Written By: Hulkar Egamberdieva
2020 is proving to be a most challenging year, having affected billions of people across the globe. With the world experiencing a healthcare crisis, amid the COVID-19 pandemic, individuals working at the frontline of healthcare are deservedly being hailed as heroes. From the perspective of healthcare technology, the pandemic has been a catalyst for the process of the digitalisation of healthcare at an unprecedented global scale, forming a pivotal point in telehealth development. Ensuing lockdown measures cornered the healthcare industry, by limiting the traditional face-to-face contact accessibility, as if to say: “What solution will you come up with now that we have affected one of your core practices?”. To that the healthcare industry responded with - Telehealth.
The Digitalisation of Healthcare post-COVID
The main goal of the digitalisation of healthcare is to bring clinical practice to the homes of patients and not the other way around, as we are accustomed to do, and moreover, to do this efficiently and effectively; integrating it into healthcare infrastructure. From digital stethoscopes to thermometers the simulation of an in-person visit via virtual means is progressively striving towards being perfected. Using telehealth as a tool, healthcare professionals can be more efficient at their jobs and patients will no longer have to wait long lines for minor concerns.
On a global scale AI can be implemented in detecting future outbreaks and spreads of viruses. Tracker apps, such as the one adopted in New Zealand, can enable a quicker response rate and greater success in eliminating viruses by contact tracing. Interactive AI maps and new technologies can be utilised for faster detection, thus speeding up the search for adequate therapies and most importantly can be transparent and accessible to the public.
These can also be integrated into preventative care, which is the direction general health care is headed towards. Early prognoses would help the population’s most vulnerable in finding more sustainable solutions to their conditions as they will be informed early on; or whether they are predisposed.
Finally, digitalisation, although often misconceived, does not necessarily equate to the redundancy of healthcare workers such as doctors, in fact, when used effectively, it should improve their efficiency. A further advantage is that PPE can be saved for frontline workers who need them more than anyone. Moreover, with the consequences of COVID-19 the outlook on telehealth has changed- telehealth is an enhancer rather than a substitute.
With the acceleration of the digitalisation of healthcare it is important not to lose sight of both clear and obscure challenges. These include obstacles in legislature, inequality and security. It is vital that if we were to move into the new age of telehealth, that everyone would have access to it; rather than it being a privilege for the few. Although in terms of geography or mobility healthcare would be more accessible; high-speed internet or capable smartphones and devices are essential to telehealth success. An alternative solution could be the design of apps that are available for offline services. An ethical concern that has always been coupled with telehealth is privacy, where secure data exchange and user privacy has to be guaranteed.
Mental Health concerns in the post-COVID landscape
Undoubtedly one of the most significant challenges is mental health. Mental health should become a priority especially during a pandemic as we see spikes in COVID-19 related stress, anxiety and depression. Furthermore, this should not only be applied to the general population but in particular to healthcare workers; and more specifically frontline workers. Professional psychological support should be accessible, more widespread and cost-effective. For this to happen, mental health must be acknowledged as an issue in the first place, and proper education on the topic should be implemented.
With COVID-19, telehealth and remote therapies have been utilised for mental health care, however, unlike other conditions, this proves to be a greater challenge as there has to be a different, personalised approach when it comes to mental health patients. Therefore, at this stage, digital services ultimately could not replace in-person treatment in this case.
The world of healthcare post-COVID-19 will see numerous changes, adjustments and will evolve into an amalgamation of the new digitalised approach and the traditional methods. A stressful period for all, this will be the time to channel productivity and stay educated. This is an especially busy time for healthcare workers, telehealth providers, legislators and innovators who will all have to be on board for a new era of healthcare. The end goal – the creation of an integrated healthcare industry that is effective and sustainable for all.
Written By: Hulkar Egamberdieva
With COVID-19 making its mark on history, as it spreads indiscriminately across the globe, it may be hard to keep up with the ever-changing landscape of the pandemic. The majority of the world’s population has been urged to stay home and self-isolate to ease the burden on the health care systems and prevent a collapse. While mainstream media and news outlets blast statistics at us, it is also important to look beyond the numbers and focus on the actions being taken. As these may be more obscure, this article will highlight the main efforts of research institutes, health-tech companies and pharmaceutical giants, which are happening behind the scenes. It will discuss the vaccines being designed, the key compounds being tested, technologies being used, as well as other innovations such as designing test kits and mobile apps; all in the fight against COVID-19 and the race to find a cure.
