Global Medical Business Magazine - December 2023

International edition

Global Medical

Business Winter 2023

“Researchers have produced an engineered tissue representing a simplified cerebral cortex by 3D printing human stem cells”

Most Accurate Test to Measure Biological Aging The Crucial Role of DevSecOps in Protecting Healthcare Data

The Top 5 Healthcare Trends in 2023

EXPLORING VOICE-BASED AI IN HEALTHCARE 1

2

3

Contents How To Choose The 10 Emerging Public Health Issues of 2023 Right E-Commerce Platform For Your Health 22 Organization 06

Research: How Successful Health Care Organizations Keep Worker Morale Up 08

Hospitals are in a World of Denial 14

Scientists Develop 3D Printing Method that Shows Promise for Repairing Brain Injuries

Most accurate test to date developed to measure biological aging 24

Exploring Voice-Based AI In healthcare 28

The Top 5 Healthcare Trends In 2023 34

Medical Devices: From Design to Production 36

New Organ-on-aChip Model of Human Synovium Could Accelerate Development of Treatments for Arthritis

The Crucial Role of 38 DevSecOps in Protecting Healthcare Data 30

AI Language Models Could Help Diagnose Schizophrenia

16

Latest Tento+ to be First Generative AI Tool in Medical Complian

42

Patient Engagement: The 21st Century is Calling, Texting and Sending Video

32

Coaching Program Reduces Burnout in Medical Residents 44

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01

How To Choose The Right E-Commerce Platform For Your Health Organization

By Bjoern Sjut

The healthcare industry is undergoing

■

Access medical records

For example, healthcare organizations

a rapid transformation, with more

■

Order and refill prescriptions

can use e-commerce platforms to:

and more patients turning to online

■

Ask healthcare professionals

channels to access healthcare services and information. To meet this growing demand, healthcare organizations need to invest in a solid e-commerce platform that can help them to know the benefits such as: Improved patient care: E-commerce platforms can help healthcare organizations improve patient care by making it easier for patients to access healthcare services and information. For example, patients can

questions and get advice.

Increased revenue: E-commerce

■

Sell their products and services to patients in other countries

■

Offer telemedicine services to

platforms can help healthcare

patients in rural or underserved

organizations increase revenue

areas

by providing new ways to sell their

■

Provide educational resources to

products and services. For example,

patients and customers around the

healthcare organizations can use

globe

e-commerce platforms to sell:

E-commerce management services can

■

Over-the-counter medications

■

Medical supplies

■

Health and wellness products

choose the right e-commerce platform

■

Educational resources

for their needs and ensure that it is

help healthcare organizations

implemented and managed correctly.

use e-commerce platforms to: Expanded reach: E-commerce platforms

Consider these number of factors including:

■

Schedule appointments

can help healthcare organizations

■

Pay for services

expand their reach by allowing them to reach patients and customers worldwide.

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■

Compliance and security: Choosing

■

Cost: E-commerce platforms

■

Train your staff on how to use the

an e-commerce platform that

can vary in price. It is important to

e-commerce platform. This will

complies with all applicable

choose an e-commerce platform

help ensure they can provide good

healthcare regulations, such as

that fits your budget and offers the

customer service to your patients

HIPAA, is important. Additionally,

features and functionality you need.

and customers.

you need to choose an e-commerce platform with a strong security

■

system to protect patient data.

■

E-commerce platforms can offer

■

Monitor the performance of your

several benefits for healthcare

e-commerce platform and make

organizations. By choosing the right

adjustments as needed. This will

Scalability and growth: You need to

e-commerce platform, healthcare

help you ensure that the platform

choose an e-commerce platform

organizations can improve patient

meets your needs and provides a

that can scale to meet the needs

care, increase revenue, and expand

good experience for your patients

of your growing business. You

their reach.

and customers.

must also choose an e-commerce platform compatible with your

Additional Tips for Choosing and Using

existing healthcare systems.

an E-Commerce Platform for Your Healthcare Organization

■

Features and functionality: You need to choose an e-commerce

■

Read reviews from other healthcare

platform with the features and

organizations. This can help you to

functionality your organization

learn about the pros and cons of

needs. For example, if you plan to sell

different e-commerce platforms.

prescription medications, you must choose an e-commerce platform to

■

process prescriptions electronically.

Contact the e-commerce platform vendor and ask questions. This is a good way to get more information

■

Ease of use: It is important to

about the platform’s features,

choose an e-commerce platform

functionality, and pricing.

that is easy to use for both patients and healthcare professionals. The

■

Make sure that the e-commerce

e-commerce platform should be

platform is compatible with your

easy to navigate and provide clear

existing healthcare systems.

instructions on using its features.

This will contribute to a smooth and efficient transition to using the new platform.

7

Reference Sjut, B. (2023) How to choose the right e-commerce platform for Your Health Organization, Healthcare Business Today. Available at: https://www. healthcarebusinesstoday.com/how-to-choosethe-right-e-commerce-platform-for-your-healthorganization/ (Accessed: 29 September 2023).

02 Research: How Successful Health Care Organizations Keep Worker Morale Up

By Jessica Dudley, Milissa Eagle, and Thomas H. Lee

The workforce burnout and retention

a five-point scale, engagement declined

crisis has been dominating health care

.10 the year after the pandemic started

for the last three years, but data (finally)

(calendar year 2021) — the largest decline

shows some encouraging trends.

in engagement for caregivers that Press

Analyses of survey responses from the

Ganey has observed, but the decline has

last three years show that the decline

slowed, with only a .02 decline in 2022.

in workforce “engagement” has flattened out and “resilience” is actually improving.

ALIGNMENT

The data also shows a spreading of the

There was a similar flattening of the rate

pack — with bigger variation between

of decline of alignment, which is assessed

organizations where workforce morale

through measures that reflect providers’

and retention is improving versus others

perceptions of their relationship with

where the slide continues. This article will

organizational leadership. For example,

capture some of the best practices that

if they do not feel respected or that their

have the potential to turn a vicious cycle

voices are heard in decisions that impact

into a virtuous one..

their practice, they are not likely to feel aligned with the organization even if they

SURVEY FINDINGS The following analyses are based on about 1.6 million survey responses from employees of U.S. health care organizations (including over 121,500 physicians) during 2020, 2021, and 2022 conducted by our company, Press Ganey.

While burnout has been worsening for all types of health care professionals, three additional metrics provide a more complete picture of what is happening in health care:

are proud of it. This helps explain why so many women physicians have quit.

RESILIENCE There was actually some improvement in 2022 in resilience: the ability to find meaning in work (activation) and recharge when away from work (decompression). (See this article for specific survey items used to gauge both.) The good news is that activation remained stable throughout the pandemic for virtually everyone in health

ENGAGEMENT

care. These are good people motivated

During the last year, there has been

by doing good. But the even better news

a flattening of the downward trend

is that decompression improved in 2022

for engagement, which measures

after two years of steep decline. This data

employees’ emotional bond with the

indicates that caregivers are learning how

organization and their willingness

to cope with the stresses of this era, their

to go above and beyond their job

organizations are doing a better job

descriptions to meet the needs

of supporting them, or both.

of patients and colleagues. Using

8

9

These three encouraging trends don’t

of the contribution of employees,

groups of employees and reveal

apply to everyone. Our data shows

respect and involvement

opportunities to address their specific

a widening gap between the top 10%

in decision-making, manageable

needs. Virtual focus groups and digital

of organizations in workforce

job stress, and adequate staffing.

communities can “bring together”

engagement and the bottom 10%.

employees facing similar challenges

In short, employee engagement

How do we get from a vicious cycle

and enable both connection and

at many organizations is improving,

to a virtuous one? By implementing

opportunity to collaborate and solve

while at others it is getting worse. The

these measures:

shared challenges.

AUTHENTICALLY LISTEN

Crowdsourcing technology allows

data suggests that some organizations are trapped in a vicious cycle in which stress is leading to burnout leading to worse performance leading to more stress. But other organizations (or sub-units of those organizations) are in a virtuous cycle in which pride among caregivers leads to better engagement which leads to better performance which leads to more pride.

The first thing organizations and their leaders should (and can) do immediately is to listen and understand the challenges facing their individual employees and their leaders. What it means to authentically listen changed during the pandemic.

It no longer means just getting out for “leadership walk rounds,” surveys every

managers and leaders to involve their front lines in identifying solutions to problems and prioritizing which solutions to start with. By leveraging artificial intelligence (AI) and natural language processing, employee comments can be organized and channeled to reveal both challenges and successes, both of which create opportunities to fix the problems and

The picture that emerges from this

one or two years, or occasional town

data is that health care has dedicated

halls for the shift that happens to be

and hardworking people who have

on duty at midday. It involves not only

been through a lot but, in the right

amassing more information but also

circumstances, still have more to give.

simultaneously showing employees

What are those right circumstances?

that you are doing so.

authentically listening is a sign of respect.

decile of workforce engagement

Today, authentically listening requires

offers insights.

a major shift in the frequency, breadth,

MAKE ENGAGEMENT AND WELL-BEING A PRIORITY

and depth of listening, which can be

While every organization will have

accomplished thanks to technology.

different and unique results from

For example, new tools can empower

its listening efforts, top-performing

managers to perform pulse surveys

organizations all have one thing

scale the existing successful solutions.

