Approach to Healthcare and to the Delivery of Services

Present and future trends

Cutting across clinical disciplines, non-communicable diseases have come to occupy centre stage in our day to day practice of medicine. This phenomenon has considerably changed our outlook towards patients and their families, although an epidemiological disaster the pandemic of COVID-19 has made us more sensitive to co-morbidities and has changed the way we deliver services. This article has cited these trends and has elaborated upon them and their possible causation. This review puts these trends in perspective in order that our peers might prepare themselves for the road ahead.

Mira Govindarajan, Cardiodiabetologist, Safeguard Family This is a vast topic which normally cannotbe encompassed. Save for our day-to-day practice which finds its resonance in the current medical literature and in media reports.

By this token, some trends now observed are: 1. A focus on wellness 2. Acceptability and mainstreaming of online practice 3. A cultural shift in the doctor patient interaction 4. A focus on cellular structure and genomics apart from merely tissues or body organs

5. A focus on the family and society instead of the individual patient alone 6. A greater understanding and acceptance of interventions related to mental health.

Let us now discuss them one by one.

A focus on wellness:

Everybody intuitively relates to the aphorism ‘an ounce of prevention is better than a pound of cure’.

Nowhere has this been more extensively studied, than in coronary artery disease. Primary prevention here means modifying one’s lifestyle to address modifiable risk factors such as diabetes, smoking, hypertension, dyslipidemia (cholesterol) and obesity. Secondary prevention means managing risk factors, when an individual patient has one or more of them, so as to prevent effects on the heart and the circulation.

However, in practice, one had to consider the cost of these treatments against the benefit of the events prevented. Namely, the cost-to-benefit ratio.

Until the first decade of the millennium it was held that the costs for prevention and risk factor modification for coronary artery disease could not be justified vis-a vis the benefit of preventing hospitalisation or myocardial infarction (MI).

Subsequent experience and studies proved otherwise. For instance, an article published in Circulation in 2011 Updated under the auspices of the American College of Cardiology and the American Heart association made a strong case for secondary prevention.

It advised that intensive modification of conventional risk factors like diabetes, hypertension, smoking, cholesterol and obesity reduced risk improved outcomes and prevented recurrence in the context of heart disease, stroke and diseases of the blood vessels. It set down recommendations based on levels of evidence for each.

For the patient and family, the advantages of such an approach, if it were followed at the present time are obvious —no need to take time off work, no need to make and keep appointments, no need to wait in the queue, expose oneself to crowds, noise, rudeness and infections. All this to obtain a 15 minute or half hour consultation with the doctor!

The obvious demerits from the doctor’s perspective are traffic snarls, time, costs of fuel and the spread of infection.

The Covid-19 epidemic brought online consults to the fore. Now this has become an acceptable way to interact with the patient and their family from the comfort of their home!

Lyrically put: formerly Mahomet used to visit the mountain. Now the mountain moves to Mahomet!

Further, the epidemic of COVID-19 proved to us decisively the hazard posed by co-morbidities.

The implication for cardiovascular care and for healthcare as a whole is that we would need to focus on preserving wellness and not merely managing illness.

That the profession should focus on keeping the patients away from hospitals rather than only treating them therein. One more benefit of this approach is the prevention of infections acquired by the patient in the hospital setting.

For instance, diabetes gives us a 10 year ‘heads up’ in the form of the pre-diabetic stage where damage to the small blood vessels which forms the basis of future complications starts. Diabetes is about 80 per cent preventable at this stage.

Acceptability and eventual mainstreaming of online practice

In the traditional practice of medicine, regardless of they were Indian, Chinese or Western, the physician used to visit the patient’s home. The chief merit of this practice was an ability to assess the patient, their lifestyle and their support systems as a whole.

A cultural shift in the doctorpatient interaction

In the past, the relationship between the doctor and the patient was paternalistic. The doctor acted as a father or a mother or even a god-like figure issuing prescriptions and proscriptions.

The internet served to bridge the traditional asymmetry in information between the doctor and the patient.

With regard to chronic disorders such as diabetes which is linked patient education becomes paramount doctors need to encourage their active participation at every turn. Put simply the patient’s role has become more proactive.

Furthermore, with a focus on the wellness of the mind-body patients have become ‘clients’ or ‘beneficiaries’. The designation ‘customer,’ which is often used in corporate practice is inappropriate because the system has to act to protect and enhance the person’s health. This clearly overrides the end points of ‘customer satisfaction’ or ‘customer delight’.

Strong therapeutic alliances between doctor and patient have become the order of the day.

A focus on cellular structure and genomics apart from merely tissues or body organs

The major scourges of modern times— diabetes, hypertension, cholesterol, cardiac diseases, stroke, deficiencies of Vitamin D and B12, disorders of the thyroid, depression and so forth are complex in nature. There is interplay of multiple genetic and environmental factors in their genesis.

