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April 2018

www.healthcareglobal.com

Using 3D

printing

to make implants

smart

TOP 10 HEALTHCARE BRANDS

CLAUDIA TOLEDO

Elsevier’s Director of Clinical Solutions discusses the future for digitally enhancing the patient experience

COULD CANNABINOIDS have a place in paediatric care?


ABOUT GE HEALTHCARE DIGITAL GE Healthcare Digital’s solutions help enhance patient care and operational efficiency for healthcare providers from independent physician practices to integrated delivery networks (IDNs). These solutions are aimed at supporting digital transformation in the healthcare industry through continuous innovation in the next frontier of technologies, professional services and deep domain expertise. GE Healthcare Digital’s most recent solutions include PREDIX-enabled Healthcare Analytics Services and AI, the GE Health Cloud, Centricity 360 collaboration suite and Population Health.

For more information about GE Healthcare please visit: www.gehealthcare.com


FOREWORD THIS ISSUE, WE start the conversation with Claudia Toledo, Clinical Solutions Director at Elsevier, who highlights how its focus on the patient journey has led to the development of exceptional patient-centered solutions. The emergence of digital tools has fully disrupted traditional models of health. Due to a growing global population, greater emphasis has been placed on delivering care which is increasingly connected and patient-centered. We speak with Dr James Barlow at Imperial College London, who outlines how the emergence of digital triage will further support older populations and support providers in the delivery of personalised health solutions. Technology companies are increasingly moving into the healthcare industry to enable consumers to take full control over their healthcare needs. We speak with Matt Parkes, Senior

Medical Development Engineer at Renishaw regarding how the use of smart implants are improving patient outcomes by changing the way a variety of bone diseases and injuries are treated. Such breakthroughs in healthcare are not just situated within the technological field and within adult care. Across the pharmaceutical industry, John-David Belfontaine, Founder and CEO of Phivida, discusses how the CBD hemp oil producer’s expansion across America can benefit families and help children suffering from conditions like epilepsy to live a normal life On top of this, we’ll be rounding up the top 10 global healthcare brands, in addition to industry events across the globe for this calendar year.

Enjoy the issue!

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Using 3D printing to make implants smart


MEDICINE

Could

TOP 10

CANNABINOIDS

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have a place in paediatric care?

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Pacific Reach Properties & Retirement Concepts CANADA

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State University NY Downstate Medical Centre USA

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DIGITALLY ENHANCING the patient experience Healthcare Global speaks with Claudia Toledo, Director of Clinical Solutions, about Elsevier’s ambition to develop personalised products and solutions to support the patient journey

W r i t t e n b y C AT H E R I N E S T U R M A N


H E A LT H C A R E S T R AT E G I E S ELSEVIER EFFORTLESSLY STRIVES to support researchers, governments and universities to develop key insights and clinical skills, as well as partake in essential knowledge-sharing in an everchanging healthcare landscape. Whilst the number of women in STEM subjects remains relatively low globally, in Brazil numbers are flourishing. Presently one of the largest investors in science and technology in Latin America and the Caribbean, a study published on Elsevier’s Connect platform has revealed that the country’s focus on social and gender equality has transformed Brazil into a country with a diverse, skilled workforce. The country has encouraged women to take advantage of new opportunities, particularly within scholarships and research support. This has provided a multitude of advantages, not least across the healthcare industry. Recently acclaimed as one of the 100 most influential people in healthcare under the category of Innovation at the South American Healthcare Exhibition (SAHE), Claudia Toledo, Director of Clinical 12

April 2018

Solutions at Elsevier, is clearly passionate about her role within an industry that is ripe for disruption. “I came from an infrastructure segment of work and joined Elsevier and the healthcare industry over 20 years ago. I have worked both in the public and private sector, for small and large institutions as well as big corporations,” she says. Disrupting traditional processes and implementing personalised digital tools to enhance the patient


“THERE ARE ESTIMATIONS THAT BY 2020, MEDICAL KNOWLEDGE WILL DOUBLE EVERY 73 DAYS. IT WILL NOT BE POSSIBLE TO MANAGE THIS WITHOUT TECHNOLOGY” – Claudia Toledo, Director of Clinical Solutions, Elsevier

Elsevier’s Clinical Solutions team looks at key healthcare trends

journey has become a key focus at Elsevier’s Clinical Solutions division. The unit works tirelessly to support hospitals, providers and local governments within primary, secondary and tertiary care areas. In its bid to develop solutions to support clinical performance and professional development, Elsevier’s Clinical Solutions team continually looks at key healthcare trends which could influence the development of new products and services to 13


H E A LT H C A R E S T R AT E G I E S further improve safety, reduce costs and maintain compliance at every stage of the patient spectrum. “We have regular meetings with customers, as it’s not only about Elsevier’s internal communication, it’s about communicating with the market,” Toledo says. “We need to understand all the time what is happening. “Elsevier is one of the companies that I feel is most invested in training to further gain awareness of influencing factors and customer support, for example,” she explains. “Elsevier wants to guarantee that we are updated with everything that we need to know about our business, our customers, and our knowledge. This is something of a mantra for us.” It has become essential for healthcare providers to overhaul outdated ways to further drive efficiencies, improve and speed up clinical decision making, whilst improving the quality of patient care. However, Toledo adds that this is only possible through reducing variability through the increased use of technology. “There are estimations that by 2020, medical knowledge will double every 73 days. It will not be possible to 14

April 2018

Elsevier focuses on four core areas: prevention, diagnosis, treatment and homecare

manage this without technology, and without trustworthy information which Elsevier provides,” she says. “The solutions that Elsevier has been developing are therefore integrated to Electronic Health Records (EHRs), which support the workflow of doctors, nurses and care providers. “In Brazil, for example, we also have one of the largest ageing populations in the world. The healthcare spend is also frozen. Although healthcare issues are set to increase, health expenses are not set to increase


the same way. The big challenge that we have in Brazil is how can we guarantee that we are going to provide the best care with less cost.”

Clinical solutions With a keen focus on the entire patient journey, Elsevier has developed clinical solutions within four core areas: prevention, diagnosis, treatment and homecare. “When we talk about prevention, we have one platform called First Consult. This is a mobile app, where

you can type in your symptoms and this connects to a patient’s EHR in the hospital,” comments Toledo. “The app then provides instructions and advice, and also advises whether a doctor’s appointment is needed. “Another clinical solution that we have for prevention is our website, Health Library. This is where the hospital can provide instructions for wellness. It also helps the hospital remain connected to the patient, even when the patient is not situated in the hospital.” 15


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“FROM THE MOMENT THE DOCTOR DETECTS A PATIENT’S CONDITION, THEY UTILISE ELSEVIER’S CLINICAL PHARMACOLOGY SOLUTION, WHICH INCORPORATES A CHECKLIST OF ALL THE TREATMENT THE PATIENT WILL NEED, WHILST FOLLOWING BEST PRACTICES” – Claudia Toledo, Director of Clinical Solutions, Elsevier

Through its medical platform, Clinical Key, medical professionals are also provided with essential clinical data which supports the delivery of a swift diagnosis, where the patient is then able to receive treatment. “From the moment the doctor detects a patient’s condition, they utilise Elsevier’s Clinical Pharmacology solution, which incorporates a checklist of all the treatment the patient will need, whilst following best practices,” Toledo states. Additionally, Elsevier houses exceptional care planning, and has developed digital tools to place all 16

April 2018

interdisciplinary areas of the hospital into the same treatment plan. “Nursing, physical therapy, phrenology and nutrition – all parties follow the same treatment plan to provide transparency and guarantee care which is increasingly connected,” Toledo adds. Lastly, even when patients are discharged from hospital, Elsevier has recognised the importance for treatment to continue, particularly for those with long-term chronic diseases such as hypertension and diabetes, and utillises digital tools such as videos to provide further guidance.


Positive patient outcomes Across Elsevier’s Clinical Solutions division, visionary group RELX has supported the company’s development of patient-centred tools and aims to further drive its healthcare vision for the future. “RELX is a source of inspiration, and a vision for Elsevier to follow,” observes Toledo. Additionally, with the rise of technology companies entering the healthcare space, Toledo expresses optimism of the benefits which this will deliver. “Products such as the Apple Watch, which encourages you

to walk 10,000 steps per day, is something positive. When this connects to a healthcare system, we can provide real information about a patient direct to the hospital. This helps the hospital to gain increased insight and an understanding of the patient as a whole.” Elsevier’s focus on improving clinical outcomes through evidencebased care is therefore clear to see. The company will continue to innovate and develop patient-focused products and services to enhance the quality of care and deliver patient outcomes at each and every turn. 17


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The telehealth revolution is underway, but some hurdles remain Despite the idea of telemedicine being around for well over a century, it has yet to see widescale global adoption. Professor James Barlow details some of the reasons why Writ ten by STUART HODGE


H E A LT H C A R E 4 . 0 TELEHEALTH HAS ACTUALLY been around for a long time. The very first report of telemedicine in a scientific journal was in 1879 in The Lancet. It was a report of a telephone diagnosis, where the doctor held the receiver of the phone to the patient’s chest and made a diagnosis from that. Then you have the flying doctor service, which has been around in Australia for 90 years. Why, then, does it not feel like the medical industry has fully embraced the technological shift we’ve seen over the past quarter of a century to its full potential? To try and find out, Healthcare Global spoke to James Barlow, Professor of Technology and Innovation Management (Healthcare) at Imperial College Business School, and author of ‘Managing Innovation in Healthcare’. By his own admission, he has spent the last 15 to 20 years trying to work out why the adoption of ideas is so slow within healthcare, but even he says there’s no one quick answer to that question. “A lot of work I’ve done has been around remote care to telehealth, to telecare, telemedicine, because it’s a very interesting example of a technological innovation, which, at least on paper, 22

