IMPACT OF TECHNOLOGICAL INNOVATION ON HEALTH

TOURISMMODERATOR:

Dana Msaddi, MSc HCMChief Operating Officer and Board Director

Neuro Spinal Hospital - DUBAI

SETTING CONTEXT

Technology and information technology– what has it done to the

world and for the world

TRAVELING FOR CARE – THE BEFORE AND AFTER

Medical tourism dates back to the beginning of time although the concept did not appear till recently – in ancient Greece people travelled to springs for their

healing effects.

BEFORE AFTER

• “We heard of a good doctor”• Unclear costs• Huge cultural barriers• Challenging continuity of care

• Information platforms, patient reviews

• Increased reach and care planning• Diminished cultural barriers• Post treatment access to physicians

MEDICAL TOURISM - TODAY

According to WHO report drivers for medical travel:

• Technology• Quality

• Access• Cost

BACK TO BASICS

Medical Tourism defined:

• No global regulatory body yet to agree on a universal definition

Differentiate between Medical Tourism for elective surgery or treatment, Health Tourism for wellness and cosmetic and International patients who

do not travel with the intent of treatment

Credible bodies:• IMTJ award

• TEMOS certification

BACK TO BASICS

Medical Tourism defined:

• All definitions agree on the involvement physical movement of a patient across borders for elective care

Is technology going to challenge that definition?Where do we find the balance between patients travelling for treatment

or treatment travelling to patients?

VS VENKATESH

Received a number of awards and recognition:• CEO of the year 2017 Award

Dubai, UAE• Best International Speaker Award 2016

IIMTC India• Emerging Leader of the Year Award 2014

India• Rotary Youth Merit Award for his

exceptional work symbolizing – service, dependability & leadership

• CEO & Director of Morgenall Healthcare Ventures India

• Independent Board of Director of GlobalSpace Technologies Ltd.

• Executive Trainer, Mentor & CEO Coach who is passionate about developing leaders to build a New India.

• Keynote Speaker and has spoken in over 15 countries on issues relating to Healthcare, Medical Tourism, Change Management, Technology & Healthcare, etc.

THE IMPACT OF ARTIFICIAL INTELLIGENCE IN

HEALTHCARE AND MEDICAL TOURISM

V S Venkatesh CEO & Director

Morgenall Healthcare Ventures India

• The human brain is an amazing work of art, it has very complex neural circuits and the way it registers, stores, processes and analyzes information and takes decisions has always been a matter of fascination.

• It has been used in the airline industry for years now, to assist pilots to make decisions under difficult, high-pressure, complex situations .

• Many a scientist has been fascinated with this concept and thus was born “artificial intelligence” and “deep machine learning”.

Artificial Intelligence is “the stethoscope of the 21st century.”

YOUR FUTURE DOCTOR MAY NOT BE HUMANThis is the rise of Artificial Intelligence in Medicine

• Cognitive computing and cloud-based AI technology is slowly transforming Radiology, Ophthalmology, Oncology, Pathology or even Surgery.

• Imagine a nurse or doctor popping up virtually on your smart phone and handing out consultation and prescribing meds driven by ‘digital tsunami’

• To be inside a hospital, you will have to be very-very sick with some very complex condition,

• Each Room bristling with technology

• Clinicians won't have to be physically present

• Tele Diagnostic applications powered by cloud systems would guide the treatment

• AI applied to cloud-based ‘Big Data’ will assist clinicians

46 BILLION DATA POINTS TO PREDICT THE MEDICAL OUTCOMES OF HOSPITAL PATIENTS

• AI concept was propounded & has come a long way since Tin Man and Turing

• The Limitation to Progress was the limit of computer storage (MONEY!?!)

• But as memory and speed of computers doubled every year, they finally caught up and even surpassed our needs.

• Deep Blue & Google’s Alpha Go• We now live in the age of “big data,”

an age in which we have the capacity to collect, compress & store huge sums of information too cumbersome for a person to process.

AI - REVOLUTIONIZING HEALTHCAREArtificial Intelligence has proved itself in many practical tasks - from labeling photos to diagnosing disease

AI - REVOLUTIONIZING HEALTHCARE

• Design Treatment Plans – to reach a specific goal

• Mining medical records and Analyze Big Data

Machines can be taught to “read” images- X-rays, CT scans, MRIs and

angiograms. This will be of immense value in mass-screenings, across

continents any abnormality can be potentially treated through

Telemedicine. – Cleveland Clinic &

Intermountain Hospitals

AI - REVOLUTIONIZING HEALTHCARE

• Decision making and guidance –Evidence Based Practice• An AI system could alert a clinician

when it detects a Disease Pattern its contraindications due to any possible genetic variation , to a planned treatment across Demographic Divides of the world

• Heart Sound Fluctuations• Predicting patients at highest risk

• Companion robots for the elderly• Terradata, Clouderra, Hadoop, Python

R

AI - REVOLUTIONIZING HEALTHCARE

• Generating alerts and reminders

• IOT , Wearables pick up changes in a patients condition, scan laboratory results, critique therapy & send medication

• A tiny medical drone delivers a package in your backyard containing medication the GP prescribed for you earlier and which you forgot to buy.