For instance, in hypertension, we need to consider growth retardation in the fetal stage, complex genetic factors, hormonal issues, metabolism of salt and water and its complex regulation, output of nerve impulses which control the blood pressure, stress, salt intake, smoking and alcohol, the level of activity and soon…

This interplay becomes even more complex in psychiatric disorders.

A focus on the family and society instead of on the individual patient alone.

Many of the above cited disorders are based on the demerits of modern

It, therefore, becomes mandatory to understand the family, the professional and social background of patients and healthy clients.

The poetic phrase ‘No man is an Island’ (by John Donne) gains meaning!

We need to understand each disorder in terms on individual cells, their internal structure and the genetic makeup of each individual.

lifestyles—erratic habits with respect to food and sleep, lack of family support in many instances, lack of physical activity and above all, stress. For instance diabetes evidently runs in families. This could be passed on from generation to generation. It could be genetic as in a tendency to have a certain gene or set of genes which make one more prone for diabetes. It could be because of shared diet and activities such as exercise in a given family. It could be combination of one or more of these factors.

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A greater understanding and acceptance of interventions related to mental health

Depression is quite clearly one of the epidemics of modern times. It is part of many chronic disorders. For instance, after a heart attack or in diabetes. It might mimic disorders such as muscular pains or the chronic fatigue syndrome.

Stress is causally linked to hypertension and diabetes. In high blood cholesterol. Stress induces a specific disorder of the heart muscle. The role of stress in our lives can never be overstated!

Further, as we have discussed, changes in lifestyle pose many challenges.

In the past, there was a stigma attached to mental health as reflected in many colloquialisms such a ‘screw loose’ and ‘mental’ used in our society.

With greater awareness, this stigma is gradually disappearing. Body and mind are being increasingly treated as one unit.

Within their professional span, physicians now have the opportunity to lead and to witness seismic shifts in their profession. Only time will tell if these trends would crystallise for the greater good. References are available at www.asianhhm.com

Mira Govindarajan is a physician with a focus on Non-Interventional cardiology and diabetic care. She obtained her graduate and postgraduate qualifications from a premier national institution, JIPMER, Pondicherry. She is also a qualified clinical administrator having obtained Master’s in Health Administration from Indiana University, USA. She has worked for reputable institutions in India and in the US in both clinical and administrative capacities. She currently works for Safeguard family, an organisation dedicated to the care of diabetes and other lifestyle disorders.

Trends Shaping the Future of Healthcare Delivery

Stella Ramette, Director, Healthcare Customer Relations & Sales, Southeast Asia for InterSystems

Innovation in digital health is accelerating in the Asia Pacific region. With rising consumer demands, technology advancements, increased life expectancies, and more complex care needs, healthcare organisations are under pressure to deliver digital-first, seamless, and connected healthcare experiences.

But what are the trends shaping the future of healthcare delivery in the Asia Pacific? Which opportunities are ripe for innovation? And how can healthcare leaders help their organisations take advantage of them?

Trend 1 Exploding data drives new solutions

Over a decade ago, the world’s total data storage capacity was around 487 exabytes. By 2025, it’s estimated that we’ll be generating the same volume in under two days.

The healthcare sector is one of the most significant contributors to this data explosion, accounting for around 30 per cent of the world’s data volume. The increased use of MedTech devices, apps, moni-

toring, and wearable technologies means more data is flowing into healthcare organisations than ever before.

As data volumes continue to rise, so does our difficulty managing it. Healthcare organisations are searching for ways to integrate and harmonise their data to make meaningful connections that lead to actionable insights.

For example, it’s important to ensure that healthcare data is accurate, complete, and accessible in real-time. This is easier said than done and involves sophisticated methods to standardise and transform data so that it is universally understood.

One solution, according to Gartner, is an enterprise data fabric, a way to continuously identify, transform and connect data from different sources to discover relevant and valuable relationships.

Trend 2 AI adoption in healthcare accelerates

Artificial Intelligence (AI) has the potential to make care better, faster, and more accessible.

We have seen incredible progress in AI diagnostic applications to aid clinicians in interpreting complex data. This has helped to shorten the time to diagnose and treat cancer patients. Other AI tools, such as early sepsis detection, have helped reduce newborn babies' mortality rate.

However, concerns about patient safety and a lack of quality data have slowed the progress of AI initiatives. For example, it can be difficult for clinicians to be confident in AI algorithms without testing them in their own environments.

With healthcare catching up to other industries in maturity, data will be both a critical success factor and a barrier to the successful application of AI.

What do we need to get right before we can realise the full potential of AI technology? An essential prerequisite is for hospitals to build the right foundations at a technology level, like interoperability and data management.