April 2018

offers huge prospects to improve the quality of care,” Barlow says, “and to shift care from expensive settings like hospitals out to the community. “There have been a huge number of trials and there is an evidence base, yet all countries are finding it immensely difficult to get it adopted as part of a mainstream healthcare system. “I think we need to make a distinction between telehealth


“There have been a huge number of trials and there is an evidence base, yet all countries are finding it immensely difficult to get [telecare] adopted as part of a mainstream healthcare system” – James Barlow, Professor of Technology and Innovation Management (Healthcare) at Imperial College Business School

services and what I call ‘telemedicine’, which is much simpler in the sense that it’s essentially a patient and a doctor, or specialist, who will be remotely situated. It’s all about diagnosis, and triage, and looking at a particular type of data from the patient, which is inherently sort of simpler to put in place than patient monitoring, or monitoring elderly people, in real time, in their own homes or on a mobile basis where you’ve got much

more complex processes involved. “It usually spills across different parts of the heath and social care system. So there’s been a lot of telemedicine in the form of video consultations and simple sort of telediagnostics, going back a long time and obviously right back to the flying doctor service. “But, as I say, that’s easier to put in place because it’s basically just a patient and a specialist, and it’s doing 23


H E A LT H C A R E 4 . 0 one thing at a time. It’s when you start looking at these telehealth and telecare services aimed at people with multiple chronic conditions, or who are frail and elderly, and you’re monitoring different vital signs, movement in the home, medication and compliance. It just becomes an inherently more complex thing to put in place. “So that is basically why it’s difficult to implement. You’ve got several different parts of the care system involved. As we know, health and social care is very fragmented. There are different financial silos, different sorts of professional silos, and you’ve got to align all those if it’s going to work.” The complexity of how health services around the world are funded is without doubt one of, if not the biggest barrier to widescale adoption, alongside the fact that no solution or technology has come to the fore which guarantees cost savings for a healthcare provider. The lack of any sure-fire solutions on the market is a problem, but it does appear, at least, that a market and competition is being created when it comes to how specialist medical equipment is now being produced. 24

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“Health and social care is ver y fragmented. There are different financial silos, differen sorts of professional silos, and you’ve got to align all those if it’s going to work”

– James Barlow, Professor of Technology and Innovation Management (Healthcare) at Impe College Business School “All the big global electronics traders are now involved,” Barlow says. “Back in the early noughties, it was very much specialist companies just making one sensor monitor, for example, for a particular length of time. But now it’s Philips, it’s Samsung, it’s Siemens, all involved in telehealth and telemedicine, and trying to push it. I think the momentum will speed up from now on.” Barlow was involved in the world’s biggest trial of telehealth and telecare, the Whole System Demonstrators programme, which was funded by the UK Department of Health and finished about six years ago. Despite


e

nt

d erial

the scale of that trial, there still wasn’t enough definitive evidence, according to him, and that appears to be part of a wider ambiguity when it comes to understanding the costs and benefits of these systems. There are, however, some parts of the world, including a few Mediterranean countries, which have pushed ahead in terms of embracing the benefits of telemedicine. “Spain and Italy have got what I would regard as mainstream services,” says the 61-year-old. “The Veterans

Health Administration in America does use a lot of telehealth. “There’s a lot of telemedicine, particularly in developing countries where you’ve got problems with access to doctors, GPs or specialists. There are circumstantial examples of straight telemedicine where the patient and a nurse in a village are talking to a doctor in a hospital in a city. So that, I would say, is becoming mainstream. “When it’s focused on specific conditions and you can roll it out for a particular group of people 25


“What’s different now compared to 10 years ago is the fact that more people have got Fitbits and Apple watches, and there’s a whole generation of people becoming used to monitoring aspects of their health” – James Barlow, Professor of Technology and Innovation Management (Healthcare) at Imperial College Business School

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then I think that does make it easier to implement. It’s when it’s targeted at a generally frail, elderly population that it becomes much more difficult because there is just so many other factors involved, which would have to be in place. “You’ve got to have housing services and home visiting, social care has to be involved, and frail and elderly people have multiple commodities so you’re monitoring lots of different medical conditions. It’s just a wholly different order of magnitude and complexity when it comes to elderly people. “What’s different now compared to 10 years ago is the fact that more people have got Fitbits and Apple watches, and there’s a whole generation of people becoming used to monitoring aspects of their health. “There’s a generation of people now who are comfortable with the idea of monitoring their health and the data being looked at by other people, or more sophisticated algorithms that can interpret

what’s going on from the data.” As the population changes and becomes more accepting of change, then the more likely it is that change will begin to happen in earnest. Barlow is in no doubt that things are improving slowly in terms of global uptake, but he still reckons we are at least a decade away from seeing fully-integrated telehealth systems becoming mainstream around the world. “Version two of remote care then I think will be focused on elderly people, and that hasn’t happened yet,” he adds. “I think it is a sort of 10-20 year horizon to get remote care for elderly people fully-embedded in health and social care systems. “It’s not the technology or the actual users of telehealth that are the barrier. It’s the organisational and funding issues that are the big challenges, and reorganising services for elderly people is a massive problem for health systems around the world – and you need to do that around the technology, so that’s the big challenge.”

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MEDICAL DEVICES


Using 3D printing to make implants smart Healthcare Global hears from Matt Parkes, Senior Medical Development Engineer at Renishaw, about how smart implants are improving patient outcomes by changing the way a variety of bone diseases and injuries are treated Writ ten by DAN BRIGHTMORE


BACK IN THE 16th century, broken bones were physically manipulated back to the correct orientation by a bone setter. Failing that, the local blacksmith would step in. Thankfully, advances in medical treatments since the early 1900s have allowed surgeons to use metal implants in healthcare, typically to treat bone diseases including osteoarthritis and inflammatory rheumatoid arthritis, as well as in reconstruction therapy. Though a wellestablished technology, traditional implants often cause challenges for patients and surgeons. One area currently being developed is that of smart implants, which improve patient outcomes, bringing the technology into the modern age. “Implants can be smart in two ways, either by being additively manufactured to produce patient specific implants (PSIs) from computed tomography (CT) data, or by

Smart implants are a key focus for Renishaw 32

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MEDICAL DEVICES incorporating sensors,” explains Matt Parkes, Senior Medical Development Engineer at Renishaw, a company at the forefront of new engineering technologies utilised across sectors in everything from jet engines to dentistry. “Still in the early phases of development, inbuilt sensors could collect patient-specific data, enabling surgeons and other healthcare professionals to tailor treatment to the needs of individual patients.” What patient challenges can PSIs help overcome? “One of the key issues that traditional implants present is loosening,” explains Parkes. “Particularly common following joint replacement procedures, loosening can be a result of poor osseointegration – the structural and functional connection of the implant with the patient’s bone. This can occur due to wearing over time and is exacerbated by factors including infection and poor compliance with advised physiotherapy regimes.” Parkes notes this can be exacerbated by the limitations of traditional metal implants, which are only manufactured in a discrete 33


MEDICAL DEVICES number of shapes and sizes. “It is unlikely patients will receive an implant that fits them accurately,” he concedes. “This can cause poor physical function and contribute to loosening. Poor physical function can also occur because of stress shielding – the process whereby metal implants remove stress from the patient’s bone. The bone responds by reducing in density and therefore becomes weaker.” Parkes also highlights the increasing incidence of obesity as one of the reasons why joint replacements are becoming more common in young people. “This poses longevity issues as implants can reach their maximum lifespan and need replacing several

times during the patient’s lifetime,” he says. “To combat these issues, researchers and engineers have been developing implants in new ways, using techniques such as additive manufacturing (AM). The technology aims to improve the form, fit and function of implants.” AM, also known as 3D printing, offers exciting opportunities to develop new technologies across industry sectors. It can remove many of the constraints seen in more traditional manufacturing methods such as milling, casting or fabrication. This opens up new possibilities for complex geometries and mass customisation of parts, at a commercially viable cost, that were

3D CAD image of a hip x-ray, smart implants are changing medicine

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“Renishaw's laser melting is a pioneering additive manufacturing process capable previously unfeasible. of producing fully dense metal 3D printing parts direct from 3D CAD is highly suited files using a high-powered to the production of fibre laser” medical devices in both cobalt chrome and titanium, and capable of producing complex features and accurate parts. Renishaw is working to apply additive manufacturing to custom medical device production for craniomaxillofacial implants and guides, and is keen to work with its customers to improve existing custom devices and develop new applications that are yet to be exploited. “Renishaw’s laser melting is a pioneering additive manufacturing process capable of producing fully dense metal parts direct from 3D CAD files using a high-powered fibre laser,” explains Parkes. “Parts are built from a range of fine metal powders that are fully melted in a tightly controlled atmosphere layer by layer in thicknesses ranging from 20 to 100 microns.” AM has been used as a manufacturing method in the medical

