INTERNATIONAL Telemedicine and the networking of health services, is going to have a major impact on the way we live, especially in the Gulf where there are many people working in the dispersed oil & gas sector and others who are out in remote places needing medical attention.
It has been said that telemedicine is healthcare's new frontier, a means of facilitating the distribution of human resources and professional competences. It can speed up diagnosis and therapeutic care delivery and allow peripheral and primary healthcare providers to receive continuous assistance from specialised centres.
Many Middle East agencies and healthcare providers have been at the forefront of developments. In the UAE and Saudi Arabia physicians have risen to be at the highest level in the world on Internet usage for diagnosing and treatment. Telemedicine, which enables hospitals around the world to share diagnostic information digitally, is on the upswing in the region as the technology gains a foothold internationally, industry insiders say.
As well as improvements in quality of care delivery, telemedicine can enhance efficiency and reduce health care costs by reducing the number of patients who visit a hospital and use facilities and equipment.
Shift in attitudes and competition
According to one of the largest online medical web portals, physicians within the UAE rank at the top in the Middle East when it comes to utilising the Internet for diagnosing and the selection of treatment options for their patients. In a comprehensive survey conducted by Univadis, a leading online medical library and research engine for physicians, it was found that Internet usage amongst medical professionals was high, with approximately 52% utilising the Internet daily, and that nine out of ten UAE physicians rate the Internet as an “extremely positive” tool for receiving continuous education programs and has become the main source of medical information for daily practice.
Over the years, the Internet has seen huge leaps in popularity within the medical world, and due to savings in time efficiency. There has been an increased use of online professional Internet usage as opposed to offline usage. These days, medical professionals prefer to access online medical journals and association websites for updates on news and information relating to diseases within their field of specialty.
Through the Univadis survey, it was found that physicians within the UAE possessed a number of different beliefs and attitudes towards using the Internet for professional purposes, and that these beliefs determined how often, and the extent to which, they relied on the Internet.
Through the information that was gathered, it was determined that the majority of medical professionals want fast and easy access to the Internet, and access to information that is both specialised and credible. It was found that physicians in general were attracted, but skeptical towards, local information and felt that international information was more objective, and therefore had more influence on clinical practices.
In developed and developing countries alike, healthcare consumers will seek out more convenient, effective and efficient healthcare means, settings and providers. Payers including governments and third-party health insurers will direct citizens and customers to these alternative options.
The shift in consumer attitudes toward venues of healthcare delivery will be accompanied by a corresponding shift in how, where and who provides preventive, acute and chronic care services. There will be a shift from episodic and acute care to more patient-centred, value-based, longitudinal care by healthcare teams and there will be better management of chronic conditions, especially as more acute diseases evolve into chronic diseases through advancements in detection and treatment.
Meanwhile medical tourism is beginning to subject healthcare delivery to global competitive pressures. For example if we consider the cost of heart bypass, which is US$33,000 in the United States, US$13,000 in the UAE, US$13,200 in Mexico, US$14,500 in Costa Rica, US$7,800 in India, US$9,200 in Thailand and US$13,00 in Singapore.
Healthcare systems must also address major issues and questions to reach a sustainable system. Factors such as new treatments and increasing demand for services and value are converging to increase the pressures, and without major changes many countries will not be able to continue on their current path in the next decade. New levels of accountability, tough decisions and collaborative hard work are needed on the part of all stakeholders to transform healthcare systems into a national asset.
The ecosystem, which consists of healthcare providers, medical professionals, consumers, pharmaceutical companies, medical devices companies, has to work together. And we see the major themes affecting healthcare such as globalisation, consumerism, aging and overweight populations, diseases that are more expensive to treat, as well as new medical technologies and treatments.
In order to compete long term in a global economy, hospitals have to make sure they have something of value so that they can maintain a competitive edge, such as a combination of healthcare and tourism and advanced treatment and technologies. Consumers have greater choice and they can compare and shop around for services, he added.
Counterbalancing the drivers for change are key inhibitors that threaten to maintain the healthcare status quo. These include financial constraints, societal expectations and norms, lack of aligned incentives, inability to balance short and long term perspectives, as well as inability to access and share information.
According to an IBM study, a patient-centric model puts the needs of the patient first and requires greater patient responsibility and accountability. Individuals have the right to expect improved care as long as they educate themselves and change their behaviours to better mange their health, access medical records and information, and contribute an appropriate share to the total cost of care. Open technical and interoperability standards are necessary for extensive use of the Internet, while there needs to be highly-secure storage for patient data.