This is already happening. McKinsey’s analysis of The State of AI found that healthcare organisations were leading the way in AI investment, with 44 per cent of organisations surveyed saying they have increased investment in AI in each major business function.

It’s also important to encourage innovation and create a data analytics culture. Clinicians must be willing to adopt digital systems and see the value in capturing and sharing data. Organisations must constantly answer the question, “What’s in it for me?” as they roll out their digital transformation strategies.

Trend 3 Interoperability unlocks true power of data

According to a Sage Growth Partners report, 51 per cent of healthcare executives say data integration and interoperability are the most significant barriers to achieving their strategic priorities related to data analytics.

This is due to the amount of data being created and the number of sources that data is flowing from. Medical devices, patient records, hospital databases, and data lakes all house crucial data within the healthcare system.

Accessing real-time data remains an uphill battle without a way to connect these siloed data sources. Without real-time interoperability, hospitals can only analyse data within one system at a time or after it is out of date. They cannot use all sources of information to get the complete picture when needed.

A persistent hurdle to interoperability is the existence of many healthcare standards such as HL7, DICOM, XML, and more. Systems using different standards are not able to communicate with each other efficiently. Many remote monitoring devices, for example, currently require their own data infrastructure. Because of the cost involved, this is a barrier to hospitals approving business cases.

But there is some good news. New standards such as Fast Healthcare Interoperability Resources (FHIR) and tools such as Application Programming Interfaces are closing the gaps created by the explosion of data and sources in the region.

If medical products include standards-based interoperability, for example, they can leverage existing infrastructure to make them easier and more cost-effective to deploy. Adopting a modern standard like FHIR, which works securely via the Internet, could make a real difference.

These approaches to interoperability make synthesising data from multiple sources much more easily achievable. And by making data more accessible, computable, and usable, you can use analytics to improve healthcare decisions and outcomes or drive digital engagement with patients.

Trend 4 Telehealth delivery moves to virtual care

A global pandemic and rising consumer expectations have made telehealth a permanent fixture of the healthcare landscape. And it continues to increase, according to McKinsey, which reported 38 times higher uptake in 2021 compared to the pre-Covid baseline.

Healthcare professionals in the APAC region are embracing this trend, seeing it as a valuable opportunity to improve access to healthcare. The HIMSS 2021 APAC Health CIO Report found that 88 per cent of participants would continue to leverage connected health technologies following the pandemic.

Telehealth is shifting from an isolated mechanism to deliver care outside the hospital to a more holistic, integrated model known as virtual care. Enabled by connected devices, information systems, and data, virtual care enhances the care experience and enables new models of care.

For example, you can significantly reduce the number of trips patients with chronic conditions must make to the hospital. This way, virtual care improves access to care while making better use of resources. Hospitals can invest in enhanced virtual care capabilities to overcome challenges like finding enough qualified staff or caring for a population living longer with more complex conditions.

The challenge is now how to seamlessly blend remote and in-person care seamlessly. Integrating telehealth into our digital systems and meeting individual care needs while improving patient access and experience is one of the critical challenges facing APAC healthcare leaders.

Trend 5 The rise of the Internet of Medical Things

Over the last decade, rapid technological advances have led to the development of an increasing number of connected medical devices that generate, collect, analyse, and transmit data. Commonly referred to as the Internet of Medical Things (IoMT), these devices are revolutionising how healthcare is delivered.

From connected glucose and heart monitors for patients with chronic diseases to ingestible sensors revolutionising disease diagnostics and monitoring, the IoMT enables more efficient, accurate, and costeffective healthcare delivery.

This opportunity is not lost on Asian health professionals. According to an IDC study of Asia Pacific healthcare providers, nearly 75 per cent have already deployed IoMT solutions, and one-third have firm plans to implement IoMT solutions this year.

The proliferation of devices, while positive, is also causing an explosion of data. As the number of devices grows, so does their associated data and the systems that analyse and communicate that data. Healthcare organisations are now faced with a “data deluge” that may prevent us from unlocking the full value of this technology.

You need the right foundations to take full advantage of IoMT and other digital trends. This includes interoperability and data management capabilities, like those supported by an enterprise data fabric. And you need a culture that rewards data-driven innovation.

By bringing these elements together in their digital transformation strategies, Asian hospitals and other healthcare providers will find new ways to overcome the challenges they face.

To find out more, please download the free InterSystems e-book “5 Trends Shaping the Future of Digital Health in 2022 | Asia Pacific”

AUTHOR BIO

Stella Ramette is Director, Healthcare Customer Relations & Sales, Southeast Asia for InterSystems, a creative data technology provider dedicated to helping customers solve the most critical scalability, interoperability, and speed problems. Based in Singapore, Stella provides local resources to a growing healthcare customer base and ensures that InterSystems is responsive to their needs.