Matt Parkes, Senior Medical Development Engineer, Renishaw field for over 10 years, but Parkes believes the technology is yet to reach its full potential in this industry. “Because AM builds an implant layer by layer, it’s possible to produce PSIs that are a more accurate fit for the patient. The manufacturing method also has fewer geometric constraints than subtractive manufacturing. PSIs designed and manufactured according to a patient’s CT scan encourages the implant to integrate with the patient’s bone, reducing the risk of loosening.” As a result, patients are less likely to suffer pain or require revision surgeries. “As well as being able to 35


MEDICAL DEVICES

“One parameter a sensor could measure is temperature, as a raised temperature can indicate an infection before symptoms appear� Matt Parkes, Senior Medical Development Engineer, Renishaw 36

April 2018


manufacture an exact shape, AM enables surgeons to control additional properties of the material,” he adds. “They can design implants that mimic the patient’s bone stiffness, density and trabecular structure, which can reduce stress shielding and improve osseointegration and physical function further.” Implants can also be made smarter by adding sensors. This allows clinicians to accurately measure patient data – a key to evidence-based medicine, notes Parkes: “One parameter a sensor could measure is temperature, as a raised temperature can indicate an infection before symptoms appear. This could benefit both patients and doctors by enabling treatment before the infection becomes complicated and expensive to treat.” Parkes believes sensors could also be incorporated into bone reinforcement implants, which are used to help fractures heal. “In this example, sensors can measure the strain exerted on the implant, which indicates the extent the fracture has healed. From this information, surgeons can determine the best time to progress the patient to the

next stage of therapy and could also identify healing problems earlier than currently possible,” he argues. “As implant loosening can be affected by non-compliance with physiotherapy, technology has been developed to overcome this issue. Incorporating accelerometers to monitor the movement of patients would allow healthcare professionals to remotely obtain data. These could be used to determine whether a patient is complying with their prescribed physiotherapy and rest regime.” One institute developing technology in this field is a collaboration between Renishaw and Western University in Ontario, Canada, which has set up the Additive Design in Surgical Solutions (ADEISS) Centre to bring together clinicians and academics to generate novel 3D printed medical devices. “ADEISS recently showcased the smart hip concept, which uses temperature sensors and accelerometers to collect patient data that can be communicated to a remote device,” reveals Parkes. “By making use of advanced sensor technology, there is now potential for the development of implants that can detect an infection 37


MEDICAL DEVICES and subsequently secrete the appropriate dose of antibiotic to treat it before it becomes symptomatic. This could reduce the number of patients admitted to hospital.” The ultimate driving force for developing smart implants is the potential to considerably improve patient outcomes. Parkes believes AM offers several benefits, one major advantage being that the fit time schedule is reduced – a benefit to both patients and surgeons. The benefits smart implants have over traditional metal implants could mean patients would suffer less pain and discomfort and be less

Additive manufacturing solutions for healthcare applications removable partial dentures

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likely to become seriously ill due to infection while at lower risk of needing revision surgeries – critical for younger patients. However, Parkes maintains that for widespread clinical adoption of smart implants, there are still challenges to overcome. “Clinicians must run clinical studies to collect data on the safety and performance the implants offer to patients,” he says. “This must all be done in line with regulations such as the EU regulations on medical devices. A further key consideration is the processing of personal data in smart implants and how that data is used by the industry and clinicians.”


The treatment of bone diseases and injuries has come a long way since the days of bone setters and blacksmiths, with patients now able to receive metal implants specifically designed to their individual requirements. Parkes expects that trend to develop further as new technology is enhanced: “Pioneering research institutes are overcoming the hurdles and improving the technology, so the

uptake of additively manufactured and data-driven implants is set to rise, improving outcomes for patients and hospitals.”

About Renishaw UK-based Renishaw is a world leading engineering technologies company with over 4,000 employees located in the 35 countries. For the year ending June 2017 Renishaw recorded sales of £536.8mn (US$748.9mn) with 95% coming from exports. The company’s largest markets are China, the USA, Japan and Germany. Renishaw has made a significant commitment to research and development, with up

to 18% of sales invested in R&D and engineering annually. The majority of this R&D, as well as manufacturing of the company’s products, is carried out in the UK. Renishaw’s success has been recognised with numerous international awards, including 18 Queen’s Awards recognising achievements in technology, export and innovation. Find out more at www.renishaw.com 39


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MEDICINE

Could

CANNABINOIDS have a place in paediatric care? JOHN-DAVID BELFONTAINE, FOUNDER AND CEO OF PHIVIDA, TALKS ABOUT HOW THE CBD HEMP OIL PRODUCER’S EXPANSION ACROSS AMERICA CAN BENEFIT FAMILIES AND HELP CHILDREN SUFFERING FROM CONDITIONS LIKE EPILEPSY LIVE A NORMAL LIFE Writ ten by DAN BRIGHTMORE


MEDICINE PHIVIDA’S FOUNDER AND CEO John-David Belfontaine started out in the food and pharma industry as a wholesale CBD (cannabidiol) hemp oil commodities broker with partners in Europe and across the US. Phivida now has major distribution partners for its CBD products, and is preparing for the commercialisation and launch of a strategic suite of CBD infused foods and beverages alongside a range of clinical grade products for healthcare practitioners. With a promotional drive currently focusing on Washington, Oregon and California in the US, the company is also making inroads to expansion into new markets in Asia and the UK. “We’ve gone from being a commodities-based wholesale farming company into one that focuses on creating branded formulations of CBD infused natural health products eligible for sale in stores,” explains Belfontaine. “Compared with other products, we’re offering the medicine but none of the side effects. We’re all about health,

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not the high. We want to offer products to people that will not only treat their conditions with a therapeutic dose of cannabinoids with full-spectrum hemp oil extract, but also have an element of nutrition combined with a supplementary regimen for a more holistic approach to alternative plant health.” Belfontaine has attracted an advisory board chaired


“Compared with other products, we’re offering the medicine but none of the side effects. We’re all about health, not the high” – John-David Belfontaine, Founder and CEO of Phivida

HOW

CANNABINOIDS

WORK by Jon Silverman, the former Executive Vice President of Seagram, including the likes of Jim Bailey, former GM of Red Bull Canada, and Bill Ciprick, former VP of Proctor & Gamble Healthcare. “You don’t normally see this level of c-class executives being involved in a startup, but our story begins with an element of benevolence,” explains Belfontaine.

“As we were looking to acquire farms across the US we connected with farming families and heard stories of children suffering with various forms of intractable seizures. We experienced first-hand what full spectrum hemp oil can do to help a child suffering from such a severe disease. Some of these families have given us stories that are like little miracles.” While the idea of introducing the cannabis plant for paediatric care may 45


MEDICINE seem a step too far for some, Phivida feels that the potential benefits must be recognised and taken into account. Belfontaine has met families with children suffering from epilepsy experiencing up to 450 seizures a week, typically suffering broken bones due to the nature of their drop-down seizures. “Most of them are 95% terminal and don’t make it over the age of 15 due to liver failure from the ant-seizure drugs they’re taking,” he says. “The families are typically in financial ruin due to being under-insured. After seeing these families use full spectrum hemp oil (a product that has no THC but is rich in cannabinoids that are not psychoactive) for a 30-day period, these children go from catatonic and potentially terminal to coming back to life. Mothers talk about meeting their children ‘for the first time’ at the age of 10 when, thanks to a simple plant medicine, they finally have the opportunity to go to school after being prisoners in their own bodies for so long. There’s a bright horizon. We all have an element of wanting to do some good in the world and that’s why we’ve 46

April 2018

“The Phivida Families Program will subsidise and support any family with a child under the age of 18 or elderly parent over the age of 65 that’s under insured and give them the product for free” – John-David Belfontaine, Founder and CEO of Phivida

attracted such a great team.” Has Phivida hit on wider potential to more widely use cannabinoids in chidlren’s healthcare as well as for adults? Belfontaine identifies a triple mission for Phivida: to be a leader in the healthcare sector with its alternative products, to educate through research and to partner with scientists to further the understanding of what’s possible in the field of plant health. An important element is the Phivida Families Program with its three pillars of education, research and subsidy. “The


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MEDICINE

“Mothers talk about meeting their children ‘for the first time’ at the age of 10 when, thanks to a simple plant medicine, they finally have the opportunity to go to school after being prisoners in their own bodies for so long” – John-David Belfontaine, Founder and CEO of Phivida clinical research on cannabinoids has already captured the attention of healthcare practitioners, regulators, professional athletes and the media, which is why investors are so keenly interested in the industry,” Belfontaine says. “One of the factors that sets Phivida apart is our unwavering support for research and education into this important field of health and wellness, and our commitment to apply what we learn to benefit families. Appointing our clinical advisory team is an important first step in that process.” Phivida’s clinical advisory team includes Dr Sunil Pai, Dr Joost Luecker, Dr Brian Martin and Dr Chris Meletis – all naturopathic MDs with PHDs in Botany. They have taken Phivida’s analysis on clinical trials previously performed around the world and compiled it into a concise literature review format for medical practitioner review. “We’ve created a seminar series to go around universities and educate