Many leaders still shudder at the idea of surveying employees when they know the feedback will be painful, but

Data from organizations in the top

Top performers scored markedly higher than others in five specific domains: support from and confidence in senior leadership, recognition

focused on specific issues or specific

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in common: Senior leaders (often

through surveys, focus groups,

to retain the remarkable people who

including their boards) have prioritized

and other listening approaches.

continue to work in health care.

engagement and well-being. They

Developing leaders and building teams

Organizational leadership that

recognize that an engaged and healthy

is also a critical tactic for maintaining

embraces a coordinated strategy of

workforce is critical for them to provide

virtuous cycles. This requires investments

authentically listening to its employees

excellent patient care and reduce

in coaching and more structured

and patients, developing their leaders,

patient suffering.

training. Focusing on the skills that

and continuously improving workflows

leaders require to engender trust and

will drive the flywheel of pride and

These top performers hold themselves

confidence should be taught so that new

engagement necessary to sustain

accountable for improving every year

leaders have the skills to support and

the virtuous cycle.

and are making the investments

build their teams. Ultimately the goal for

to support this improvement. While

leaders is to create a psychologically safe

they rely on their HR leaders heavily,

environment where those around them

they engage leadership across the

feel comfortable speaking up and out

organization, including nursing,

and actively contribute to improvement.

the importance of employee

physician, and quality and safety leaders to collectively address these issues.

FIX BROKEN SYSTEMS FOCUS ON THREE

AND PROCESSES

IMPROVEMENT AREAS

Finally, top-performing organizations

Next, virtually all top-performing

demonstrate their commitment

organizations focus on doing

to fixing dysfunction in the systems

these things:

and processes currently in place.

They fix broken processes, leverage

ENCOURAGE SELF-CARE

technology, and build teams so that

Tactics to support individuals should

they can all work smarter. And they

emphasize the importance of self-care

know that to solve these problems,

— something done poorly in health care.

they must include the voices of their

Organizations should share positive

front lines. They have developed reliable

feedback from colleagues, leaders, and

processes for ensuring that those closest

patients (and the vast majority of patient

to the work are supported in solving

feedback is positive) to demonstrate

the problems. Many organizations

organizational gratitude and respect.

have adopted the approach of GROSS (“getting rid of stupid stuff”) and have

Organizations should both invest

put processes in place to listen to their

in peer-support programs so that

front lines and then implement solutions.

colleagues can identify suffering in their

Others are using new crowdsourcing

ranks and design solutions that will help

technology that enables employees

them. And they should continue their

to submit innovative solutions to

evolution from the traditional in-person

challenges revealed through annual

workplace to one that embraces hybrid

surveying; these organizations

or remote work where possible —

then use these submissions to blaze

an evolution that introduces complexity

a path forward.

for managers but can enhance resilience for their employees.

This continuous reevaluation of systems and processes must be built into the

SUPPORT LEADERS AND TEAMS

organizational frameworks of health care

After listening, the best organizations

providers. This type of approach is one

take their data and go deeper. They

that many organizations have already

identify teams that are facing more

taken to build a safety culture and

obstacles and leaders who are struggling.

improve quality outcomes for

They support the managers of these

patients. It must now be applied

units in developing improvement plans

to organizational efforts to improve

to address specific issues revealed

engagement and resilience in order

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Reference Dudley, J., Eagle, M. and Lee, T.H. (2023) Research: How successful health care organizations keep worker morale up, Harvard Business Review. Available at: https://hbr.org/2023/05/research-how-successfulhealth-care-organizations-keep-worker-morale-up (Accessed: 29 September 2023).

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03

Hospitals Are In A World Of Denial

By Molly Gamble

14

Hospital and insurer contract

The reimbursement rates secured

Data and numbers on denial rates are

negotiations are often framed as an

in contracts are what you can see

not easy to find, but some examination

industry gauntlet, a defined period

above water. Beneath, health insurers

paints a picture rich with variation.

of time with an objective outcome where

are moving faster and kicking harder.

An analysis of 2021 plans on Healthcare.

big talk does not translate to money.

Throughout the first three months of

gov conducted by KFF found nearly

But reimbursement rates secured

2023, about one-third of inpatient and

17 percent of in-network claims were

in new contracts are only one piece

outpatient claims submitted by providers

denied, with rates varying from 2 percent

of hospitals’ payer-induced headaches.

to commercial payers went unpaid

to 49 percent. The reasons for the bulk

for more than 90 days, according

of denials are unclear. About 14 percent

to an analysis from Crowe. “So many

were attributed to an excluded service,

more claims are now surfacing with

8 percent to lack of pre-authorization

some kind of a fallout on a denial,

or referral and 2 percent to questions

a downcoding or a pre-authorization

of medical necessity. A whopping 77

— you know, the proverbial dotting

percent were classified as “all other

the i’s and crossing the t’s, sometimes.

reasons.” Adding to the inconsistency

But what is abundantly clear is it is

is the fact that health plan denial rates

not fundamentally about a clinical

fluctuate year over year. In 2020,

difference,” Mr. Johnson said.

a gold-level health plan offered

Traditionally, a health system and commercial insurer would occasionally run into a wall in the contract negotiation process. This could play out into a dispute palpable enough to consumers that it warranted headlines. These impasses generally lasted a matter of weeks with no significant disruptions before outside pressure drove the parties to compromise.

Over the past five years or so, the nature of provider-payer conflicts intensified and may be on the cusp of unprecedented severity given health systems’ financial pressures. At the same time, agreed-upon reimbursement rates are only the tip of the iceberg when it comes to payment health systems can expect from commercial insurers, who have many more defensive plays in their playbook. They boil down to a classic line from a 1968 movie:

by Oscar Insurance in Florida denied Denials were once reserved for a sliver of expensive treatments and have now become common occurrence for mundane, ordinary medical care and treatments such as inhalers or familiar medications for chronic conditions a patient has managed for years. The administrative burden is something close to a requirement to prove residency every month to receive electricity or verifying eligibility to work in the U.S. every week for a paycheck — redundant,

deny, deny, deny.

timewasting activity for ordinary,

Russ Johnson is CEO of LMH Health,

to keep up with what I frankly think

a 102-year-old, independent, nonprofit health system based in Lawrence, Kan. The $350 million organization is anchored by a 174-bed hospital. As he puts it: “We’re not tiny, but we’re not very big.”

Mr. Johnson has spent 37 years working in healthcare, holding senior leadership positions in hospitals and health systems

essential things. “For our business office is mischief by the payers in terms of denials, pre-authorization, DRG downcoding and a completely unengaged experience trying to negotiate — or to have our physicians call in and do a peer-to-peer conferences about clinical necessity — it’s demoralizing, frankly,” Mr. Johnson said.

in rural communities and large cities.

“Dealing with denial from our payers

It’s difficult to identify many things

our physicians face.”

is one of the biggest dissatisfiers

going well when it comes to providerpayer relationships, but Mr. Johnson told Becker’s that it’s the payer movements beneath the reimbursement rates that are worsening and causing greater pain today. “The part that’s getting worse is the practices behind and underneath the contracts — the sophistication and implementation of pay practices, information systems, artificial intelligence and computer algorithms that are just denying claims by the thousands every month,” he said.

66 percent of payment requests; in 2021 it denied 7 percent.

There is much to learn about the ways AI will shape healthcare, and its potential to further expedite and increase denials is concerning. Cigna faces a classaction lawsuit alleging it bypassed requirements for claim review before denial by having an algorithm — dubbed “PXDX” — complete review before having physicians sign off on batches of denied claims. The lawsuit followed a ProPublica report on the practice, which said Cigna physicians denied more than 300,000 claims over two months in 2022 through the system, which equated to 1.2 seconds of review per claim on average.

AI is often touted as a potential, looming replacement to hardworking healthcare professionals, but in the day to day it exacerbates the administrative burdens that already bring them down. “Nobody becomes a physician because they hope to feel like a cog in a factory,” Michael Ivy, MD, deputy chief medical officer of Yale New Haven (Conn.) Health, told Becker’s.

Authors of the 2010 Affordable Care Act worried that provisions to expand health insurance access — such as barring health insurers’ refusal to cover patients with preexisting conditions — could cause them to ratchet up other tactics to make up for the change. With this in mind, the law charged HHS with

“However, between meeting the demands of payers for referrals, denials of payment and increased documentation requirements in order to assure proper reimbursement and risk adjustment, as well as an increasing number of production metrics, it can be difficult not to feel like a cog.”

monitoring health plan denial rates, but oversight has been unfulfilled, leaving denials widespread.