Last month's Arab Health exhibition and conference series gave a glimpse into this new world of interconnected medical providers and one of the prominent companies on display was Siemens Healthcare. In this interview BI-ME talks to Maurice Faber, Regional Managing Director for Siemens Medical Solutions at the Dubai Internet City headquarters of the German conglomerate. His business covers the wider region, from Iran and Pakistan to the lower Gulf, including Jordan, the Levant and Cyprus.
During Arab Health 2008, Simens Healthcare announced the first contract to bring its breakthrough computed tomography (CT) technology to the NMC Specialty Hospitals in Dubai and Al Ain in the UAE. This groundbreaking technology allows physicians to obtain clearer images of the beating heart and make timely diagnoses in the emergency room. The power of the scanner is now so fast that it can capture a moving heart. The dual source capabilities of the Siemens Somatom Definition enable physicians to examine patients with elevated or irregular heart rates without having to first administer beta blocker medication to reduce and stabilise the heart rate.
At Arab Health 2008 Siemens shared a vision for the quality of healthcare worldwide and the importance of information technology. Two years ago, Siemens relocated its Near and Middle East (NME) regional headquarters for sales to the UAE. In addition, the company established a Centre of Competence specialising in high technology solutions for the region.
The two moves add to an already 100-strong team of specialists available on the ground to regional customers. “Having our specialists available right here means shorter lead times to respond to customers and an even better understanding and awareness of their needs and issues,” explains Maurice Faber.
“We are uniquely positioned within this market as the only total solutions provider. We are the only company that can provide fully integrated end-to-end solutions in this fast evolving and highly competitive industry," he adds.
The investments being made by Siemems and others signify the growing importance of the Middle East as a major global market. The region’s healthcare market is valued at an estimated US$47.6 billion and growing at 16% annually. According to Siemens, the market for the medical diagnostics and solutions part of the healthcare market is estimated to grow annually by around 5%. Saudi Arabia continues to be the leading market, with a market size estimated to reach US$578 million by 2010. Meanwhile, in the Lower Gulf region, Siemens also continues to grow sales at a rapid pace.
Recent acquisitions in the area of invitro diagnostics - such as Diagnostic Products Corp and Bayer Diagnostics - mark a significant milestone for Siemens as it becomes the world's first full service diagnostics company.
BI-ME: What is the history of Siemens in the Middle East?
MF: Siemens Healthcare has a long history in the UAE and Middle East extending at least 35 years in the country. We have always been present with our own engineers and our own staff and we have given a commitment to the region. From the old days it was mainly x-ray machines and the physical diagnostic equipment. But now with changes in technology we are moving into fully integrated health systems and in-vitro diagnostics with analysis of DNA from blood samples, up to MRI and the latest CT scanners. The software side is becoming more important.
BI-ME: What are the technologies and consulting or implementation help that Siemens can best bring to the region?
MF: Siemens is the leading provider of healthcare solutions in the region, covering diagnostic technologies and equipment, infrastructure solutions, and IT applications that streamline processes to increase efficiency. Uniquely, Siemens also has the ability to fully integrate all these elements.
This ability means that Siemens can assist healthcare suppliers to address one of the key challenges currently facing them. Factors such as aging and population growth have already led to a global surge in the demand for healthcare products, services and solutions, and they have also led to rising costs. By 2050, more people in the world will be aged over 60 than below 14.
And this region is no exception to this. Using IT and the so-called smart building technology, Siemens has created digital patient rooms that integrate monitoring and diagnostics technology, with wireless communications and room controls (such as temperature and lighting). The Digital Patient Room was one highlight at Arab Health, along with Hospital Information Systems (HIS) for medium and large sized hospitals.
BI-ME: In the areas of telemedicine and the specific healthcare technologies, is there anything the healthcare providers in the Gulf could do to improve their procurement policies? How are the Middle East institutions? Are they good clients, or challenging clients?
MF: Our strategy is very much toward early diagnosis, and the units required at every step of treatment, up to the cancer treatments such as medical linear accelerators, which is more the traditional business.
We want to function as a Centre of Competence with our 'global solutions' approach, including the planning of health facilities, the medical concept, the architectural drawings, in fact everything right up to handing over the key of the hospital. Also in the software field there are a lot of developments with the networking of imaging equipment. With the coming of compulsory medical insurance coming, this will mean also a lot of connectivity will be required to certify the treatments that are covered by a given policy, and the information management requirements.
Indeed most of the big changes in healthcare are coming on the IT side, with the need for transparency between governments and the insurance companies, which is widely recognised. For this we need a very good billing and records system.
BI-ME: Regarding the technology you were showing at Arab Health this year, and the feedback generally, would you say the show demonstrates how the Middle East region is growing in importance for global health trends and announcements?