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practitioners to teach natural path doctors how to use this product responsibly in their medical practice,” reveals Belfontaine. “It’s something that’s never been done and we’re happy to do. It has a business function, but at its core it’s a give-back program that also helps us to communicate with practitioners – at no time is our product mentioned in any of these seminars, nor do we solicit promotion of our product. It’s focused solely on the benefit of practitioners having the most up to date information and the right science.” Belfontaine believes Phivida’s commitment to R&D and innovation is a key component for the success

of both the business and the Phivida Families Program. “It can take the business crowd a moment to comprehend, but we subsidise and support any family with a child under the age of 18 or elderly parent over the age of 65 that’s under insured and give them the product for free,” he reveals. “We’re doing that in the market now and will continue to do so. If there’s an option for these people to have access to the medicine then we remove the commercial component and make sure they’re properly treated via our subsidy programme.” Beyond cannabinoids Meanwhile, Belfontaine plans to expand the Phivida product line: “Our goal is to get good penetration and market share with a strategic portfolio for products that function for different needs in the consumer experience, via two divisions – the consumer line and the clinical line.” The consumer line features functional natural food and beverages including a range of vitamin shots, for which Phivida is seeking standards at trial. “At that point of conversion, we offer an extended or larger format product like juices, teas and innovations like 49


MEDICINE a custom designed all vegan protein shake for muscle and joint repair,” adds Belfontaine. “All of these products have a special nutraceutical (functional food) blend to target key conditions in the body on a preventative health level. “The FDA prevents any company from making health claims associated with cannabinoids. However, they have not prevented the co-mingling of cannabinoids with nutraceuticals that have an FDA-recognised monograph filed. So that’s what we’ve done: we’ve found the right blend. We’ve had a doctor formulate them in conjunction with technical food scientist, Dr Victor Wong. They have created products such as shots and juices for all-day preventative health – to focus in the morning, protect in the afternoon and relax in the evening for mind, body and soul. These noncannabis products can flush out your GI tract

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to make sure you can take on more nutrients in your body, and they can be carried in all the mainstream stores.” Belfontaine highlights the recent WHO report which found no public health risk from CBD: “There’s been a paradigm shift. The marijuana lobby always came from patient advocacy groups that quite honestly were only a whisper when it came to the regulators. It’s now coming from the loudspeaker.” Phivida is targeting healthcare practitioners with its clinical line to offer high-grade products in their practice – tinctures with droppers and hard cap pills specially formulated for muscle, bone and joint nutraceuticals with full spectrum CBD hemp oil. “We’re now in the last stages of developing nanoencapsulated tinctures and hard cap pills. There’s not a significant price difference – nano has a premium of around 10%, but you’re getting four to five times more medicine into the body.” In terms of technology, Belfontaine concedes that the industry is still evolving: “It began as a cottage

industry, but it’s beginning to take shape with more professional approaches to packaging. We’re now seeing production, manufacturing and testing standards equivalent to any natural health products, food or beverages currently sold in mainstream channels. Being involved in the research and development cycle has put us in the ‘best in class’ conversation. It’s not about being first, but about being the best we can be with a strong sense of purpose and mission allied to the values that drive our company.” It’s this mission that drives Belfontaine to deliver the Phivida Families Program, underpinned by values identified by a company icon that depicts a sacred geometric shape known as the seed of life: vida.

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10

Top healthcare brands This article takes a look at the world’s top 10 biggest healthcare brands ranked by revenue, according to Forbes’ Global 2000 rankings Writ ten by HARRY MENE AR


0

TOP 10


RAMSAY HEALTH CARE LTD $6.56BN

10 CERNER CORP $4.8BN Based in Kansas City, Missouri, Cerner provides product design, development, installation, hosting and support services to healthcare organisations and consumers. Cerner reported a net revenue of $4.8bn in 2017, and was ranked 171st worldwide on Forbes’ list of best employers. In March 2018, Cerner announced its partnership with global leader in CRM (customer relationship management), Salesforce. As Healthcare Global has previously reported: “Salesforce Health Cloud will … support health providers to gain a greater understanding and awareness of patient needs, which will drive positive health outcomes.” www.cerner.com 56

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Ramsay Health Care Ltd is based in Sydney, Australia, and specialises in the provision of healthcare services and the operation of hospitals and day surgery facilities across Australia, France, the UK, Indonesia and Malaysia. The company reported a net revenue of $6.56bn in 2017, making it the largest non-US healthcare brand in the world. Demonstrating a commitment to staff working conditions, in February, Ramsay CEO, Craig McNally “blasted opposition leader Bill Shorten’s proposed cap on health insurance premiums, arguing it could force hospitals to cut wage bills,” the Australia Financial Review reported. www.ramsayhealth.com

9


TOP 10

QUEST DIAGNOSTICS INC $7.51BN New Jersey-based company Quest Diagnostics Inc reported a net revenue of $7.51bn in 2017, and was ranked 496th on Forbes’ list of best employers. The company provides diagnostic testing, information and services in order to help both patients and physicians make better decisions regarding healthcare. Quest Diagnostics announced in February that it will be partnering with Rutgers University to “build a new sports science laboratory that the two will use for research,” according to Sport

8 Techie. This direct-to-consumer service is expected to help athletes measure their health, guiding them to improved performance through nutrition and exercise physiology www.questdiagnostics.com

LABCORP $9.64BN LabCorp operates out of Burlington, North Carolina, and specialises in end-to-end drug development through its internally-operated clinical laboratories. The company reported a net revenue of $9.64bn in 2017, as well as a total profit of $722.3mn, marking a 39% increase year-on-year. After acquiring Pathology Associates Medical Laboratories in 2017, LabCorp announced in March that it will lay

7 off almost 200 employees from the Washington-based company, the Triad Business Journal reports. www.labcorp.com

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6 UNIVERSAL HEALTH SERVICES, INC $9.77BN

Based in Pennsylvania, US, Universal Health Services, Inc provides healthcare management services, including the running of hospitals, behavioural health centres, surgical hospitals, ambulatory centres and radiation oncology centres. The company reported a net revenue of $9.77bn in 2017, continuing a five-year trend of growth from $6.9bn in 2013. Universal Health is the largest operator of psychiatric hospitals in the USA. www.uhsinc.com

DAVITA INC $14.74BN DaVita Inc is based in Denver, Colorado, and specialises in the operation of clinics providing kidney dialysis to chronically ill outpatients, as well as the management and operation of medical groups and affiliated physician networks across California, Nevada, New Mexico, Florida, Colorado and Washington. The company reported net sales of $14.74bn in 2017, along with a year-over-year profit increase of over $600mn. www.davita.com 58

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TOP 10

TENET HEALTHCARE CORP $19.62BN

4 COMMUNITY HEALTH SYSTEMS $18.44BN Franklin, Tennessee-based company Community Health Systems specialises in the management and operation of hospitals, with a focus on inpatient, outpatient, and home healthcare services. The company reported a net revenue of $18.44bn in 2017, also reporting an end-ofyear loss in profits of over $1.7bn, in comparison to the previous financial year’s profits in excess of $163mn. CHS “sold 30 hospitals last year and, according to CEO Wayne Smith, more facilities will be leaving the company in 2018,” Nashville Business Journal reports.

Tenet Healthcare Corp operates out of Dallas, Texas, and specialises in healthcare management and operations services, including acute care hospitals, ambulatory surgery centres, diagnostic imaging centres, inpatient care, intensive care, cardiac care, radiology services and emergency medical treatment, as well as outpatient services. Tenet Healthcare reported net sales of $19.62bn in 2017, representing an increase of almost $1bn yearon-year. The company has also reported net losses for the past two financial years, due to asset portfolio growth of almost $15bn over the past five years. www.tenethealth.com

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HCA HOLDINGS INC $41. 49BN Headquartered in Nashville, Tennessee, HCA Holdings Inc. reported a net revenue of $41.49bn in 2017, representing a continuation of a seven-year period of growth year-on-year. The company specialises in the operation and management of hospitals, freestanding surgery centres and emergency rooms, and urgent care centres. With 241,000 employees,

HCA Holdings is the largest healthcare employer in the USA. Forbes has ranked it 93rd on its list of top American Companies. hcahealthcare.com

2

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1 EXPRESS SCRIPTS HOLDINGS CO $100.49BN Express Scripts Holdings Co reported a net revenue of $100.49bn in 2017, the highest reported sales of any healthcare brand worldwide. However, the company only employs 25,600 staff members, the second-lowest payroll on the list. Express Scripts specialises in the provision of integrated pharmacy benefit management services, including network-pharmacy claims processing, home delivery pharmacy care, specialty pharmacy

care, benefit-design consultation, drug utilisation review, formulary management, and medical and drug data analysis, according to Forbes. At $51.71bn, the company also boasts the largest asset portfolio of any company in the top 10. lab.express-scripts.com/about/

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E V E N T S & A S S O C I AT I O N S

Events Healthcare Global takes a look at some of the key industry events and conferences for this calendar year Writ te n by STUART H O DG E


E V E N T S & A S S O C I AT I O N S

Geneva Health Forum 2018 Location: Geneva, Switzerland Date: 10–12 April

Describing itself as ‘the forum of innovative practices in global health’, this year will see the seventh edition of the Geneva Health Forum take place. ‘Precision Global Health in the Digital Age’ is the theme this year, for the summit where attendees can expect to explore the impact of the digital revolution in the health practices, whilst the forum will also look to address emerging global health issues such as future pandemics and health security, antimicrobial resistance, non-communicable diseases, access and affordability to essential medicine and health equality, chronic diseases, universal health coverage, neglected tropical diseases, and essential diagnostics with a special focus on health initiatives from Central Asian countries. Organisers will once again set up The Global Health Lab, an interactive and dynamic hub where participants will be able to try out new technologies and products, which will be a very welcome return to the event, which is all about creating “meaningful connections that could lead to new ideas, new opportunities and partnerships”. www.ghf2018.g2hp.net 64