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Reference Gamble, M. (2023) ‘Hospitals are in a world of denial’, October 2023 Issue of Beckers Hospital.

04

Scientists Develop 3D Printing Method That Shows Promise For Repairing Brain Injuries Researchers have produced an

brain tissue by 3D printing human neural

strong integration, as demonstrated by

engineered tissue representing

stem cells. When implanted into mouse

the projection of neural processes and

a simplified cerebral cortex by 3D

brain slices, the cells showed convincing

the migration of neurons across the

printing human stem cells. When

structural and functional integration with

implant-host boundary. The implanted

implanted into mouse brain slices, the

the host tissue.

cells also showed signalling activity,

structures became integrated with the host tissue.

which correlated with that of the host Lead author Dr Yongcheng Jin

cells. This indicates that the human and

(Department of Chemistry, University

mouse cells were communicating with

The breakthrough technique developed

of Oxford) said: ‘This advance marks a

each other, demonstrating functional

by University of Oxford researchers could

significant step towards the fabrication

as well as structural integration.

one day provide tailored repairs for those

of materials with the full structure and

who suffer brain injuries. The researchers

function of natural brain tissues. The

The researchers now intend

demonstrated for the first time that

work will provide a unique opportunity

to further refine the droplet printing

neural cells can be 3D printed to mimic

to explore the workings of the human

technique to create complex

the architecture of the cerebral cortex.

cortex and, in the long term, it will offer

multi-layered cerebral cortex tissues

The results have been published today in

hope to individuals who sustain brain

that more realistically mimic the human

the journal Nature Communications.

injuries.’

brain’s architecture. Besides their

Brain injuries, including those caused

The cortical structure was made from

by trauma, stroke and surgery for brain

human induced pluripotent stem cells

tumours, typically result in significant

(hiPSCs), which have the potential to

damage to the cerebral cortex (the outer

produce the cell types found in most

layer of the human brain), leading to

human tissues. A key advantage of using

difficulties in cognition, movement and

hiPSCs for tissue repair is that they can

communication. For example, each year,

be easily derived from cells harvested

around 70 million people globally suffer

from patients themselves, and therefore

from traumatic brain injury (TBI), with

would not trigger

5 million of these cases being severe or

an immune response.

potential for repairing brain injuries,

fatal. Currently, there are no effective treatments for severe brain injuries,

The hiPSCs were differentiated into

leading to serious impacts on quality

neural progenitor cells for two different

of life.

layers of the cerebral cortex, by using specific combinations of growth factors

Tissue regenerative therapies, especially

and chemicals. The cells were then

those in which patients are given

suspended in solution to generate two

implants derived from their own stem

‘bioinks’, which were then printed to

cells, could be a promising route to treat

produce a two-layered structure. In

brain injuries in the future. Up to now,

culture, the printed tissues maintained

however, there has been no method to

their layered cellular architecture for

ensure that implanted stem cells mimic

weeks, as indicated by the expression of

the architecture of the brain.

layer-specific biomarkers.

In this new study, the University of Oxford

When the printed tissues were implanted

researchers fabricated a two-layered

into mouse brain slices, they showed

16

these engineered tissues might be

used in drug evaluation, studies of

Senior author Professor Hagan Bayley

brain development, and to improve our

(Department of Chemistry, University of

understanding of the basis of cognition.

Oxford) said: ‘This futuristic endeavour could only have been achieved by the

The new advance builds on the team’s

highly multidisciplinary interactions

decade-long track record in inventing

encouraged by Oxford’s Martin School,

and patenting 3D printing technologies

involving both Oxford’s Department

for synthetic tissues and cultured cells.

of Chemistry and the Department of Physiology, Anatomy and Genetics.’

Senior author Dr Linna Zhou (Department of Chemistry, University of Oxford) said: ‘Our droplet printing technique provides a means to engineer living 3D tissues with desired architectures, which brings us closer to the creation of personalized implantation

Reference Yongcheng Jin, Ellina Mikhailova, Ming Lei, Sally A. Cowley, Tianyi Sun, Xingyun Yang, Yujia Zhang, Kaili Liu, Daniel Catarino da Silva, Luana Campos Soares, Sara Bandiera, Francis G. Szele, Zoltán Molnár, Linna Zhou, Hagan Bayley. Integration of 3D-printed cerebral cortical tissue into an ex vivo lesioned brain slice. Nature Communications, 2023; 14 (1) DOI: 10.1038/ s41467-023-41356-w

treatments for brain injury.’

Senior author Professor Zoltán Molnár (Department of Physiology, Anatomy and Genetics, University of Oxford) said: ‘Human brain development is a delicate and elaborate process with a complex choreography. It would be naïve to think that we can recreate the entire cellular progression in the laboratory.

Nonetheless, our 3D printing project demonstrates substantial progress in controlling the fates and arrangements of human iPSCs to form the basic functional units of the cerebral cortex.’

17

05

Patient Engagement: The 21st Century Is Calling, Texting And Sending Video

By Will O’Connor, M.D.

18

The healthcare industry is notoriously

environment many hospitals suffer

resistant to new technologies. If you’re

from. Physicians, nurses and support

reading this, you likely know more than

staff often struggle to share information

one doctor still carrying a pager –

effectively, impacting clinical workflow

a technology that has not substantially

efficiencies and patient care.

advanced since the 1980s. It can’t deliver rich information or context. It can’t help

It’s not just doctors’ pagers at issue.

doctors set priorities on their time.

In some cases, there are too many

It is simply the spark that sets the flame

communication tools, some of which

for a game of phone tag.

are favored more by one staff person than another. Some of those tools

Contrast that with the technology

are actually built for other things, like

adoption of the patients. While there

Electronic Health Record (EHR) systems,

are no doubt holdouts among them,

but they have an adjunct texting feature

the average patient is tech-savvy

that might appear to be convenient

today. They carry a smartphone that

while you’re in the EHR, but it doesn’t

delivers constant updates on a variety

reach the right people at the right time

of topics they care about. They’ve

or doesn’t cross department barriers.

grown accustomed to ordering goods

Overhead paging systems create alert

that can be delivered in an hour with

fatigue, adding to the frustration that

those devices. Someone can reach out

is leading to staff burnout across

to them in various modes – text, voice,

the healthcare system.

social media – and they can immediately gather information, exchange views and

Patients are often at the tail end of

take action when necessary.

these dysfunctional systems, waiting for a consult, a lab result or any

Patients are consumers in their lives

information at all about their status.

outside of the hospital or in other care

Patients will benefit substantially from

situations. They expect information

a more unified – rather than fragmented

at their fingertips. So, the level of

– communication experience for

frustration that can build up from being

everyone in the hospital. Incorporating

in the dark about their own health

patients into secure communications not

situation is significant. It’s no fun being

only reduces their anxiety but, in many

sick or injured. That lack of information

routine cases, it can be done through

has implications for their anxiety level,

a secure message without staff having

potential negative impacts on outcomes

to dedicate time to standing in a room.

and certainly degrades their satisfaction with the care experience.

The hospital also benefits from incorporating the patient into the

PATIENT ENGAGEMENT

communication experience. At

SUFFERS FROM FRAGMENTED

discharge, many patients are sent

COMMUNICATION OVERALL

home with instructions, medications and follow-up appointments. If the

Patient engagement challenges stem

hospital can incorporate that patient

from the fragmented communication

19

into the communications environment,

the smartphone can supply a wide range

it can assist the patient with adhering

of information, some of which

to instructions and making follow-up

can be automated. Educational

appointments.

information about the patient’s situation could be incorporated into this exchange,

Ensuring patient follow-up means

utilizing video and other media. And yes,

additional revenue and avoiding

the platform I’m describing can easily

readmittance with its potential

replace pagers. We can all move forward

implications for reimbursement rates.

together: doctors, nurses, and patients.

The hospital further benefits from any patient satisfaction metrics that insurers and other institutions keep on quality of care. Patient satisfaction will be based on the totality of care, including what happens to them after discharge.

Reference Will O’Connor, M.D. (2023) Patient engagement: The 21st century is calling, texting and sending video, Healthcare Business Today. Available at: https://www. healthcarebusinesstoday.com/patient-engagementthe-21st-century-is-calling-texting-and-sendingvideo/ (Accessed: 29 September 2023).

THE ANSWER IS IN THE PALM OF YOUR HAND The unified communication experience that connects the patient involves the smartphone that patients, doctors and nurses carry in their pockets.

A unified communication platform for all can leverage the smartphone by using an app connected to a larger system that’s potentially in the cloud.

Hospital staff can securely communicate in the course of managing workflows.

Patients can be incorporated through secure texting. For those who need additional help, family members can be added to the system.

