or those lacking sufficient local training facilities.
- Social networks refer to online communication channels that are mostly informal and society oriented. Through social media, healthcare providers can share information and educate people.
- Health data analytics is the transformation of data with the aim of providing information and evidence for decision and policy making. The term “big data” is a general term that refers to much larger and/or more complex data sets than what traditional data processing can support, leading to data-driven predictive medicine.
- Strong legal frameworks for health, whether delivered in person or through IT, play a major role in the providing of quality health services. The benefits of eHealth are based on overall acceptance of users.
- Summary
Traditional healthcare model | New digital health model |
Paper-based | Digitalization/Disruption |
Physician cantered | Patient cantered (engagement) |
Independent | Integrated |
Security | Trust |
Sedentary – Presential | Mobile – Remotely |
II- Possibilities
- Examples of applications
Game-changer milestone : the COVID 19
The COVID-19 pandemic catalysed the rise of e-health. The quick adoption of telemedicine and virtual consultations has transformed healthcare delivery, ensuring continuity of treatment while limiting physical contacts. Electronic prescriptions have increased, facilitating access to medicines. Electronic pre-authorization tools and medical communication platforms have raised significantly, optimizing care coordination. The need to process to huge number of tests while issuing secured and authenticatable results in limited time (less than 24 hours for travels) has highlighted the relevance of digitalization. COVID-19 has accelerated the digital revolution in healthcare.
How AI can enable greater proactivity in public health
AI and big data are particularly well-suited to public health screening campaigns, such as diabetic retinopathy (DR). This is one of the leading causes of blindness, particularly in countries where diabetes prevalence is high (20% of the population of Gulf countries suffers from diabetes).
Mass screening for DR can be set up in public places (malls, schools, stadiums, beaches, etc.) with one operator using a mobile retinography camera. Images are then submitted to AI, which can provide – thanks to a mass analysis – results of patients requiring a visit to an ophthalmologist. Others can then free up slots for those in need. And the ophthalmologist only treats important cases.
Evolution of DR, as with many degenerative diseases, depends on the stage of diagnosis and the speed of treatment. Early detection increases chances of avoiding vision deterioration. And this treatment is less costly for the public finances.
Some AI solutions already exist, are CE/FDA certified and on the market. However, their use is limited to institutions, and not yet in public health.
Digital health as a support to hospital managers – Example of the quality system
Each country has its own accreditation procedure. This requires to implement a quality system covering all areas of operational management and all the departments or units of a care centre. The best-known accreditations are JCI (US), NSQHS (Australia), Accreditation Canada and HAS (France). Most of these certifications are issued from ISQUA (International Society for the Quality in Healthcare) and therefore share many similarities.
Quality monitoring requires collection and analysis of numerous key performance indicators (KPIs). This is usually done manually by healthcare facilities’ quality managers. Declarations and reports made by the teams are often in paper form, implying storage and misplacement problems. However, new information systems and EMR collect most of these KPIs natively or could do so with a simple set-up. It is also possible to report on any workstation in the hospital, using the latest version of the form. In this way, data collection and user-friendly dashboards are immediate and permanent. Coupled with a simple AI, analysis is highly simplified.
Once again, the system does not replace the quality manager but removes laborious tasks with high risks of error, letting him to focus on the implementing of improvement plans.
How AI could have boosted critical care capacity during COVID 19
Covid crisis has put a strain on intensive care units (ICU):
- Demanding in terms of human resources and equipment
- Many countries approaching maximum capacities
- Usually: 1 nurse is needed for 2.5 intensive care patients
Human resources are by far the limiting factor (ahead of respirators, contrary to popular belief). A.I. can provide a relevant solution:
- AI can monitor a greater number of vital parameters, much more rapidly while proposing an interpretation – alerts are transmitted in real time
- AI is not subject to tiredness
- Repetitive monitoring tasks can be automated
- Saves time in patient care
- Notifications can be sent just in case
- Limits contact with contagious patients
- Reduced costs for staff protection and sterilization equipment, as most of the monitoring is carried out by the AI
- Staff can focus on the most needy cases first
Example below with the use of AI in intensive care units (figure 2), resulting in a 35% increase in overall capacity in France.
- The e-health market
Global
- Revenue in the eHealth segment is projected to reach US$73.21bn in 2023.
- Revenue is expected to show an annual growth rate (CAGR 2023-2027) of 10.59%, resulting in a projected market volume of US$109.50bn by 2027.
- User penetration will be 27.87% in 2023 and is expected to hit 36.12% by 2027
Middle East and Gulf
McKinsey forecasts a market of around 7.9 billion dollars for the Middle East region, including 4 billion for KSA and the UAE alone. Telemedicine consultations in the region have doubled since the beginning of the COVID-19 pandemic, demonstrating that the region is ready for virtual health care services. More than 40% of adults in the Middle East use health and fitness apps, reflecting a growing trend towards proactive health management. Adoption of artificial intelligence (AI) in healthcare is expected to grow at an annual rate of 34%, driving improvements in diagnosis, personalized treatments and patient care.
E-health is indeed particularly relevant in the Gulf region:
- Large territories, remote areas not always well equipped (especially in KSA), telehealth offers a solution easy to implement
- Prevalence of cardiovascular and sedentary diseases: chronic disease monitoring and fitness apps allow significant improvements in care
- Public health issues: artificial intelligence allows bulk screening campaigns and high rate of use of social networks by local populations makes it possible to conduct well-targeted information campaigns
- Presence of certain rare diseases requiring a multidisciplinary approach that is easier to implement thanks to digital tools
- Ecosystem
Stakeholders
Digital health is a transversal and multidisciplinary field. It brings together all the players in the ecosystem with applications for each one of them:
- State/Government and its regulatory bodies
- Patient and family
- Health professionals as caregivers
- Hospitals, healthcare facilities, medical centres, etc.