April 2018


Patient Experience Conference 2018 Location: Chicago, USA Date: 16–18 April The Patient Experience Conference 2018, hosted by The Beryl Institute, brings together the collective voices of healthcare professionals across the globe to convene, engage and expand the dialogue on improving patient experience. The conference is hosted in an interactive format which organisers say will allow attendees to “identify strategies and discover solutions”. Organisers say: “Come prepared to network and build professional relationships, and leave inspired to further your commitment to building the field of patient experience.” www.theberylinstitute.org/page/CONF2018_OVERVIEW

Pharmaceutical Nanotechnology and Nanomedicine Location: Las Vegas, Nevada, USA Date: 18-19 April

Meet inspiring speakers and experts at our 3,000-plus global events with over 600-plus conferences, 1,200-plus symposiums and 1,200-plus workshops on medical, pharma, engineering, science, technology and business. Pharma Nano 2018-USA Conference is a multidisciplinary programme with broad participation with members from around the globe focused on learning about Nano Medicine and its advances. This year’s key theme is ‘Breakthroughs in Pharmaceutical Nanotechnology: Advancements and Challenges’. 65


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International Forum on Quality and Safety in Healthcare – Spring Edition Location: Amsterdam, Netherlands Date: 2–4 May

Over 3,000 attendees are expected in Amsterdam at one of the world’s largest conferences for healthcare professionals to meet, learn and share knowledge at the event which focuses on improving the quality and safety of care for patients and medical communities across the world. The focus this year will be on overcoming the challenges, restrictions and bureaucracy, which prevent meaningful change and to discover that quality in healthcare can be ‘reclaimed’ by making the best use of available resources, promoting innovation and working together to provide exceptional patient care. www.nternationalforum.bmj.com/amsterdam/

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World Health Care Congress 2018 Location: Washington DC Date: 29 April–2 May The 15th Annual World Health Care Congress will see decision makers from payer, provider, pharmaceutical, government, and solutions organisations come together with the aim of inspiring partnerships and defragmenting the current health care system by sharing strategic initiatives, results, and steps to overcome access and affordability issues while delivering high-value care. Speakers will include executives from Lockheed Martin, BlueCross, New York-Presbyterian, UPMC Health Plan, and Essential Health. The event is designed to “help participants form partnerships and become catalysts for change” as they seek to transform the delivery of healthcare. www.worldcongress.com/events/HR18000/ 67


E V E N T S & A S S O C I AT I O N S

Digital Health World Congress

Location: Kensington Conference Centre, London, UK Dates: 8-9 May This year’s keynotes and speakers for Digital Health World Congress 2018 in London. These include IBM, ARM, GSK, Google, TELUS and many more. Key themes informing debates will focus on AI, machine learning and wearable tech as well as numerous seminars on trends within the digital health space, such as using algorithms to dig for digital health data. www.digitalhealthcareworldcongress.com/agenda/

e-Health Conference 2018 Location: Vancouver, Canada Date: 27–30 May

The annual e-Health Conference and Tradeshow is the largest digital health event of its type in Canada and brings together key industry professionals together to network, connect, and learn from one another. Keynote presenters, expert panelists and leading-edge vendors serve to ensure that e-Health is always a popular event, which consistently delivers great education and networking opportunities. Delegates will engage with current and future leaders at the conference, showcase, and hackathon, and network with old and new colleagues at the tradeshow and social events such as the Canadian Health Informatics Awards Gala, and sponsor receptions. www.e-healthconference.com 68

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Digital Healthcare

Location: ExCeL Centre, London, UK Date: 27-28 June Europe’s largest integrated health and social care event, building relationships between commissioners, providers and suppliers, digital healthcare sits at the heart of Health+Care, the largest integrated healthcare event in the UK. In June 2017 DH welcomed 5901 attendees who came together under one roof to find practical solutions to put their transformation plans into action and drive digitally enabled care. www.digitalhealthcareshow.com

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International Forum on Quality and Safety in Healthcare – Autumn Edition Location: Melbourne, Australia Date: 10–12 September

This event follows on from the success of last year’s event at Kuala Lumpur, where 1,000 healthcare practitioners and leaders from over 35 countries were “united by the vision” to improve quality of healthcare provision and act together across professions and with service users to achieve real success in improving care worldwide. The focus at the spring conference in Amsterdam this year will be on overcoming the challenges, restrictions and bureaucracy which stifle the improvement of care, and although an agenda has still to be confirmed for the autumn, discussions could centre on a similar theme. www. internationalforum.bmj.com/melbourne/

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The Biomanufacturing World Summit Location: Torrey Pines State Reserve, San Diego, USA Date: 29-30 October The Biomanufacturing World Summit brings together the “who’s who” of pharmaceutical executives, cutting edge technology providers and media partners for North America’s premier biologics event. The Biomanufacturing World Summit series has grown to become the most senior and diverse gathering of biopharmaceutical manufacturing executives anywhere in the world. Based on an ever-growing network of referrals and recommendations, Biomanufacturing World Summit 2018 is designed and built by Executive Platforms to bring together the right people from around the world and from every relevant company to network, benchmark, learn, and share with one another. 71


INVESTING IN TO CARE FOR CANADA’S

RETIRING POPULATION


an

W Pr ritt od en uc by ed C by ath G er le in n e W S hi tu te rm

The Canadian healthcare industry is facing an uphill challenge, its ageing population in particular reshaping traditional models of care. Jason Gomes, Pacific Reach’s Director of Information Technology, delivers key insights.


PA C I F I C R E A C H P R O P E R T I E S & R E T I R E M E N T C O N C E P T S

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he healthcare industry is witnessing a digital revolution. Escalating healthcare costs, ageing populations and increased demand has led healthcare companies to overhaul traditional models of care, in favour of adopting a complete consumer-focused model. The Canadian healthcare industry in particular is witnessing a significant shift. Up to 770,000 Canadians are now over 85 years old, a figure which keeps growing year-on-year, placing increased demands on current services. Since 2015, it has been reported that there are now more people aged over 65 years in the country than children under 14 years. This changing demographic has led to an increased demand for home care and community led services, as well as the need for technology to play a central role in how care is delivered now and in the future. Noting that tech-savvy Baby Boomers will be the next key generation to retire, healthcare providers and homecare services are looking at new ways to transform

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present service offerings and embrace new digital tools, which will guarantee that the consumer, resident or patient will be at the forefront of all care delivered, whether in an acute or homecare setting. Enter Pacific Reach Established in 2014, Pacific Reach Properties & Retirement Concepts has steadily grown across Western Canada. Managing 25 care homes, the company also houses seven hotels under its umbrella, as well as commercial real estate and multifamily homes. Its growth over the last few years is impressive, but Jason Gomes, Pacific Reach’s Director of Information Technology, explains that its objective to deliver exceptional service, as well as its investment in personalised, digital tools, has been essential to its ongoing growth. “We have a lot of residents now that are more technologically aware. There are a lot of Baby Boomers coming in, where a lot of them bring their own devices,� he adds.


CANADA

Jason Gomes Pacific Reach’s Director of Information Technology

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Managing the digital transformation unable to scale in alignment with of both Pacific Reach’s retirement business growth. Rebuilding Pacific’s and hotel division, Gomes has technology backbone, encompassing introduced technologies, some of the removal of all assets from which, although small, have made a its data centre and starting from significant impact on users lives. scratch, the company has utilised He says: “When I was originally Dell Technologies, and replicated hired, one of the first questions I all its assets to a separate site. asked the ownership was ‘if you Throughout its transformation, were not owners and you Dell technology has been were potential residents embedded and replicated what would you look to a separate site, for in technology?’ enabling the Year Founded “It was very business to interesting to see adopt a disaster their reaction because recovery (DR) strategy they hadn’t thought of it and strengthen its that way. From something security across the board. as simple as wi-fi, to electronic “We’re now scalable and have medication management, to things seen no slowdowns or issues,” that will help the residents in the longcomments Gomes. “As we bring in term, that makes such a big impact new facilities, we’re able to quickly and difference right off the bat.” ramp sites up with a concept I built called “RC in a box.” We can deploy Strengthening its a fully tested solution which includes, technology backbone the Zero Client VDI hardware, Whilst looking at Pacific’s Virtual monitors, printers, firewall, switches Desktop Infrastructure (VDI) and wireless infrastructure. deployments from VMware, Gomes “Being able to change the centre noted that the company would be into a more state-of-the-art center,

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we’re able to scale very quickly. It’s made a huge difference.” The company has also worked to embed wireless technology within every facility under its umbrella in order to cater towards a growing resident and guest demand. “You definitely have to be

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cognizant of any type of brand standard when you put in a new technology – anything from the guest computers or the business areas to the wi-fi,” adds Gomes. This strategy has also led to the revamp of Pacific Reach’s teleconference, internet lines, and


CANADA

770,000

‘UP TO CANADIANS ARE NOW OVER

85 YEARS, A FIGURE WHICH KEEPS GROWING YEAR-ON-YEAR, PLACING INCREASED DEMANDS ON CURRENT SERVICES’

telecom and mobility capabilities, all completed through a number of various partnerships. However, in order to drive down cost savings, in one area alone Gomes has worked to consolidate Pacific Reach’s partners by half, saving up to CA$750,000 in the process.