Such a platform modernizes patient engagement. It unifies communications by leveraging a ubiquitous tool that everyone already possesses. In some cases, a text can be turned into a phone call with the push of a button. The combination of the overall platform and

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21

06

10 Emerging Public Health Issues Public health is about more than

essence when it comes to public

retirement age, and there aren’t enough

just responding to health crises such

health threats. By removing the

nursing programs to train new nurses,

as the COVID-19 pandemic. Government

ability of agencies to act, a disease

according to the American Association

public health agencies and nonprofit

can gain a foothold in a population.

of Colleges of Nursing. Similarly, the

organizations run programs aimed

■

Reduced health equity. As illustrated

Association of American Medical Colleges

at protecting health, promoting well-

during the pandemic, COVID

estimates a shortage of up to 124,000

being and preventing disease. They

disproportionately impacted

physicians by 2034.

use their public health authority

communities of color. Preventing

and knowledge to take on social,

laws that would reduce disease

HPSAs

environmental and economic challenges

spread will continue to impact these

Shortages are a public health issue that

that cause chronic and acute diseases,

communities the hardest.

makes it more difficult to operate disease

increase mortality rates, and lower overall health and well-being.

Following are 10 emerging public health issues that have grown to new levels or have experts concerned.

1. PUBLIC HEALTH AUTHORITY According to a 2021 report by the Network for Public Health Law, 15 states have proposed or passed laws that would undermine public health authority. This legislation comes in the wake of the controversies over mask requirements and lockdowns as COVID spread across the country. These laws would ban local and state governments from requiring masks, closing businesses or requiring quarantine, among other restrictions.

The impact of these laws may be dire, affecting the following.

■

Community spread. Highly communicable diseases will spread more easily, causing widespread sickness and death.

■

■

prevention and other public health and

2. PUBLIC HEALTH

safety programs. Provider shortages will

WORKFORCE SHORTAGE

impact access to and the quality of health

The public health workforce is made

care. According to the Health Resources

up of two components: public health

and Services Administration, 98 million

professionals who work for government

Americans live in a designated Health

agencies, health care nonprofits and

Practitioner Shortage Area (HPSA).

research institutions; and doctors, nurses and other clinical providers. Both

3. PUBLIC HEALTH SPENDING

components have been impacted

The U.S. spends around $3.6 trillion

by worker shortages.

annually on health care, but only about 3% of that is for public health, safety

PUBLIC HEALTH EMPLOYEES

and disease prevention. Programs that

According to the 2021 Public Health

promote wellness can prevent individuals

Workforce Interests and Needs Survey

from requiring more expensive medical

conducted by public health think tank

intervention. The 2022 Build Back Better

de Beaumont, 44% of state and local

Act includes funding for local health

public health workers said they planned

departments, emergency response,

to retire in the next five years. The

expansion of laboratories for disease

majority of respondents said their

monitoring and testing and training

decision to leave public health was

for additional public health workers.

prompted by the backlash against public health initiatives during the

4. HEALTH EQUITY

COVID-19 pandemic.

The disparities in health and well-being due to race, gender and socioeconomic

Loss of expertise. Legislatures that

CLINICIANS

factors has long been a stubborn

take over public health responses

There is a growing shortage of clinical

challenge for public health experts.

may not have the understanding

providers. Some 34% of nurses surveyed

People who lack access to preventive

or knowledge to respond

by health care staffing agency Incredible

health care and treatment for chronic

appropriately to a health threat.

Health said they planned to leave

and acute diseases suffer higher rates

Slow response time. Time is of the

nursing in 2022. More nurses are entering

of disease, disability and death, and

22

have less opportunity to live to their

7. THE ENVIRONMENT

same time, public health data — when

full potential. Public health initiatives

As with climate change, the environment

it has personal identifying information

at the local, state and federal levels

has a significant impact on public

removed — can help track and fight

share the goal of achieving health

health. In fact, environmental conditions

diseases and identify food-borne

equity. Examples of health equity

are among the social determinants

illnesses, among other issues. How

initiatives include:

of health that can predict a person’s

to use data to benefit patients, while

health and well-being. The World Health

also ensuring that health data

Organization (WHO) considers air

is protected, will continue to be

pollution to be a significant cause

a public health challenge.

■

Providing health information in different languages

■

Low-cost preventive health services

■

Mobile health screenings

■

Flexible appointment scheduling, or telehealth

■

Focus on wellness to prevent higher-cost medical care

■

Being mindful of cultural differences

5. E-CIGARETTES When manufacturers introduced e-cigarettes in 2006, the devices were initially marketed as a way to quit smoking. They quickly became a method of ingesting tobacco and other drugs, such as marijuana and fentanyl. The use of e-cigarettes became widespread among teens. The dangers of e-cigarettes are many, according to the Centers for Disease Control and Prevention (CDC). They have caused young people to become addicted to tobacco. They facilitate the abuse of illicit substances, which can lead to overdoses. They also can cause lung damage. A nationwide campaign to combat e-cigarette use among children is one example of a successful public health intervention.

6. CLIMATE CHANGE Drought. Floods. Violent weather.

Debilitating heat. Wildfires. Climate change is a public health issue that has already caused death and disruption in many locations around the world.

In the U.S., state and local governments can take several steps to combat the impact of climate change on their residents. For instance, some ways that governments can help keep people safe and healthy include establishing urban forest programs to help cool cities, being prepared to fight waterborne pathogens and understanding how air pollution increases cases of asthma.

of illness and death, and it mostly impacts low- and middle-income

PUBLIC HEALTH — THE

populations. But other environmental

CHALLENGE AWAITS

factors impact everyone. The presence

Public health officials understand the

of PFAS, a long-lasting plastic, is found

challenges they face in keeping people

in most people. It has been linked

safe and healthy. From the growing

to cancer, high blood pressure, decreased

attacks on public health authority

fertility and increased cholesterol.

to making sure all people have access to essential health care, the work they

8. HIV/AIDS

do is tough but necessary.

Millions of people have died of HIV/AIDS, and nearly 40 million people around

The Master of Public Health online

the world live with the disease.

at the Keck School of Medicine

It continues to be endemic in many

of USC provides a modern approach

regions. While drug treatments are

to public health management. Learn

available, they are expensive, and many

more about the program to find out

people lack access. There’s no cure

how USC prepares students for

and no vaccine. Despite global efforts,

rewarding careers in health care.

the disease continues to spread.

Research into a vaccine is ongoing.

9. RURAL HEALTH People living in rural areas face a number of public health challenges. They often live in provider-shortage areas and lack access to primary care doctors, specialists and hospitals. People in remote regions often have to drive hours to receive care, or to give birth. The opioid epidemic, while widespread throughout the country, has ravaged rural communities.

Telehealth is one solution to the provider shortage, as it can help monitor patients with chronic illnesses and allow people to receive care at home.

10. DATA PRIVACY Data privacy may seem an unlikely public health issue. However, public health experts say data privacy is an essential human right. Many consumers may not be aware that when they use a mobile wellness app, their data can end up in the hands of companies that don’t follow data privacy laws. At the

23

Reference 10 emerging public health issues of 2023: USC MPH (2023) Online Masters in Public Health. Available at: https://mphdegree.usc.edu/blog/10-public-healthissues-of-2023/ (Accessed: 13 October 2023).

07

A team of European researchers has developed a new test that can accurately measure biological aging in a clinical setting.

The discovery was made while studying patients for the aging effects of chronic kidney disease.

Most Accurate Test to Date Developed to Measure Biological Aging

The new test is an epigenetic clock - a type of biochemical assessment that looks at DNA to understand how well the body is aging in contrast to its chronological age - and is the first of these cutting-edge tests to be proven to perform accurately in a clinical setting, in both healthy and unhealthy tissue.

The work was led by a partnership between the University of Glasgow and the Karolinska Institutet, Stockholm, and is published in the Journal of Internal Medicine as part of a study into the aging effects of chronic kidney disease and its associated treatments.

The research team studied more than 400 patients with chronic kidney disease in Sweden alongside around 100 matched population controls, to better understand the impact on ageing of the disease, including during dialysis treatment and after kidney transplant. To do this, researchers used a range of tests including blood biomarkers, skin autofluorescence and epigenetic clocks. The team used the clocks to measure the change in biological age of around 47 patients one year after kidney transplantation, or one year after the start of their dialysis treatment, as well as how the healthy tissue in 48 controls aged by comparison.

The results showed that for patients with chronic kidney disease, their biological clock is ticking faster than the average person’s. This continues to be the case even after dialysis treatment. Indeed, patients’ biological clocks were only shown to slow down following a kidney transplant.

However, while the epigenetic clocks all showed a similar picture, the research team found that none of the current clocks could be shown to be accurate in a clinical setting, and all were found to be inaccurate to differing degrees when tested in healthy tissue over time.

To address this, the team developed a new, more accurate epigenetic clock - the Glasgow-Karolinska Clock - that works on healthy and unhealthy tissue.