- Social security, insurance, third-party payers
- Non-governmental organizations
- Pharmaceutical companies
- Manufacturers and suppliers of medical equipment and solutions
- New players (MedTech companies)
New Entrants
Digital health – like other industrial sectors at the time of their digitalization – has allowed the emergence of new players external to the historical ecosystem. The most notable are the giants of GAFAM (especially Google, Amazon, Microsoft). But the creators of innovative solutions and AI are in most cases companies with less than ten years of existence.
The usual model for an e-health start-up could be summarized as follows:
- Application of a digital or mathematical model to a given problem
Ex: Screening of a huge number of medical images in a short time
- Development of the technical solutions
- Validation with a sample of professionals
- If the result is conclusive, creation of the company with a medical committee – preferably multidisciplinary – chaired by a well-known doctor in his/her field
- Validation on a larger scale
- Obtaining certifications (CE and/or FDA)
- Pilot project
- Commercialization on the domestic market and then export
Fundraisings can occur at any stage depending on the strategy of founders and/or managers.
Just as an entrepreneur outside the auto industry created Tesla, the next players who can shake up the well-established incumbents may have no prior medical experience.
- Opportunities in the Middle East – Economic models – Challenges
KSA and the UAE represent the most promising markets in the short term. Iraq is also to be considered at a later stage because of its enormous demographics, wealth and needs. The classic pattern is to start in the UAE where the adoption rate is higher and the country deemed simpler from regulatory-wise. Thus one builds a reference in the Gulf, allowing to invest the other GCC countries much more easily. The second step is usually to go to KSA.
Business models:
E-health applications are usually in SaaS model rather than as license model. Hosted in the cloud, they also make it possible to limit installation costs and teams’ travels.
We then observe a switch from a licensing plus maintenance model to a subscription model. The manufacturer creates a recurring income, the customer can smooth expenses and avoid heavy investments (CAPEX vs OPEX). And he can simply terminate the service if he is not satisfied, switching costs being very low or non-existent. Counterintuitively, however, customer retention rate is significantly higher.
Use of the collected data – although strictly regulated – generates a significant additional income.
Challenges:
In e-health, the first challenge is always regulation: is the system considered, and if so, under what conditions, does it require registration? For example, the UAE recognizes CE or FDA marking where Saudi Arabia requires national SFDA marking.
The problem of data storage arises in almost all territories that require a “cloud” server labelled HDS (Health Data Host, HIPAA or equivalent) located on the national territory.
Finally, operational implementation is a challenge often neglected: the best system, solving a major problem will be obsolete, should its implementation causes a slowdown in flows and requires one more step by operators. Reluctance to change exists in all organizations. But it is more pronounced in the health sector given the disastrous consequences of a mistake. Also, the best e-health application is the one that works imperceptibly for users. For example, an AI diagnostic that would be integrated into the information system that manages the results (i.e. directly in the RIS in radiology), presenting an alert only when necessary. On the opposite, if the operator has to submit the image for interpretation, adoption is then almost impossible.
III- Conclusion
Digital health enables major improvements in access to care. It places the patient back as a stakeholder in the management of his health and possible treatment(s). It frees health professionals from uninteresting and error-prone tasks to enable them to put all their skills at the service of their core business.
In terms of public health, the processing capabilities offered by AI and big data allow earlier treatment. Patients and public finances therefore benefit from this.
Markets, both global and GCC, are promising as long as solutions respect key points specific to each country and culture. Future technologies will be even more advanced with faster networks, especially for tele-robotics and most innovative connected IoMT.
The right questions to ask yourself when exporting
For a software editor or an industrial in the sector wishing to export its products and know-how to the Middle East, it is necessary to ask and answer the right questions:
- Regulations / Markings
- Adaptation of the offer or solution to the specific problems of the region
- Operational adaptation to local processes, practices and procedures
- Adaptation of the business model
- Distribution channels, promotion, positioning (and therefore need for a pilot site to get a valid local reference)
- Set-up of a local medical committee to validate the therapeutic benefits of the solutions considered specifically to cases in the region
- Data storage partners if needed
- Available payment means
The future: Web 3.0 and NFT applied to the healthcare sector
Web 3.0 will offer significant advances by enabling smart interoperability of medical data between systems, professionals and patients. With a greater focus on IoMT, data integration and analysis by semantic AI will be much more advanced, providing more accurate and personalized diagnostics. Medical research and disease prevention will benefit significantly.
NFTs (non-fungible tokens) can transfigure digital health by offering unique proof of ownership for medical records, vaccination certificates or professional licenses, enhancing authenticity and confidentiality. They also allow fractional ownership of expensive medical equipment, fostering sharing and collaboration between institutions. By decreasing acquisition costs while allowing for increased utilization rates, operational costs could be reduced. In addition, NFTs can be used to reward participation in medical studies or encourage healthy behaviours, by turning health data into digital assets.
However, a regulatory framework, ethical reflections conducted well in advance by lawmakers and an even greater data security are necessary. The possibilities and temptations of transgressing rules are indeed increased.
To move forward, contact Orient!
IV- References
https://www.statista.com/outlook/dmo/digital-health/ehealth/worldwide
https://dhf.khaleejtimesevents.com/
FROM INNOVATION TO IMPLEMENTATION, eHealth in the WHO European Region, 2016, World Health Organization
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