People focused Across its entire portfolio, Pacific has worked to embed both resident and guest focused technologies across its operations, where both its hotel and retirement division are guaranteed to cater towards delivering exceptional services.

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‘PACIFIC REACH HAS WORKED TO CONSOLIDATE ITS PARTNERS BY HALF, SAVING UP TO CA$750,000’

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“REPORTING, ANALYTICS AND TECHNOLOGY KEEPS EVOLVING AND WE KEEP MOVING WITH THEM” – Jason Gomes, Pacific Reach’s Director of Information Technology

“We’ve got to be at the forefront. We have to make sure our wireless is top of the line and our backend is solid. We want to make sure the guest experience is the best it’s going to be,” advises Gomes. “There’s so many facets, even the way in which residents and guests connect. Is it a chargeable thing for the room or is it a free Wi-Fi? How do we limit it? Do they want to have tiered wi-fi, or do they want to have a standard? There’s a lot of things like that we have to factor in. I think that it’s a good transition from the retirement side as well as into the hotel because you have a better understanding to what people want. “We are now looking at implementing more technology for residents, such as front-end kiosks

where you’ve got a directory, which is a touchscreen and interactive. We are also bringing in guest computers for residents with Skype capabilities as well as making it easier to plan their day by introducing digital signage” Health-tech investment Pacific’s digital transformation has also impacted its healthcare services when supporting residents at its facilities. From outstanding medical documentation, to the transformation of its nurse call systems to become completely location based, residents are now seen quicker; the safety of residents has increased and any incidents are managed effectively by registered and Licensed Practical Nurses (LPNs). “When we first started, if a patient

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fell, staff would assume the resident was in their room, when in fact they could have been on the first floor. We have now changed that technology to be more locationbased, and this standardisation has also allowed for reduced interference across the line,” says Gomes. “I feel that the technology we’ve been putting in is having a significant impact on ensuring the residents’ safety and security. “Another thing we’ve really standardised was changing out all our cameras. We’ve gone to Avigilon Systems, where we’re able to put higher resolution cameras in so we can detect falls, monitor residents and have that layer of safety and security that makes everyone more comfortable,” he continues. “We’ve been working with a couple of companies so that we can predict with analytics when a person may fall or if someone is prone to falling. We can then say, ‘okay, well, based on this, we think this person will have a fall when they get out of bed at two in the morning or they’ll fall at four

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o’clock in the afternoon because they’ve done that seven times this last month.’ Nursing staff can now take a look and they can keep an eye on that person around that time. “Reporting, analytics and technology keeps evolving and we keep moving with them. I think that resident safety and care will only benefit in the long-term.” However, with the number of cyberattacks on healthcare companies, Pacific Reach is taking no chances surrounding the protection of resident data, and works with a number of security companies to ensure it remains ahead of the curve. “It’s always a challenge to make sure the technology keeps apace with what’s out there for healthcare, staying at the forefront of things. You don’t want to be behind the eight-ball,” observes Gomes. “We want to always be in the forefront and be a leader in the field, and a leader of technology rather than a follower. If there’s a new technology that definitely makes sense, we definitely evaluate it.”


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‘UTILISING HIGHER RESOLUTION CAMERAS HAS ENABLED THE COMPANY TO DETECT FALLS EASIER’ w w w. h e a l t h c a re g l o b a l . c o m

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“WE WANT TO ALWAYS BE A LEADER IN THE FIELD, AND A LEADER OF TECHNOLOGY RATHER THAN A FOLLOWER. IF THERE’S A NEW TECHNOLOGY THAT MAKES SENSE, WE DEFINITELY EVALUATE IT” – Jason Gomes, Pacific Reach’s Director of Information Technology

Continuous development Strengthening relationships with partners has therefore been crucial for Pacific Reach, particularly in the building of future projects, facilities or technologies to better support its residents and guests.

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“Working with partners and building that relationship to say, ‘we’d be happy to work with you and give you the business, but you need to work with us on the pricing as well as the quality of gear and the installation’. And having that give and take relationship and


CANADA

being able to consistently keep each other in the loop has made a huge difference as well,” Gomes says. An edge above the rest Pacific Reach will continue to look at further opportunities for expansion, looking out for key trends within its hotel division, on top of its residential offering. Never resting on its laurels, the company maintains an astute awareness that its growth and digital offering go hand-in-hand, which will see it remain a leader in the field.

“We have a very good product. I think it ends up coming down to really providing the best for everybody, but at a better price that’s not going to break the bank,” concludes Gomes. “We keep residents involved. The company has done well at making sure that the residents are put first and foremost. Considering that the business was started from a single home and has developed to one of the largest providers in Canada, I think the company has done extremely well.”

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Flying the flag for New York’s healthcare provision and education SUNY Downstate Medical Center revolutionised medical education by bringing the teaching of medicine to the hospital bedside – now it is transforming the sector again through digital transformation


Written by Laura Mullan Produced by Andy Turner


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he State University of New York Health Science Center, better known to locals as SUNY Downstate Medical Center, has consistently made its mark as one of the nation’s leading urban medical centres. “We are geographically located in an urban area and provide healthcare for an underserved community,” explains Dr. Dilip Nath, Assistant Vice President and Deputy Chief Information Officer. “We are the only academic medical centre in Brooklyn. We provide education, research, and healing. We care about local people and we also offer students a world-class education in healthcare, nursing, and other medical related fields of study. Additionally, we offer leading research facilities and we house the first State BioTech incubator. “Now the question is, how do we transform this and provide high-quality care that our community deserves?” he asks. “How do we maximise every dollar to provide excellent healthcare, training, and research?” Healthcare for a digital age Nath’s answer is simple. SUNY Downstate Medical Center is leveraging technology to automate, modernise, and transform its healthcare services. In doing so, the institution is the driving force for efficiency, business agility, and providing topclass healthcare to Brooklyn’s 2.6mn residents. As an alumnus of the State University of New York himself, Nath’s devotion to the Institution is unquestionable. The first of his family to relocate from Bangladesh to the United States, Nath has risen through the ranks from Director of IT, to Associate CIO, followed by Interim CIO, and finally to his current role today as AVP and Deputy CIO.

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USA

Dilip Nath AVP and Deputy CIO

“It gives me an immense pleasure to give back to the organisation that I went to myself and which teaches and educates hundreds of thousands of students throughout the state�

A recognised technology leader known for driving a strategic plan to achieve business goals, Dilip Nath is an accomplished Higher Education and HealthCare industry executive with over 20 years of experience in driving IT solutions measured by successful ROI, operational improvement, and organisational development. As Deputy Chief Information Officer, he leads a high-performing and responsive IT department consisting of almost 100 employees, while aligning technology initiatives with business objectives. Nath brings a unique background to any organisation through his bravery, commitment to community activism, continuous mentorship through 16 years of experience as an Adjunct Professor, to his unmeasurable success as an accomplished AVP & Deputy Chief Information Officer.

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As a result, he has an inherent computerized physician order entry appreciation of the institution’s digital (CPOE), enterprise resource planning capabilities and understands what is (ERP), cost accounting, revenue needed to take it to the next level. cycle, and ADT Systems. However, “It gives me an immense pleasure this is just the tip of the iceberg. to give back to the organization that I went to myself and which Data, cloud technology teaches and educates hundreds of and more thousands of students throughout SUNY Downstate Medical Center the state,” comments Nath. is now beginning the next Recognising the stage of its digital significance of digital transformation. transformation, Working with Nath has helped IT firm Presido, to design and the institution implement many is preparing to clinical and redesign its entire financial systems, network infrastructure Year Founded including financial to ready itself for the and statistical reports digital age of healthcare. which provided the hospital Such a modern network and academic administration needs a modern data centre and this with greater accessibility to is another technological feat which is patient’s financial records. going to help transform the healthcare What’s more, he also spearheaded and education enterprise, says Nath. the rollout of enterprise-wide Ensuring the uptime of missionapplications such as imaging critical operations is more important solutions and was instrumental in than ever with data centre downtime achieving meaningful use, rolling out costing around $8,000 per minute, electronic medical records (EMR), according to an in-depth study

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by the Emerson Network Power and the Ponemon Institute. This is something which SUNY Downstate Medical Center has taken on board and, as such, the medical centre is exploring the use of cloud technology. “The next thing that we’re working on is taking the digital assets we currently have and morphing them into a private cloud solution,” says Nath. “This will provide a private, encrypted

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connection from our campus to the private vendors that we are working with, such as GAVS Technologies. “If the network goes down, almost everything is down. The whole productivity comes to a halt and so this cloud solution is vital for our transformation,” he adds. Accessible medical records EMRs have become an up-andcoming trend in the healthcare


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landscape and it is a modern innovation which SUNY Downstate Medical Center hasn’t overlooked. More beneficial than a paper record, this tool allows healthcare providers to track data over time, identify patients who are due for visits and screenings, and monitor how patients measure against vaccination and blood pressure readings, with the ultimate aim of improving quality of care. Most importantly, it allows a patient’s health record to move with them, but this only the start of its capabilities, says Nath. “We’re also looking at how we can improve and optimise EMR,” he notes. “We’re working with another partner called Infinite and they are providing a solution whereby it doesn’t matter how many EMRs you have – when a patient shows up to your clinic, it will pull up their latest medical records. The whole goal is to modernise the healthcare we provide by automating our infrastructure and modernising our workflow. “Then the next question is: what should we do with all of this data?” he continues. “We need strong