MF: The feedback was that there was reallly a big number of exhibitors this year. The visitors were also increasing in number so that every year we see the show getting better and better. The quality of visitors was also better, in the sense that we were able to touch really with the qualified people in the healthcare sector. Our own message was mainly toward the issues of workflow in the hospital, on the issue of workflow IT, and developing a common strategy for hospital departments.
BI-ME: There is a trend from public to private provision. How does that affect how Siemens and others interacts with hospitals and institutions? For example is the tendering becoming more competitive and more demanding?
MF: The Middle East healthcare sector is developed. They are making the focus now on getting more specialised hospitals into the region. The governments want less people travelling outside for their medical treatments, and in fact to attract patients into the region for care. To do this requires more specialists and corporations to be based here, and in fact that is what is happening. The next target is for people to get their own accreditation here and many governments are working on this aspect, so that you get a knowledge transfer and a knowledge-building economy.
BI-ME: On the medical tourism aspects, with Dubai Healthcare City and other Middle East projects, the region is really trying to change its image to become a net recipient of health spending. How far do you think this trend will go? Are there not other parts of the world that are competing for this same market?
MF: The specialists follow the demand and yes there are competing medical centres such as in India, Thailand or Jordan, but with IT developments you can bring all the best from Europe and the US institutions and that is what is happening.
BI-ME: In some areas of technology it seems the Middle East does not have an existing 'legacy' system to deal with. This makes the region very forward thinking and it becomes easier to implement the latest systems. Would you say this is true in healthcare technology?
MF: We have the newest and the best equipment installed here. They go for the latest equipment, for example our specialised CT scanner for cardiology. This was not existing at all before as a medical option. The patient can have what would previously have been an invasive procedure like an angiogram, he will get in his, or her, car and go home the same day.
With our Syngo interface there is the possibility to link seven or eight hospital groups together, whether it is New Medical Centre, Wellcare or government hospitals. The Syngo DynaCT Cardiac software adds the capability to generate three-dimensional displays of the heart ventricle. Physicians are able to view the 3D object from all sides, even during an intervention such as ablation therapy.
So the benchmark here is the very highest and the tendering is very professional and competitive. In some countries you have a differerent mix of private and government hospitals so the procedures for entering a market have many different types. But they all have professional tender systems, that normally include a finance committee, a medical committee, and a technical committee. In some cases you still see this tendering, governed by the power rating of the equipment. But for diagnosis these days, it is more about the software and what you can actually do with the unit.
For private and public systems, they all have a modern way of tendering. They are looking at what the unit can do, not only the hardware aspects. They have to give good quality care to get the patients.
BI-ME: Are you seeing telemedicine with more healthcare providers being connected to a network? Can you give any specific examples or case studies?
MF: With this IT trend that I mentioned, yes you can get 24/7 care in small clinics or primary healthcare centres connected from anywhere to the hospital. You can have a remote station connected to a qualified cardiologist or radiologist, who can give advice about treatment or make the decision that the patient needs to be brought to hospital. This is coming more and more into normal practice and you have to have transparency in the system to make this a reality.
At Siemens Healthcare we recently managed a project in a large province of South Africa to connect 35 hospitals and 350 clinics.
BI-ME: What are the future technologies that Siemens Healthcare is working on? How will these change the way that hospitals and institutions operate?
MF: I would say that the trend is to invitro diagnostics of DNA, to nanotechnology and molecular imaging from blood or cell samples, and minimally-invasive diagnostics. It is going in that direction. There is always a constant movement toward faster and better performance and smaller size units, for example in MRI technology. Nowadays 10% of our budget at Siemens Healthcare is going into research and development.
For the future in the Middle East, Arab Health showed that the Middle East is becoming very important for the global launches of systems, ranking alongside the top three events around the world.
I mentioned our long-term commitment to the region and our commitment to creating Centres of Competence with all the skills and certification being generated from within the region. We are able to do this because of all the product specialists are here. With this we are able to support the continued medical advancements in the region. After all the better the driver, the better the car.
Note: Siemens Medical Solutions is one of the world’s largest suppliers to the healthcare industry. The company is known for bringing together innovative medical technologies, healthcare information systems, management consulting, and support services, to help customers achieve tangible, sustainable, clinical and financial outcomes. From imaging systems for diagnosis, to therapy equipment for treatment, to molecular medicine to hearing instruments and beyond, Siemens innovations contribute to the health and wellbeing of people across the globe, while improving operational efficiencies and optimising workflow in hospitals, clinics, home health agencies, and doctors' offices.
See also: www.siemens.com