The results from this new clock matched what

24

doctors saw in patients with chronic

on the extent of biological as opposed

has real potential to be able to evaluate

kidney disease, and also appeared

to chronological ageing in chronic kidney

lifestyle interventions, including

to accurately assess healthy tissue too.

disease patients. Our findings, using

diet, that could benefit the public

This study is the first real-world test

the new Glasgow-Karolinska Clock -

and help to address issues such

of epigenetic clocks in a normal ageing

show that not only are these patients

as health inequalities.”

setting, and against clinical parameters.

aging faster than people in the general population, their accelerated aging only

Peter Stenvinkel, Professor at Karolinska

As the body ages, a series of factors

slows down once they have had

Institutet, said: “I found the new tool

lead to epigenetic changes and loss

a transplant. Treatment with dialysis

to estimate effects of interventions

of a chemical tag (DNA methylation)

does not appear to impact this process.

on biological age of much interest.

from your DNA. This is often

“This is also the first clinical test

The tool could be used to study

associated with a range of disease

of epigenetic clocks, and the discovery

treatment strategies in patients with

common to ageing, such as chronic

that most are inaccurate when compared

end-stage kidney disease - a group

kidney disease, cancer and heart

with medical evidence has led us to

subjected to premature aging.”

disease. Epigenetic clocks have been

develop a new more accurate test which

proposed as a ‘gold standard’ for

can accurately measure methylation

measuring age accurately, beyond

tags on DNA of both healthy and

a person’s biological age, as they are able

unhealthy tissue. We have proven

to measure methylation tags on DNA.

it is accurate to the high standards of a clinical setting.

Professor Paul Shiels, lead author of the study for the University of Glasgow, said:

“Methylation tagging of DNA is impacted

“This study is the first time in a clinical

by what we eat and also out gut

setting that we can accurately report

microbiome. As a result, this new clock

25

Reference Ognian Neytchev, Helen Erlandsson, Anna Witasp, Louise Nordfors, Abdul Rashid Qureshi, Ken Iseri, Hokuto Morohoshi, Colin Selman, Thomas Ebert, Karolina Kublickiene, Peter Stenvinkel, Paul G. Shiels.

Epigenetic clocks indicate that kidney transplantation and not dialysis mitigate the effects of renal ageing.

Journal of Internal Medicine, 2023; DOI: 10.1111/ joim.13724

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27

08

Voice recognition technology has become commonplace in society, with personal assistant programs gaining frequent use across countless mediums. As described in Forbes, AI and ML are increasingly used in healthcare applications to expand clinical efficiency, boost diagnosis speed and accuracy, reduce physicians’ duties, and improve patient outcomes. Healthcare

Exploring Voice-Based AI In Healthcare

AI can also help with administrative tasks like appointment scheduling and insurance claims processing, freeing up time for clinicians to focus on patient care. Especially during the pandemic, voice AI bots helped to screen patients;

Dr. Rekha Bhandari

for instance, Apple’s Siri guided users through the CDC’s COVID-19 evaluation questions.

28

As a result of voice-based technology,

if it has not encountered a specific

faster and more accurately. With

patients can get prompt answers to their

sequence of words before. ChatGPT

appropriate privacy and security

questions about symptoms, therapies,

generates a response based on facts

safeguards, big data can further

and pharmaceutical availability using

on its server. According to the company,

advance machine learning and

smart healthcare voice assistants like

ChatGPT may also acknowledge errors,

artificial intelligence technologies

Alexa and Google Home. Voice assistants

respond to follow-up inquiries, and

in healthcare.

can also offer patients up-to-date

dismiss inappropriate ones.

information on their mental health; audio acoustics change in response

Dr. Victor Tseng co-authored a 2023

to a person’s health. These audio qualities

study in which ChatGPT demonstrated

can help diagnose various physical

that it could pass a medical licensing

and mental diseases and conditions.

exam. He claimed that his coworkers

Chatbots—computer programs that

experimented with ChatGPT and were

simulate and process written or spoken

intrigued when it correctly identified

human conversation—also allow

fictitious patients in hypothetical

people to interact with digital devices

situations. He asserted that it could

as though they were communicating

pass the three-part medical exam

with a live person.

that U.S. medical students must pass to be licensed to practice medicine.

CURRENT TRENDS

Tseng’s research group used 305

According to the National Center

questions from the June 2022 sample

for Biotechnology Information (NCBI),

test made available to the public. They

in 2020, the World Health Organization

were not part of the data set used to train

developed a chatbot via WhatsApp and

ChatGPT, and without any specialized

Facebook to find answers about how

training, the chatbot nearly passed

to protect themselves from COVID-19

all the exam’s components.

2. BETTER EXPIRIENCE Voice recognition, as it continues to improve, will support faster and easier transactions and exchanges, improving patient experience. This technology could translate to easier appointment-making, quick and more accurate intake of medical histories and other patient data, and the application of insurance, billing, and payment matters.

3. IMPROVED CARE Voice recognition can reduce the burden of information exchange and data collection between patients and physicians and allow more attention to the patient-professional relationship.

4. NEW INSIGHT As voice recognition technology advances, it will yield insight beyond

and how to understand news and facts related to the disease. This started

THE FUTURE

what the patient says to provide

a trend in chatbots in the healthcare

According to the National Center for

more reliable evidence about how

market; health chatbots are anticipated

Biotechnology Information (NCBI),

the patient is doing. The patient’s voice

to grow by over $498 million by the end

in 2020, the World Health Organization

will become a data source, similar

of 2029. Chatbot technology can assist

developed a chatbot via WhatsApp

to blood pressure, temperature,

consumers in scheduling appointments

and Facebook to find answers about how

and other vital signs.

and acting as health consultants.

to protect themselves from COVID-19 and

Those working in healthcare

how to understand news and facts

and technology should continue

Recently, ChatGPT, a natural language processing tool driven by AI developed by the company OpenAI, has attracted the attention of researchers and medical professionals. ChatGPT collects web data stored on a server by a human

A.J. Ghergich, a Forbes Technology Council member, recently outlined four major ways he believes voice recognition could improve healthcare:

1. MORE DATA

programmer. The algorithm can

Getting data into electronic health

anticipate which word will appear

records (EHRs) must be easier, faster,

in a sentence based on context;

and more accurate. Voice recognition

it can answer questions even

can enable placing data into EHRs

29

to follow these trends, looking for ways to collaborate to learn how to best serve patients using voice-based and other intelligent technologies.

Reference Bhandari, Dr.R. (2023) Exploring voice-based AI in Healthcare, Healthcare Business Today. Available at: https://www.healthcarebusinesstoday.com/exploringvoice-based-ai-in-healthcare/ (Accessed: 02 October 2023).

09

The Crucial Role of DevSecOps In Protecting Healthcare Data

By Archie Agarwal

30

Data breaches in the healthcare

lost revenue. However, in the healthcare

of device safety and the Quality System

industry are increasingly common,

sector, the consequences

Regulation (QSR), adopting secure by

with the U.S. Department of Health

are potentially fatal.

design principles, ensuring transparency,

and Human Services reporting 875

implementing security risk management

breaches of unsecured protected health

Inevitably, a data breach in the healthcare

practices, establishing a robust security

information since December 2020 – that’s

industry is also a HIPAA violation. The

architecture, and conducting thorough

more than one per day. This alarming

severity of the violation determines

testing with objective evidence.

statistic highlights the urgent need for

different levels of penalties, with the

robust cybersecurity measures within

2022 HIPAA penalty structure imposing

SECURE BY DESIGN

healthcare organizations.

fines that can reach up to $2 million.

Adopting the right DevSecOps tools

Healthcare data breaches can result

automatically yields many of these

Hackers are drawn to healthcare

in fees and fines from multiple additional

principles. For example, security

organizations due to the value of the

entities such as the U.S. Department

by design, security risk management,

patient information they store, including

of Health and Human Services (HHS),

and appropriate physical and technical

personal health data, financial details,

the Federal Trade Commission (FTC),

safeguards are all byproducts

and insurance information. This data

and state Attorneys General.

of implementing an ongoing threat

is in high demand on the black market,

modeling program. Such proactive

making healthcare organizations

Any amount of money spent by

measures are essential for protecting

lucrative targets. However, the risks

a healthcare organization to prevent

medical devices and preventing data

extend beyond health records. According

a data breach or safeguard their devices

breaches. A threat model itself serves

to a recent report from the FBI, 53%

is probably worth it when considering

as evidence for device manufacturers

of digital medical devices in the US,

these costs, but it doesn’t have

to demonstrate to the FDA the security

as well as internet-connected tools

to break the bank.

of their devices. By implementing these

in hospitals, are at risk of cyberattack.

types of DevSecOps tools, healthcare

Though it may seem impossible, devices

MITIGATION STRATEGIES OFFER

organizations can proactively safeguard

including pacemakers, defibrillators,

TOO LITTLE TOO LATE

sensitive data and IoT devices while

insulin pumps, nurse call buttons, and

For healthcare organizations, establishing

optimizing their operations.

numerous other crucial medical devices

a strong, proactive cybersecurity

are vulnerable – many of which are

foundation and compliance posture

The benefits of implementing

lifesaving. Malicious actors who breach

is imperative. It is crucial to recognize

DevSecOps practices extend beyond

these devices can manipulate them

that the presence of one secure device

efficiency gains and cost savings.

to provide inaccurate data, administer

does not guarantee overall security – if

A proactive and ongoing DevSecOps

excessive doses of medication, or pose

even one unsecured device remains

strategy provides peace of mind

other risks to a patient’s health.

undetected, the organization’s entire

for organizations, patients, and

ecosystem is at risk.

stakeholders by ensuring proper

Clearly, there is a lot more to protect

utilization of healthcare resources.

than just data, and unfortunately, these

The need for proactive cybersecurity

By implementing preventive measures,

breaches aren’t going to stop anytime

for healthcare organizations has gotten

healthcare organizations can mitigate

soon. Implementing effective and

so serious that effective March 30, 2023,

risks, maintain a secure environment,

proactive DevSecOps practices is crucial

the US Food and Drug Administration

and safeguard the well-being of both

for healthcare organizations to protect

(FDA) mandated that medical device

patients and their business.

their businesses, their patients’ data,

manufacturers include cybersecurity

and most importantly, the overall

information in their premarket device

safety of their patients.

submissions Further, the FDA will refuse submissions lacking adequate

A COST OF A HEALTHCARE

cybersecurity measures from

BREACH IS MORE THAN

October 1, 2023, onwards.