POTENTIAL COST SAVINGS IN AI APPLICATIONS

SOURCE: Healthcare IT News

AI & ROBOTICS IMPACTS THE HEALTH CARE INDUSTRY & CAN BE A VALUABLE TOOL IN MEDICAL TOURISM

In healthcare industry

1. drug manufacturing

2. moving inventory

3. dispensing drugs

4. monitoring patient vitals

5. carrying out surgeries

Robotics has already proven its potential in improving the quality of patient care, as well as making it more affordable.

EARLIEST MEMORY OF MEDICAL TOURISM

• The latest entrant to this domain is the cutting edge Cloud robots.

• Cloud robotics convergence of information, and intelligent motion with the help of the cloud

• Can Perform Remote Surgeries.

AI RISKS – Sans Human Touch

• Medical data is very fuzzy and can be difficult to analyze at times.

• Medical evidence, Empathy, and Caregivers dedicated to their jobs make healthcare unique.

• Thus, a lot of techniques which Big Data, AI & Robotics proponents use, would have catastrophic consequences in healthcare. Especially in direct patient care. • In a system trained to learn which patients

with pneumonia had a higher risk of death• It inadvertently classified patients with

asthma as being at lower risk.

• The machine learning took this to mean that asthma + pneumonia = lower risk of death.

AI RISKS – Sans Human Touch

Artificial intelligence is touching our lives in ever more important ways - it's time for the ethicists to step in.

- Bryan Lufkin

“More to see how technology can be used to help humans rather than to entirely substitute it.”

Fears of a robot apocalypse mask the actual problems that we face by increasingly letting our lives be run by algorithms

And it is here we draw the line between Patient Centric , Empathy driven Treatment vs. Cold Data Crunched Analytics

CAN AI REPLACE HUMAN EMOTIONS AND INTUITION?

VS VENKATESH

CEO & DirectorMorgenall Health Ventures

Ind. Board of Director GlobalSpace Technologies India

Hon. DirectorInternational India Medical Tourism Council

+91 96 00 11 88 11venkatesh@vsvenkatesh.comVS VenkateshVenkatesh VastareVSVENKS

BRIAN DE FRANCESCA• In 2015, he founded Ver2 – an innovative

telemedicine services platform, that recently received an Expo2020 Global Innovator’s Grant for its “Connecting Minds” work in Africa.

• 20-years international healthcare experience and has worked at both extremes of the medical tourism continuum.

• One of Brian’s personal goals, is to connect 700 refugee camps to healthcare and education resources over the Ver2 Platform.

• Johns Hopkins and Loyola Universities educated expert in the use of digitalization and connectivity to improve healthcare quality, access and efficiency.

• Worked for Bangkok Hospital and Bumrungrad Hospital for more than a decade – both of which receive large numbers of medical tourists.

• Worked for Johns Hopkins in Abu Dhabi, from where many patients travel to North America, Europe and Asia for care.

Case study: The use of Telemedicine

to facilitate medical tourism

Brian de FrancescaFounder & CEO Ver2

In Bound Out Bound

Bangkok Hospital Tawam Hospital

Telemedicine for Tourism

1. Teleconsultations (secure video conferencing)

2. Cloud-based health records:

• With patient consent

• Including images, lab results etc.

• Built on Blockchain (Q3 2018) – for authentication

3. Remote monitoring

Challenges with inbound travelers

• Many “leads” but few “conversions to visits”

• Un-scheduled visits (doctors booked or out of country)

• Stacks of paper, disks and scribbled notes

• Wrong diagnosis

• Diagnostic testing that should have been done before travel (cultures taking 4-6 weeks etc.)

• Have a fixed budget; actual costs exceed what was budgeted

• Would lose track of them once they left

With 15 min tele-consultations

Conversion-to-travel doubled!

Challenges with outbound travelers

• Reason for traveling:• 40% did not trust local diagnosis or treatment plan

• Lose them when gone – no communication with patient or attending physician.