As the only academic medical centre in Brooklyn, SUNY Medical Center serves a large population –

over 2.6mn people

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analytics, and so we are actually in the process of deploying solutions such as Tableau to achieve this. Then, in the future, we hope to use technologies such as artificial intelligence and predictive analytics so that we can not only provide reactive care, but also be predictive. “There is currently a huge gap between the provider and the patient and all healthcare associates – that’s exactly why we are optimising our EMR,” he adds. “Integration is key in this. We need to integrate and exchange data amongst ourselves and with our patients and other care providers outside of our organisation.” Challenges in the health tech space Bringing about a root-and-branch digital transformation is by no account an easy task, especially when the enterprise is partly responsible for the healthcare of Brooklyn’s 2.6mn residents. However, this challenge is one the medical centre has taken in its stride. “Delivery of care is a challenge as a whole, especially being an

“There’s no quick win. I am more interested in sustainable growth that brings added value to the organisation” – Dilip Nath, AVP and Deputy CIO

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urban area,” reflects Nath. “But transforming technology is much more challenging than in more developed areas because, for example, we can provide patient information through a portal, but when our patient goes home, some may not necessarily have a computer or wi-fi access. “If we could change this, patients would not have to make a phone call or come and visit a clinic,” he adds. “They would be able to communicate with their physicians through telemedicine and telehealth tools. We could see more patients at home, rather than at our clinics. As much as we’re pushing this information as an organisation, there is a lot of work that we, and the government, need to do for the community itself.” On top of the need to provoke deep change within communities, Nath says the healthcare space also needs to have a significant culture shift amongst healthcare staff. “Employing these technologies is a challenge but it’s really about

understanding the needs of our staff and how we can provide the technological solutions for the puzzles they need to solve,” he says. “That’s the key to success. “Once they see the value of technology, it becomes much easier to deploy. Therefore, we take smaller steps, to pilot the technology and roll it out slowly – that’s how you change the cultural barrier or shift to a success. There’s no quick win. I am more interested in sustainable growth that brings added value to the organisation.” Nath’s pride for SUNY Downstate Medical Center shines throughout our conversation. This admiration and commitment to both the institution, its staff, and students also transcends throughout the centre’s technology strategy, and it is this which is helping the medical centre become a leading player in the healthcare space and serve the residents of Brooklyn.

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BECTON DICKINSON – A procurement transformation


BD’s procurement operations have been completely revolutionized in recent years, as the company has embraced transformative technology Written by James Henderson Produced by Glen White


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oday, the procurement operations at Becton Dickinson (BD) – the global medical technology company – are admired and respected across the industry spectrum, with collaboration and joined-up thinking from the company’s procurement teams driving forward the medical equipment giant which turned over more than $12bn in 2016. But what you see today is the result of a near two-decade effort to make BD’s procurement functions best-in-class. The transformation began in 1999, a time when the company’s procurement was decentralized, fragmented and not perceived to be especially important in the grand scheme of all things BD. In total, BD’s core procurement team numbered four. One of the first ambitions for the procurement function was developing effective category management and sourcing, as well as delivering demonstrable value to the business as a whole. That gave BD a base from which to build into what is now a truly global end-to-end procurement operation, with various skilled and

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knowledgeable teams – including source-to-pay, indirect, risk and supplier management to name a few – working together for the benefit of the wider company. From a team of just four less than 20 years ago, BD’s present-day procurement function is home to more than 180 employees and growing, who work towards carefully planned three and five-year roadmaps.


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BD Global Procurement strives to continuously deliver the highest sustained value for the company by leveraging its full competitive supply base using highly effective and efficient systems and processes. Source-To-Pay Critical to the success of BD’s overall procurement function is sourceto-pay. Roger Ambrose is BD’s Senior

Director for Global Source-to-Pay, and has been with the organisation since 1994, when he joined as its European Internal Audit Manager, before taking on responsibility for implementing SAP across the business. Since 2002, Ambrose took responsibility for global processing in Europe, before taking on his current role. Originally a Chartered Accountant, Ambrose says: “As you move into

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“The challenge right now is there is so much information out there – how do you bring it all together in a way that is meaningful and easy to use, so that our expensive sourcing managers can spend their time using the data instead of collecting it?” – Roger Ambrose, Senior Director, Global Source-to-Pay

the procurement space, you realise that actually paying the invoice is the least thing that you’re really worried about from a procurement point of view. You want to be using the right suppliers, have the right supply base, get the right pricing, and have access to accurate analytics.” Ambrose says that the changes made since 2002 are marked, with BD utilizing technology to drive its supply chain transformation. “If I think back to what I was doing in 2002, it’s vastly different to what we’re trying to do today because of technology, but also because of our maturity as a company. That maturity also shows itself up on what we’re doing on the category side.

“I would say that is true particularly with indirect, but probably across the entire spectrum; our sourcing managers are much more knowledgeable about what goes on in their market sectors. Their job is to understand their category, and not just what BD wants out of it, but what we can then offer to our users and stakeholders, so that they can really leverage that and make more use of it. “The challenge right now is there is so much information out there – how do you bring it all together in a way that is meaningful and easy to use, so that our expensive sourcing managers can spend their time using the data instead of collecting it? I think that’s

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the journey that we’re on. I think back to those early days, what we used to collect information from, all of our different systems and spreadsheets. “It was very heavy workload just to put it all together in sensible categories, even assuming the data was correct. Then, we went over to the category managers who would look in their categories, and their job really was to manually cleanse the

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data and make judgements about supplier categories or look the reasons for increased spending. “Over the last few years, what we have done is automate a lot of that work, and freed up our teams to use their time more effectively. We’ve eliminated a lot of the administration that’s needed just to bring them together, and we have been pretty successful in building business rules


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that reflect the cleansing that the category managers did last time, and so they don’t have to do it again. You can see there’s a shift there from the cleansing, even the analytical work, to leveraging it and using it.” Ambrose believes that there is now an opportunity to begin to build in technology – and automation in particular – when designing new procurement tools and systems.

Giving the example of building a new vendor into master vendor list, he says: “We currently have a workflow process that goes through various approvals, and we have to collect a significant amount of data for that vendor for legal and regulatory purposes as well as a sourcing and category strategy purposes. A lot of this information is public and we have the opportunity to use AI to collect it for us. “We can collect that information in, which not only speeds the transaction, but also probably provides more data than we could get on that supplier, that we can feedback into spend analytics and help our sourcing managers do their jobs. “We have the opportunity to be really creative about thinking how we use suppliers in our environment, either to ease the transactions or provide information or identify a risk, or be proactive, such as recognising when a supplier is struggling and how can we help, or being able to identify whether one of our competitors has just signed a deal with them. It’s a really exciting time.”

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Indirect Procurement Williams and the Indirect Procurement Since being appointed as VP team have been able to build and Procurement – Global Indirect in April implement five-year strategies across 2014, Patrick Williams is credited with multiple channels, saving hundreds of leading a large-scale transformation millions of dollars for the organization across the full breadth of the Indirect in the process. Such has been the categories to utilize cross functional success, the ‘ReCapture’ name has teams to develop category strategies fallen by the wayside – “it’s just the that drive competitive advantage. way we work now, indirect is very The program was known internally as much on the company’s radar now,” ‘ReCapture’, and is says Williams. fully endorsed by “When I first joined BD’s management BD, our ‘spend committee. under source plan’, Williams says which is when you the buying and develop a strategy, engagement from actually write what Number of senior management we call a ‘source Employees at BD has been integral to plan’, which is the the success of the official document initiative, describing that completely it as “critical”. “The management outlines the strategy I think was in the committee is not something we had 20% range. We are now at 59% and before,” he says. “The program is climbing, so we are making excellent not just sponsored, but governed progress when it comes to developing and controlled by those at the very strategies and implementing them.” highest level of the company. Teams In the company’s journey to supply also do not get to opt-out, so the chain transformation, Williams says scope of it stays consistent.” it has benefitted from taking a wide Off the back of the program, view of what strategies are working

49,500

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“As an R&D team, we have to push the status quo when it comes to technology and how it can help the business” – Noelle Lee, Vice President, WW Procurement R&D


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within the market sector, an approach which has led to the company exploring other business avenues. “Essentially, we have the advantage of many companies have actually done some really great things that we can leverage. We can follow it, so it gives us that late-mover advantage of saying, ‘There is a model, somebody cut their teeth on it a little bit, and we can actually apply it and gain lots of advantage.’ A good example would be outsourcing, which BD has started to do more. “There used be zero appetite for it; the philosophy was that our business extended to the fence at the end of our offices – the attitude is that we could do things better than anyone – which is obviously now not smart. So, this idea of outsourcing is an example where we’re smartly doing certain things. We recently outsourced some IT and it drove tremendous value.” On leveraging new technology – AI, machine learning, automation, et al – to drive BD’s procurement journey and transformation, Williams is unequivocal. “I am convinced that is the wave of our future across all

of our categories, not just indirect – our focus on digital is laser. “I’ve assigned members of our IT procurement team to develop strategies for their peers in departments such as IT, finance, legal, sales and marketing, plant indirect, etc. What we’re asking them to do is pair up and look at digital opportunities where there’s machinery involved and you can use technology to be smarter. “We think on a long-term basis, we could drive hundreds of millions of dollars in the categories themselves by leveraging technology. We are looking at what we can get working on today, and what is perhaps in more of a concept stage that we need to develop to eventually make it usable.” Global R&D Procurement Less than 12 months old, BD’s Global R&D Procurement division is headed up by Noelle Lee. She leads a global team of associates and that help drive sourcing strategies that supports BD’s innovation pipeline, enabling top-line growth and accelerated time to market. She says the division was