MONETARY Whenever any company falls victim

Perhaps most importantly, the FDA

to a data breach, they face numerous

has introduced guidance for medical

costs both directly and indirectly

device manufacturers, with six key

associated with recovering from the

principles for protecting devices.

incident. These costs include everything

These principles include incorporating

from incident response expenses to

cybersecurity as an integral part

31

Reference Agarwal, A. (2023) The crucial role of DevSecOps in protecting healthcare data, Healthcare Business Today. Available at: https://www. healthcarebusinesstoday.com/the-crucial-role-ofdevsecops-in-protecting-healthcare-data/ (Accessed: 02 October 2023).

10 Latest Tento+ to be First Generative AI Tool In Medical Complian Tento+ has announced

takes 3-7 years to reach the market

and more. Users can also understand

that the latest iteration of its

and compliance is cited as one

automatically which design standards

ground-breaking dashboard will

of top concerns for business leaders.

apply to their device and generate

serve as the first ever generative AI tool being used in the medical compliance sector.

Tento+ is on course to enhance and boost the evolution of the medtech market across the world as more medical devices are set to enter service across a wide range of medical sectors in response to a diverse and ever-growing range of health needs.

The medical device market has undergone consistent levels of growth over the past decade and is projected to grow at a compound annual growth rate (CAGR) of 5.4% in forecast period 2021 - 2028. The World Health Organisation reports that there are an estimated 1.5 million medical devices globally, across more than 10,000 specific types. However, it is reported than the average medical device

automated checklists that are required.

To account for the spiralling demand

In a recent trial of five projects using

for regulatory approval of new medical

Tento+, the AND Technology Research

devices, Tento+ has leveraged generative

team was able to calculate how much

AI to streamline the process for

time Tento+ can save a company

any business. Already, the Tento+

when working through the medical

team has documented and tested

submission regulation process.

significant time savings. For the average project/submission, 236 hours of time

Commenting on the launch of Tento+

could be saved by using Tento+’s

and the trial findings, CEO of Tento+,

generative AI-tool.

Dr Nicola Thorn said: “The potential of generative AI in medical compliance

Tento+’s AI-powered in-built tool guides

is enormous. From authoring content

and supports companies with meeting

to assessing changes on a device, the

the compliance requirements; it’s

generative AI is the first tailored to the

a one-stop-shop for companies looking

world of medical compliance. It is fine-

to develop medical devices, and

tuned with expert input and tested

to manage their design controls.

on hundreds of devices. This is proving to be a genuine game changer!

The tool allows users to enter a brief device description, and then provides tailored insights and suggestions for design requirements, test plans,

32

“So many innovators and engineers struggle in navigating the regulation process and not knowing where to start.

This no longer has to be the case.

There are many hurdles, so many complex considerations to make, and it bleeds businesses’ time and money.

This is where the power of generative AI comes in. Tento+ has always offered a simple platform, that aides and speeds up management of design control process. And now, our algorithm means that the whole of Tento+ is tailored directly to your device, specifically generated for your product.

“It’s a ‘world first’ that’s set to change the world for medical compliance!

Anyone interested should book a demo with us today.”

OTHER TENTO+ FEATURES: Users will also be able to capture and analyse certain technical, risk and clinical information directly in Tento+. Users will then be able to record traceability matrices, testing records and anomalies as well as risk and usability controls.

From here, users can automatically generate technical documentation such as test plans, test logs and records, software decompositions and software requirements for use within submissions to regulatory bodies.

Tento+ dashboard is a purposebuilt web-based tool that enables developers, project managers, QR, and test engineers to track, manage, and organise their product development and testing journey. The dashboard provides engineers with quick insights into the progress of their project as test scripts, anomalies, and the requirements traceability matrix are all accessible in one place. Thanks to end-to-end visibility across the software testing lifecycle, development teams can now easily map and visualise the relationship and test coverage of user requirements, software function, unit, and code.

References: https://www.med-technews.com/news/MedtechRegulatory-News/latest-tento-to-be-first-generativeai-tool-in-medical-compl/.

33

11

The Top 5 Healthcare Trends In 2023 Bernard Marr

as processing insurance claims and management or analysis of medical record keeping. It can also be used to analyze data collected from patient wearables or in-home sensors used in virtual hospital settings (more on that in my next trend) to provide early warning or predictive diagnosis of various conditions. Put together, all of these use cases indicate that AI and ML will continue to be a prominent trend in healthcare throughout the coming year.

The world is a very different place than it was ten years ago, and nowhere is this more evident than in healthcare. The aftermath of the covid-19 pandemic, combined with the financial downturn and an acceleration in the adoption of technology and digitization, have dramatically changed the landscape for everyone, patient or practitioner.

Here’s my overview of what I believe will be the most important trends of the next 12 months:

ARTIFICIAL INTELLIGENCE IN HEALTHCARE The market for Artificial intelligence (AI) – specifically, machine learning (ML) tools in healthcare is forecast to top $20 million in 2023. Various AI-aligned technologies, such as computer vision, natural language processing, and pattern recognition algorithms, are already deeply embedded in the healthcare ecosystem and will continue to be adopted as evidence of their usefulness grows throughout 2023. Some examples of areas where AI is used include drug discovery, where it can assist with predicting outcomes of clinical trials and potential side effects of new drugs, as well as analysis of medical imagery, which involves using computer vision algorithms to spot early warning signs of disease in x-rays or MRI scans. It has also successfully been used to detect and treat neurological disorders, including Parkinson’s Disease and Alzheimer’s Disease.

Outside of frontline clinical work, AI also has applications in clerical work, such

Healthcare delivered remotely increased significantly during the pandemic. Even now that it’s generally safe to resume face-to-face routine appointments, many patients and providers have realized that for many conditions, care can be provided more efficiently and cost-effectively at a distance.

Remote healthcare falls into a number of different categories. There is an increase in home-based care driven by evidence that shows that a familiar environment and proximity to a family can have a positive effect on patient outcomes, as well as being hugely cost-efficient compared to inpatient care. Then there is telemedicine, which

to specific health conditions, where

covers everything from video calling

users can come together to share help

your doctor rather than visiting their

and advice related to their treatment

surgery to remote surgery, where

and recovery. Some examples of these

a surgeon carries out surgery on

include Patients Like Me, Care Opinion,

a patient in a remote location using

and cancer.org.

robotic technology. Another remote healthcare model is the virtual hospital

With the cost of delivering in-person

ward, which involves practitioners

healthcare continuing to rise, and

in a centralized location providing care

ongoing shortages of medical

for a number of remote patients, often

practitioners in many countries,

with related conditions. Another initiative

it’s a safe bet that all varieties

involves enabling patients to complete

of remote healthcare will

more of the procedures that are related

be a growing trend in 2023.

to their illness and treatment at home before being admitted to hospital. In the

RETAIL HEALTHCARE

UK, for example, it’s planned that this

According to researchers at Forrester,

will be rolled out in 2023 to all patients

the amount of healthcare business

facing hospital stays for surgery.

conducted through retail outlets will double during 2023. This is becoming

Additionally, there is a growing

an increasingly visible trend as retailers

understanding of the importance

like Walmart, Amazon, and CVS offer

of online communities, which may

healthcare services such as blood tests,

be patient-led rather than practitioner-

vaccinations, and medical check-ups that

led, or may be run by charities linked

have traditionally been delivered

34

by hospitals, clinics or doctors’ practices.

heart rate and blood oxygen levels to

delivery that is personalized specifically

This trend will become more prominent

smart watches capable of sophisticated

to them. This includes the concept

as global economic conditions lead

scans such as ECGs, smart textiles that

of precision medicine, where drugs and

to squeezed budgets at traditional

can detect blood pressure and predict

other treatments are specifically tailored

frontline primary care facilities. This

the risk of heart attacks, and smart gloves

to a group of patients – based on factors

is compounded by Retail healthcare

that can reduce the tremors suffered

such as age, genetics or risk factors –

providers leveraging consumer

by patients with Parkinson’s Disease.

rather than administered on a one-size-

expectations of streamlined customer

As well as physical illness, a growing

fits-all approach. The most advanced

experience and choice to create services

emphasis is being placed on developing

and precise forms of personalized

that patients will increasingly find

wearable devices capable of monitoring

healthcare take into account a person’s

a more convenient and better value

and detecting signs of mental illnesses.

genetic information or genome and can

than traditional primary care delivery.