There has already been multiple collaborative research efforts established, one called the COVID-19 Therapeutics Accelerator involving pharmaceutical companies such as GlaxoSmithKline and Novartis.
GSK has responded by sharing their adjuvant technology with scientists. Adjuvants are added to vaccines to trigger a greater and more long-lasting immune response. As a result, this can reduce the concentration of the compound being used in the vaccine design and thus lower the required doses.
Novartis, on the other hand, is focusing on repurposing existing medicines and are currently donating 130 million doses of hydroxychloroquine (administered for some rheumatological and dermatological diseases), in support as it is labeled by the WHO as one of the potential treatments with antiviral properties against COVID-19.
Sanofi, not part of the same collaborative effort, is also working on this compound. They estimate to have a vaccine candidate available for in vitro testing within 6 months. If successful, it will enter clinical trials within a year and a half. Sanofi is also working together with Regeneron to enroll their drug ‘Kevzara’ (sarilumab) that is used to treat rheumatoid arthritis into clinical trials immediately. The clinical programme has been initiated in Italy, Spain, Germany, France, Russia, Canada and the US.
Another pharmaceutical giant, Johnson & Johnson, has announced that they will have a leading vaccine, along with two back-ups that will be ready for clinical trials in September 2020 with emergency use being made available in early 2021. They also promise making available 1 billion vaccines being supplied worldwide. They are leveraging Janssen’s ‘AdVac’ and ‘PERC6’ technology that in conjunction with each other produced rapid, high-yield, and cost-efficient vaccines and monoclonal antibodies against life-threating infections.
Besides the pharmaceutical industry, we have key players from the biotechnological industry. One of the most notable names is Moderna. Moderna’s core technology is based on mRNA technologies. As soon as Chinese authorities disclosed the genetic code of the novel coronavirus, Moderna focused all its coronavirus research onto COVID-19 specifically and within days they created a computer model of a vaccine; all without access to the physical virus itself. Its vaccine candidate is the first to reach clinical trials. The company is currently waiting for approval of Phase II trials and while the vaccine will not be commercially available for 12-18 months, it is possible that it may be used for emergencies in the autumn of this year.
mRNA technologies together with the repurposing of existing drugs is the approach taken by VECTOR a biotech company of the Institute of Virusology and Biotechnology in Russia. They are currently working on 18 potential vaccine candidates, and will present their successful candidate by June. Besides their efforts to produce a leading vaccine candidate, they have also developed test kits with high accuracy rates.
Test kits have also been evaluated by the UCSD, which promise to identify COVID-19 in patients in, as little as, 45 minutes to 1 hour. The University of California Health group is also recruiting participants for Phase II trials to investigate the efficacy of redmsivir. Redemsivir has been labeled as one of four promising therapies in treating COVID-19 according to the WHO.
Other contributors to the pandemic relief are manufacturing giants who are working on producing ventilators, medical equipment and antiseptic gels.
Last but not least, a few tech companies are investing in developing apps that monitor movement to track the virus in the general population. For example, MIT Media Lab, experts from Harvard University as well as software engineers from Facebook and Uber, designed an app called Private Kit: Safe Paths. The app allows people to trace their contacts or avoid people and areas that have been impacted by the coronavirus. This raises ethical concerns, which is why a safe approach has to be taken and lots of care has to be taken to prevent harming the population and community’s privacy.
A similar approach has been employed in Singapore, where a telehealth app called MaNaDr has been used by more than a million people. It is a virtual diagnostics platform that determines whether an individual’s symptoms are severe enough to be treated in hospital; only after which the doctor will order an ambulance to collect the person. This remote care monitoring system is essential today in order to reduce the overwhelming strain that frontline healthcare professionals are facing, which a lot of countries are battling today.
Overall, the abundance of information available to us with the current situation is truly staggering. With efforts being made from so many nations, institutes, private companies and scientists working around the clock, it is evident that a global work ethic has been established to fight the pandemic. Time is indeed of the essence, but it is also important to acknowledge that the safety of the aforementioned devices is of equal significance. That being said, although the data may not be conclusive just yet as the situation is constantly developing, we may see the first patients being administered new vaccines very soon.