• Return with prescriptions not on local formulary

• With devices not locally supported

• Lack of follow-up upon return

• Always over budget

• Physicians at home reluctant to care for patient = risk

2nd Opinions by “trusted specialist”

= 40% reduction in travel

Fragmented Care Continuum

• Limited follow-up• Reluctance of home based doctors to pick up care• Prescriptions and devices are not available

• Limited ”pre travel” preparation • Loss of “patient visibility” once abroad• Unnecessary travel

1. Puts patients at risk 2. Wastes money 3. Comprises the reputations

of medical institutions

Telemedicine is the solution

• Reduces risk to patients and providers

• Improves experience of patients and caregivers

• Increase revenue and reduces wasted money• Conversion to travel using teleconsultations

• Telecare and Second Opinions (avoiding travel)

• Not about the ”technology”• Workflows and processes

• Scheduling

• Communications

• Planning and coordination

A B C D E F G H I J K L M N O P Q R S T U V W X Y Z

is not about the letters of the alphabet

A Shakespeare Play

is not about the notes on a scale

A Mozart Symphony

CASE STUDY

Medical Tourism

Tele-Medicine

Digitalization

The Valiant Journey

Connects to remote specialists, on an as-needed basis

Required continual access to a full range of high-quality radiology sub-specialists, in order to best serve patients needs

A new local clinic needed access to high quality diagnostic services. Contracted with Valiant Clinic.

Management saw the tremendous

potential in Telemedicine !

Valiant Virtual

A step beyond medical tourism

Core Tenets of Valiant Virtual

• Using Telemedicine to attract medical tourists to Dubai and effectively manage their cases

• Improving the continuum of care for patients traveling from the UAE to other countries and upon their return home

• Using Second Opinions and Telecare to reduce the need to travel abroad

Travelers from the UAE (outbound)• Pre-travel

• Offer “trustable” second opinion (will reduce medical travel)• Tele-consult with host healthcare provider• Orient them with Valiant Medical Travel Process • Established shared cloud based personal health record (with patient consent)• Tentative agreement of care plan

• While abroad• Establishment of diagnosis and treatment plan (agreed by AP and RF)• Referring physician continually reviews patients status (cloud record)• Attending physician seeks approval of any modifications to the pre-agreed care plan• Able to schedule teleconferences as required• Family is also able to be involved with patient consent

• Prior to returning• Pre-discharge case review between remote clinical team and referring physician• Confirmation that prescribed medications are locally available (and devices supported)

• Once they are back home• Integration of PHR with local health record system• Arrival teleconsultation with attending physician• Case close by referring physician, attending physician and patient.

• Valiant develops relationships in target countries

• Reputable agents / local clinics with diagnostic ability

• Enable them for “telemedicine” service ability

• Patient Pre-travel (before they leave home)

• Teleconsultation between patient and Valiant team (increases conversions to travel)

• Establish on-line health record (with their consent)

• While they are here

• Referring physician (and family) has continual access to patient record

• Teleconferences can be scheduled as needed

• Prior to returning to their home country

• Pre discharge teleconference with the referring physician (and family)

• Review of medical record (made available to referring physician and patient)

• Once they are home

• Integration of PHR with local health record system

• Arrival teleconsultation with attending physician

• Case close by referring physician, attending physician and patient.

Travelers to the UAE (inbound)

USA

U.K.

KSA

Portugal

France

No Bounds: Tele-Psychiatry

• Tourism Management• Psychology• Dermatology• Neurology• Disease Management

World class care - as a medical tourism destination

Telemedicine extends Valiant’s reach

• Medical education• Second Opinions• Expert Consultations• Surgery Support

Permits Valiant to access the world of clinical and educational expertise

What about follow-up ?

International Sim Card

Patients will take Valiant home with them…

PANEL DISCUSSION

DR. MOHAMMAD ABDULQADER AL REDHA

• Assistant Chief Operating Officer at Rashid Hospital – a 600 bed trauma facility serving Dubai since 1973.

• Graduate and postgraduate of the Royal College of Surgeons in Ireland and holds a Masters Degree (MSc) in Healthcare Management

• Member of the Mohammed Bin Rashid Program for Leadership Development Programme and a Fellow at the Dubai School of Government

• Director Health Data & Information Analysis Department, Dubai Health Authority. Where he developed standards for implementing and managing the HIS in the Emirate of Dubai.

• Research Fellow in Clinical Informatics at the Division of Clinical Informatics, Harvard Medical School in Boston (2008-2009). His main focus was redefining the standards of healthcare to meet international standards while creating a very patient-focused, research-enriched environment.

IMPACT OF TECHNOLOGICAL INNOVATION ON HEALTH TOURISM

MODERATOR:

MS. DANA MSADDI, MSc HCM

Chief Operating Officer and Board DirectorNeuro Spinal Hospital - Dubai

PANELIST:

• DR. MOHAMMAD ABDULQADER AL REDHADirector - Health Data & Information Analysis Department, DHA

• MR. V S VENKATESH

CEO & Director of Morgenall Healthcare Ventures India

• MR. BRIAN DE FRANCESCA

CEO, Ver2 Digital Medicine