A study was published this year showing

help healthcare practitioners predict how

As Forrester’s research puts it, “In 2023,

how physical indicators such as activity

effective specific drugs will be or whether

patients will choose retail health

levels, sleep patterns, and heart rate can

they are likely to suffer from side effects.

for their primary care needs as health

be used to detect when individuals may

AI and ML algorithms are sometimes

systems, constrained by inadequate

be at risk of depression, and we may start

used to assist with these predictions.

resources, fail to match retail’s

to see medical wearables incorporating

elevated patient experiences.”

some of this functionality soon.

The term personalized healthcare is also sometimes used in relation

Retail healthcare providers are typically

In 2023, we will increasingly see wearable

to moves to allow patients to make

more accessible and may not require

medical devices acting as “edge” devices,

more choices about how their care

appointments to be booked in advance,

which means they will be equipped with

is planned and delivered. This usually

compared to traditional healthcare

processors and capable of utilizing

involves drawing up a personal treatment

providers. They are also less affected

in-device analytics rather than requiring

plan for an individual, considering their

by the shortages of trained clinical

that data is sent back and forward

own circumstances, opinions and beliefs

staff that many countries are currently

between the device and the cloud

when making choices about how and

experiencing – a problem that

to be processed. This has two main

where they should be treated. As is also

is only predicted to worsen.

benefits: The first is privacy, as sensitive

true in industry and the wider economy

patient personal data never has to leave

outside of healthcare, every form of

WEARABLE MEDICAL DEVICES

the device. Secondly, there’s speed –

personalization is likely to be a major

Wearable devices will be increasingly

which is critical in the case of devices

trend throughout 2023.

used by individuals during 2023 to track

designed to detect and warn

their own health and exercise activity,

of potentially life-threatening

as well as by clinicians to monitor

conditions in real time.

patients remotely. The “Internet of Medical Things” has rapidly expanded

PERSONALIZED HEALTHCARE

in recent years from simple devices

During 2023, patients will have more

designed to track vital signs such as

opportunities to receive healthcare

35

References: Marr, B. (2023) The top 5 healthcare trends in 2023, Forbes. Available at: https://www.forbes.com/sites/ bernardmarr/2022/12/06/the-top-5-healthcare-trendsin-2023/?sh=1a036481565b (Accessed: 02 October 2023).

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12

Medical devices: from design to production

By Henrique A Almeida and Rui B Ruben

A medical device is an instrument,

These results demonstrate increasing

apparatus, implant, in vitro reagent,

interest in research and development

or similar or a related article that

of medical devices within the industrial

is used to diagnose, prevent, or treat

and academic communities. Not only

diseases or other medical conditions

the numbers of published papers have

and does not achieve its purposes

increased as demonstrated, but

through chemical actions within

also the numbers in healthcare has

or on the body such as drugs. The main

also increased. According to Shih,

goal of any medical device is to improve

the investment in healthcare

the patient’s daily quality of life or well-

is increasing at a very high rate and will continue to grow.

being during diagnosis, treatment, and/or medication. Over the last decade, the medical device industry is a fast-growing and demanding industry. Advances in design, materials, and technologies have increased the potential to develop improved solutions for all medical applications. These advances have managed to supply the clinicians with new products, tools, and procedures, supporting them in their work by making surgery, diagnosis, or treatment processes easier

This special collection intends to bring together industrial and academic researchers willing to present new design methodologies, material selection and manufacturing processes, and medical device case studies, illustrating new developments in both product design and prototype methods. Topics may include, but are not limited to the following:

■

than ever before. These advances have also aimed to reduce both lead times

Medical device design and prototyping;

■

and costs in the production

Design for multi-scale manufacturing;

of existing medical devices, reducing

■

Biomaterials and processing;

global health-care costs.

■

Multi-scale material modeling and process simulations;

Due to this fact, medical devices are a hot topic among the industrial and

■

Tissue engineering and regenerative medicine;

academic domains regarding issues such as design, materials, prototypes,

■

Additive manufacturing processes;

or manufacturing processes. For

■

Machining, forming, electro-

instance, after performing a search

discharge machining (EDM) and

on the SAGE Journals Publishing

electrochemical machining (ECM),

platform with the combination of both

laser-based processing, casting

words “medical” and “devices” in the

and molding, and others;

titles, a total of 129 results were obtained.

■

tooling, fixturing, sensors systems,

Based on the results, between 1932 and

and control;

1989, 10% of the papers were published.

Then the next two decades, the number

Machines and equipment including

■

Metrology, material handling, joining, and assembly;

of papers increased to 21% (1990–1999) and 27% (2000–2009). Since 2010, the

■

Prostheses and orthoses;

number increased dramatically, reaching

■

Implants;

42% of the papers being published.

■

Robotics in medicine.

40

References: 1. Ciurana J. Designing, prototyping and manufacturing medical devices: an overview. Int J Comp Integ M 2015; 27: 901–918.

2. Ciurana J., Rezende R. New opportunities and challenges for additive manufacturing to produce biomedical devices. IFAC Proc 2013; 46: 283–288.

3. Fiorentino A, Marenda GP, Marzi R, et al. Chapter 89. Rapid prototyping techniques for individualized medical prosthesis manufacturing. In: Da Silva Bartolo PJ (ed.) Innovative developments in virtual and physical prototyping. Boca Raton, FL: CRC Press, 2012, pp.589–594.

4. Shih AJ. Biomedical manufacturing: a new frontier of manufacturing research. J Manuf Sci E: T ASME 2008; 130: 210091–210098.

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13 New Organ-on-a-Chip Model of Human Synovium Could Accelerate Development of Treatments For Arthritis 42

The synovium is a membrane-like

The new synovium-on-a-chip model

cell and tissue types) can be added.

structure that lines the knee joint and

is a three-dimensional microfluidic device

In addition, we envisage that our model

helps to keep the joint happy and healthy,

that contains human synovial cells and

could eventually form part of the drug

mainly by producing and maintaining

blood vessel cells. The device is subjected

discovery pipeline in an industrial setting.

synovial fluid. Inflammation of this

to mechanical loading, which mimics

Some of these conversations have

tissue is implicated in the onset and

the forces applied to the synovium

already commenced.”

progression of arthritic diseases such

during joint movement.

as rheumatoid and osteoarthritis.

The researchers are currently using

Therefore, treatments that target the

The developed synovium-on-a-chip

the synovium-on-a-chip model to study

synovium are promising in treating

model was able to mimic the behaviour

the disease mechanisms of arthritis and

these diseases. However, we need better

of native human synovium, producing

to develop stratified and personalized

models in the laboratory that allow

key synovial fluid components and

organ-on-a-chip models of human

us to find and test new treatments.

responding to inflammation. This

synovium and associated tissues.

We have developed an organ-on-a-chip

suggests that the new platform has

based model of the human synovium,

immense potential to help researchers

“We believe that our synovium-on-a-chip

and its associated vasculature,

understand disease mechanisms

model, and related models of human

to address this need.

and identify and test new

joints currently under development

therapies for arthritic diseases.

in our lab, have the potential to transform pre-clinical testing, streamlining delivery

Researchers at Queen Mary University of London have developed a new organ-

“Our model is the first human,

of new therapeutics for treatment

on-a-chip model of the human synovium,

vascularised, synovium-on-a-chip

of arthritis,” Prof. Martin Knight, Professor

a membrane-like tissue that lines

model with applied mechanical loading

of Mechanobiology said. “We are excited

the joints. The model, published

and successfully replicates a number

to share this model with the scientific

in the journal Biomedical Materials,

of key features of native synovium

community and to work with industry

could help researchers to better

biology,” said Dr Timothy Hopkins,

partners to bring new treatments

understand the mechanisms of arthritis

Versus Arthritis Foundation Fellow, joint

to patients as quickly as possible.”

and to develop new treatments for this

lead author of the study. “The model

group of debilitating diseases.

was developed upon a commercially available platform (Emulate Inc.), that

In the UK, more than 10 million people

allows for widespread adoption without

live with a form of arthritis, which affects

the need for specialist knowledge of chip

the joints and can cause pain, stiffness,

fabrication. The vascularised synovium-

and swelling. There is currently no cure

on-a-chip can act as a foundational

for arthritis and the search for new

model for academic research, with

therapeutics is limited by a lack

which fundamental questions can

of accurate models.

be addressed, and complexity (further

43

Reference: 1. Clare L Thompson, Timothy Hopkins, Catrin Bevan, Hazel R C Screen, Karina T Wright, Martin M Knight. Human vascularised synovium-on-a-chip: a mechanically stimulated, microfluidic model to investigate synovial inflammation and monocyte recruitment. Biomedical Materials, 2023; 18 (6): 065013 DOI: 10.1088/1748-605X/acf976 2. Queen Mary University of London. “New organ-ona-chip model of human synovium could accelerate development of treatments for arthritis.” ScienceDaily.