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created due to a recognition that as the importance of innovation grows, more dedicated R&D procurement will be needed to manage the rising spend. Elaborating on the division’s remit, Lee comments: “It’s about getting as much value out of every dollar that we spend. The industry is going through a lot of change and innovation is being driven forward, so it’s really important for us to have

established this R&D team. We want to become a really trusted partner of the business, and push real top line growth for the company. “As an R&D team, we have to push the status quo when it comes to technology and how it can help the business. For example, there are now companies that can automate a function such as labelling, which in the past has been typically a manual

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Better together: BD and Bard

job. So we are able to take that to the business with the argument that it will drive efficiency and take over from a function that was previously very labour intensive. This R&D team is taking these ideas and implementing them, which is very positive for BD.” The expectation for the division is such that members of the team are required to have a broad breadth of experience across the procurement

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spectrum, so they speak the language of all stakeholders – liaising with IT in one instance, and then marketing the next, for example. “It is essential that we are able to fully understand the challenges and targets of all of our stakeholders,” Lee comments. “We are being asked to connect the dots and drive change; we need to act as a change agent and to do that we have to be able to speak the


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“I want BD to become bestin-class compared to our peers, the best-of-the-best” – Patrick Williams, VP Procurement – Global Inderect

language and get everybody on board with our ideas. BD has been very consistent in driving change, whether that’s across the entire organisation or in single functions, and we have to be an important part of that.” In the months since it has been established, the R&D Procurement division has already introduced insight and perspective to the overall global procurement operation, and Lee says there are many more areas where it can push improvements and growth. “We need to collaborate more with our preferred suppliers to really challenge them and drive innovation. We know what the business needs

now and will need in the future and we need to challenge the supplier base to drive that and innovate with us. There is a lot more we can harness from our suppliers and that’s something we will look to do over the next three to five years. “It’s also important that when we’re working in a global role, we understand how different approaches work for different territories, negotiating with suppliers is very different depending on where you are. A Japanese supplier is going to be very different from an American supplier, for example.” Lee believes that the transformation

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being pursued by BD and the R&D procurement team will be vital in the overall effort to secure and develop the best new talent to the organisation. “There is an opportunity for us to


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understand procurement so we have to engage with them, communicate what procurement really is and the opportunities within the industry.”

establish procurement as a hugely important driver for change in the business and that is only going to help attract and retain the best talent. I think many graduates don’t really

Driving ahead BD has come a long way since the turn of the millennium. Where there was previously just a handful of procurement staff, there is now a highly competent and knowledgeable division comprising almost 200 professionals. Once perhaps considered a cautious, BD’s global procurement teams have fully embraced technology to drive both the procurement function and the wider company’s top-line performance. The company is now thinking about how it can utilize AI and machine learning, automation and further bleeding-edge technology to improve yet further. Describing his goals for the future, Patrick Williams says: “I want BD to become best-in-class compared to our peers, the best-of-the-best.”. If BD continues its current trajectory, it would take a brave person to bet against the organization achieving exactly that.

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Lagoon Hospitals and Nigeria’s growing private healthcare sector WRITTEN BY FRAN ROBERTS PRODUCED BY GREG CHURCHILL


Lagoon Hospitals is one of the largest healthcare companies in Nigeria. With an impressive track record stretching over 30 years, the company is committed to driving up quality standards throughout its operations as it looks to increase its footprint in the coming years

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agoon is the only Joint Commission International (JCI) accredited private healthcare provider in Nigeria, and only one of two in sub-Saharan Africa. The company has been in operation since 1986, when it managed a single hospital in Lagos. Today, Lagoon has expanded to three hospitals and two clinics and is today the largest private healthcare operator in Nigeria. Lagoon is a part of Hygeia Nigeria Ltd and has consistently been providing healthcare of international standards to the people of Nigeria. Last year, Lagoon added its third hospital – Gold Cross Hospital Ikoyi – and the organisation is looking to expand the services it offers to patients. “We are moving towards tertiary care, so some of the key medical programmes that we’re looking at are the neurosciences, as well as orthopaedics, which will include joint replacements and arthroplasty. We’re moving into cardio thoracic surgery, interventional cardiology later on in the year, while focussing on

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Lagoon Hospital Ikoyi, Lagos

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building nephrology, urology, critical care, and neo-natal critical care. These are some of the key specialities within the medical care programme that will be launching throughout the course of the year,” advises Rajeev Bhandari, CEO. With this in mind, Lagoon is investing in its hospitals and clinics. “We have already been revamping some of our facilities with state-of-the art units. We’ve set up new critical care units in our hospitals,” explains Bhandari. “All of that is to ensure that we provide the right kind of care and the right levels of service.”

MAJOR GOALS A PwC survey of Nigerians found that more than 90% of respondents associated advanced healthcare delivered in Nigeria with “low quality”. Despite this, Lagoon is striving hard to deliver healthcare that meets and exceeds international standards. “We’re consistently looking at increasing our footprint to be the best healthcare provider in Nigeria. Nigeria currently has a very substantial population that goes out of the country for medical treatment,” states Bhandari.

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“We’re consistently looking at increasing our footprint to be the best healthcare provider in Nigeria” – Rajeev Bhandari, CEO, Lagoon Hospitals

“One of our major goals is to provide healthcare at affordable rates, of high quality standards to Nigerians so that they can actually avail those services here and do not have to go out of the country. We have a very strong commitment to quality – the quality of the healthcare we provide, patient care and clinical excellence,” Bhandari continues. It is this commitment to quality that sets Lagoon apart from other private healthcare providers in Nigeria. “We don’t compromise on

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quality at all,” notes Bhandari. “Our standards of quality are very high and that is something we are very committed to and of course the other thing that sets us apart is the quality of clinicians. The profile of the clinicians that we offer are definitely the best in Nigeria. We feel proud that we offer the right clinical mix and quality of service to our patients.”

ENSURING CONSISTENCY Guidelines set out by JCI help Lagoon to meet such high standards of quality. “We actually follow certain healthcare guidelines that have been provided by JCI on adherence to quality patient care,” Bhandari comments. “We have been given scorecards based on all our processes, procedures and medical methods. We also have non-medical indicators, which give us a scorecard for patient care services. They start right from waiting times to turnaround of lab test times to radiology tests, so covering approximately 18 different parameters based around clinician satisfaction and patient experience.” As well as the quality of care,

patient safety is at the heart of everything Lagoon does. “We ensure consistency through training, again as per JCI standards and other internal SOPs. We have consistent training and retraining for our people. We follow a system where we check on all processes that have been laid out,” Bhandari advises. “We collect data, validate the data and track the data as per our SOPs and guidelines provided. Of course, we have a strong culture of empowering people to speak out whenever there are any issues, so that we can ensure that we rectify them.” In order to meet international healthcare standards, Lagoon works with partners overseas to keep up to date with the latest expertise. “We have a JV with Fortis Healthcare in India where we take clinical expertise in terms of SOPs, protocols, processes from them so that we can actually manage to deliver international standards of healthcare here,” explains Bhandari. “We work with them closely, they’re our international partners.”

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THE IMPORTANCE OF INNOVATION Lagoon has long pioneered advanced medical care in Nigeria, becoming the first private hospital in the country to successfully perform open-heart surgery. Today, such pioneering innovation continues, where Lagoon eagerly embraces the latest technology. “Innovation has always been very important to us. In Nigeria, we were the first operators to actually launch fully electronic medical records. We predominantly operate paperless facilities and

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we have gone electronic for our patients. This can be accessed across facilities,” Bhandari advises. “Additionally, we have our own hospital information system that we work with. All our facilities are connected to each other so a patient can walk into any of our facilities and with one registration number we can access their medical records. That ensures continuity of care. Technology is of course paramount to our business, and so we’re investing in the best and latest medical technology.”


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STRONG DEMAND

“Our standards of quality are very high and that is something we are very committed to and of course the other thing that sets us apart is the quality of clinicians”

With facilities around Lagos, Lagoon is able to cater to the healthcare needs of Nigeria’s, and indeed Africa’s, largest city. It is one of the fastest growing in the world, and also one of the most populous urban agglomerations. Indeed, Nigeria as a whole has experienced exponential population growth over the preceding decades. According to the 2017 revision of the World Population Prospects, the total population of Nigeria was 185,989,640 in 2016, compared to only 37,860,000 in 1950. This means that there is significant potential for Lagoon to expand outside of its home city in the coming years. “Our objective is to increase our footprint across Lagos and eventually across Nigeria,” Bhandari comments. “If any appropriate opportunities come along we will be evaluating those to see if we can increase our footprint. There is a strong demand for the private healthcare set up in Nigeria.”

– Rajeev Bhandari, CEO, Lagoon Hospitals

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Healthcare Global magazine - April 2018  
Healthcare Global magazine - April 2018