ScienceDaily, 12 October 2023. www.sciencedaily.com/ releases/2023/10/231012111714.htm

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14

AI Language Models Could Help Diagnose Schizophrenia 46

Scientists at the UCL

the way the brain learns relationships

The team from UCL and Oxford now plan

Institute for Neurology have

between memories and ideas, and stores

to use this technology in a larger sample

developed new tools, based

this information in so called ‘cognitive

of patients, across more diverse speech

on AI language models, that

maps’. They find support for this theory

setting, to test whether it might prove

in a second part of the same study

useful in the clinic.

can characterise subtle signatures in the speech of patients diagnosed with schizophrenia.

The research, published in PNAS, aims to understand how the automated

where the authors used brain scanning to measure brain activity in parts of the

Dr Nour said: “We are entering a very

brain involved in learning and storing

exciting time in neuroscience and mental

these ‘cognitive maps’.

health research. By combining state-ofthe-art AI language models and brain

Lead author, Dr Matthew Nour (UCL

scanning technology, we are beginning

Queen Square Institute of Neurology

to uncover how meaning is constructed

psychiatric conditions.

and University of Oxford), said: “Until

in the brain, and how this might go

very recently, the automatic analysis

awry in psychiatric disorders. There is

Currently, psychiatric diagnosis is based

of language has been out of reach of

enormous interest in using AI language

doctors and scientists. However, with

models in medicine. If these tools prove

the advent of artificial intelligence (AI)

safe and robust, I expect they will begin

language models such as ChatGPT, this

to be deployed in the clinic within the

and brain scans.

situation is changing.

next decade.”

However, this lack of precision prevents

“This work shows the potential of

The study was funded by Wellcome.

analysis of language could help doctors and scientists diagnose and assess

almost entirely on talking with patients and those close to them, with only a minimal role for tests such as blood tests

a richer understanding of the causes of mental illness, and the monitoring

applying AI language models to psychiatry - a medical field intimately

of treatment.

related to language and meaning.”

The researchers asked 26 participants

Schizophrenia is a debilitating and

with schizophrenia and 26 control participants to complete two verbal fluency tasks, where they were asked to name as many words as they could either belonging to the category “animals” or starting with the letter “p,” in five minutes.

common psychiatric disorder that affects around 24 million people worldwide and over 685,000 people in the UK. According to the NHS, symptoms of the condition may include hallucinations, delusions, confused thoughts and changes in behaviour.

To analyse the answers given by participants, the team used an AI language model that had been trained on vast amounts of internet text to represent the meaning of words in a similar way to humans. They tested whether the words people spontaneously recalled could be predicted by the AI model, and whether this predictability was reduced in patients with schizophrenia.

They found that the answers given by control participants were indeed more predictable by the AI model than those generated by people with schizophrenia, and that this difference was largest in patients with more severe symptoms.

The researchers think that this difference might have to do with

47

Reference: 1. Matthew M. Nour, Daniel C. McNamee, Yunzhe Liu, Raymond J. Dolan. Trajectories through semantic spaces in schizophrenia and the relationship to ripple bursts. Proceedings of the National Academy of Sciences, 2023; 120 (42) DOI: 10.1073/pnas.2305290120 2. University College London. “AI language models could help diagnose schizophrenia.” ScienceDaily.

ScienceDaily, 9 October 2023. www.sciencedaily.com/ releases/2023/10/231009191615.htm

A pilot program aimed at female physicians was expanded to a national level with significant results in all aspects of burnout A pilot program that successfully reduced burnout among female medical residents has shown even greater results on a national level, according to researchers at the University of Colorado Anschutz Medical Campus.

The study was published today in the journal JAMA Network Open.

“We did a pilot program in 2021 to see if it would work and it did,” said study co-author Tyra Fainstad, MD, associate professor at the University of Colorado School of Medicine. “Then we expanded it to 26 graduate medical institutions in 19 states. There were 1,017 participants.

We saw significant improvement in every wellbeing outcome we assessed including all three subscales involved in burnout.”

Burnout within the health care community is a national epidemic disproportionally affecting women.

Last year, the U.S. Surgeon General declared it a `crisis’ deserving ‘bold, fundamental change’ though little was known about scalable, effective solutions to the problem.

Women are hit harder by burnout for reasons that include bias and sexism at work, pay disparities as well as a disproportionate burden of home management and child/elder care,

15

the researchers said.

Fainstad and co-author Adrienne Mann, MD, both faculty in the CU Department of Medicine, created the web-based Better Together Physician Coaching Program at CU Anschutz with the goal of reducing

Coaching program reduces burnout in medical residents

that burnout. Then they replicated it to a national level and published their findings. While the pilot program saw improvements in `imposter syndrome’ (feeling as if you don’t really belong in the

48

job’) and self-compassion, the expanded

(PA), beliefs around competence

system, working with individuals who

national study also showed significant

and success at work.

have been harmed along the way will be

improvements in outcomes across the board including moral injury and flourishing, offering actual evidence that the program works.

imperative to healing.”

The EE score is a key construct in health care related burnout. A one point increase in the EE scale has been associated with a 7% increase in suicidal

“Physician trainees who received online

ideation and a 5-6% increase in major

group coaching over four months

medical errors.

(burnout, moral injury and imposter syndrome) and improvements in well-being (self-compassion and flourishing),” said Mann.

healing the culture would be making coaching programs like Better Together accessible to everyone - not necessarily mandatory but at least made available by institutions.

had substantial reductions in multiple dimensions of professional distress

Mann suggested a step towards

The researchers said a reduced mean

“There are other coaching programs

EE score among those that took part

in this space but this one is rigorously

in the training and an increased

evidence-based. We studied it,” Mann

EE score in those that did not.

said. “There are no downsides. It helps in all aspects of burnout.”

Mann and Fainstad are both certified life

“From what we see in this study,

coaches. Better Together is owned and

coaching helps in every aspect of

operated by the University of Colorado.

burnout,” Fainstad said. “The multi-modal

It’s not a business, they said, and they

nature of our program is unique. You

don’t personally profit financially from

can interact in many ways. That partially

it. The program is available to any heath

explains the powerful impact -that

care institution, school of medicine,

and the group nature of our coaching.”

department, or residency program wishing to meaningfully support the wellbeing of their clinicians and trainees.

Better Together is web-based.

Mann said the majority are watching others being coached and share in the experience.

Participants take part in two videoconferencing coaching calls

“That is deeply connecting. They try

per week where up to five people can

to see themselves in someone else’s

be coached live on any topic with an

story,” she said. “When someone is on a

unlimited audience. Calls are recorded

view screen you have compassion and

for later listening on a private podcast.

empathy for them and, by extension, learn to practice compassion and

Participants can also access unlimited,

empathy for yourself.”

anonymous written coaching in a forum by submitting a narrative reflection and

While few strategies to address burnout

receive a coach’s response published to

have shown much overall effect, Fainstad

Better Together’s secure, members-only

said this study demonstrates that group

website. There are also weekly self-study

coaching works.

sessions using videos and worksheets.

They focus on topics pertinent to the physician lifestyle such as goal setting, cultivating a growth mindset, receiving critical feedback, imposter syndrome

“We’re now showing that we have an actual evidence-based answer to burnout,” she said.

and perfectionism.

Fainstad and Mann said burnout The researchers use the Maslach Burnout

is a product of the current, often toxic,

Inventory (MBI) to measure their work.

medical culture pervading every

The MBI has three subscales: emotional

aspect of the profession.

exhaustion (EE) or feeling emotionally

“Culture is a belief system,” Fainstad

exhausted from work; Depersonalization

said. “And while structural changes are

(DP), detached and impersonal treatment

absolutely necessary to fix our medical

of patients; Professional accomplishment

49

References: 1. Adrienne Mann, Ami N. Shah, Pari Shah Thibodeau, Liselotte Dyrbye, Adnan Syed, Maria A. Woodward, Kerri Thurmon, Christine D. Jones, Kimiko S. Dunbar, Tyra Fainstad. Online Well-Being Group Coaching Program for Women Physician Trainees. JAMA Network Open, 2023; 6 (10): e2335541 DOI: 10.1001/ jamanetworkopen.2023.35541 2. University of Colorado Anschutz Medical Campus. “Coaching program reduces burnout in medical residents.” ScienceDaily. ScienceDaily, 4 October 2023. www.sciencedaily.com/ releases/2023/10/231004132427.htm

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