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Writer: Hulkar Egamberdieva
Now more than ever, the digital world of healthcare is on the rise; impacting and changing the face of medicine. Healthcare data is being collected with an unprecedented rate and accuracy, leading to the democratisation of health care, with implications for both the patient and physician alike. This growing phenomenon of democratisation is defined as the increasing accessibility of data on one’s health by means of distribution, allowing for future insights. According to the Faculty of Medicine at Stanford University, this can be achieved through data flow and new technologies. They proceed to delve into the description of the “three pillars” of this event: intelligent computing, sharing and security – answering the questions that would keep people up, including us, such as: ‘Who will be entitled to our health data?’ ‘Will be monitored constantly?’ ‘Will the democratisation of health care override the humane aspect of Medical practice?’ - And more.
With the invention of smartwatches, health monitoring apps, AI technologies, VR, smart lenses to mention a few of the newest innovations published in the latest Medical issue of National Geographic, a sci-fi-like future is no longer pure fiction we would see in action-packed movies. Every single step, every single heartbeat is being measured and taken into account under population health. The data flow from digital devices to medical institutions and health care professionals is enabling a fluid medium of communication between patient and physician. There will no longer be a need for one-to-one appointments as data will be constantly fed to your physician. In fact, according to Stanford University, this will become a ‘one-to-many’ relationship, where there will be an open conversation between multiple sources of information and advice, focusing on each individual. Furthermore, the creation of new intricate algorithms, which will enable fast and accurate diagnostics; virtual care will become a primary source of health care for many people. This individualised style of practice will lead to a better understanding and more elaborate development of the field or preventive and personalised medical practice.
It goes without saying, however, that with great innovations come great risks, and democratisation of health care is no exception. Setbacks in this field include issues with physician burnout, consumer reluctance, limitations with globalisation, and perhaps most importantly, privacy concerns. Due to constant inputting of data and computing doctors are complaining that they have less time to actually have their one-to-one meetings with patients. On the reciprocal side, people are apprehensive of sharing their personal health data through technology as this is still a relatively new field; there are natural doubts about personal privacy and consent. Patients also question how trustworthy an AI being would be in sudden unexpected circumstances, which is why many believe that the traditional practice of medicine will not wean or die out. Further relating to customer apprehension, privacy may be the greatest concern, for all parties involved. The question of confidentiality is perhaps the most important one in this process. In a multi-layered, multi-media industry the motion of data itself poses a risk of malicious attacks. This places cyber-security at the forefront of democratisation, where health care institutions, technologists, ethics committees and legal implications have to form a stable environment, prioritizing every individual’s safety. Finally, in terms of globalising this phenomenon, there is still a lot of ground to cover with up-to-date technologies and discrepancies in languages and cultures. For example, a patient whose native tongue is not English will have different results to the same test as for someone where it is. Moreover, “only a third of hospitals have access to electronically retrieved data”. This already creates a large gap in the health care industry, one that has to be covered with further education and investment.
The idea of democratisation of health care, one of the most valued sectors of our lives, maybe a daunting one. Tackling issues with privacy are perhaps one of the most important areas for improvement. However, by building strategic partnerships across multiple professional sectors even beyond medicine, this ongoing event is a beacon of hope for preventive, precise and personalised medicine. There is still a lot of work to be done; a lot of intricacies to be fleshed out and yet by integrating innovations and building trust with patients democratising health care is definitely a promising path we can take to improve population health.
Speaker: Christine Lu, an associate professor and co-director at the Precision Medicine Translational Research centre & Joe Kimura, the Chief Medical Officer at Atrius Health
Writer: Christiane Zhao
Christine Lu, an associate professor and co-director at the Precision Medicine Translational Research centre, give her opinions based upon on the public health sites of Precision Medicine. "Precision is not just about using genomic; it is trying to reunite patient preference in care delivery and the outcome of care." Precision medicine is increasingly used in life; it widely appears in clinical settings and used for consumer genomic testing as well. She then pointed out three main challenges that the U.S. market is facing. First of all, there is a lack of clear evidence to support the implication of precision medicine, even though we have various use of precision medicine. We do not have enough substantial and robust evidence to show that the use of technology in genomics can make a real difference to our daily life. The reason for that is mainly because the human genome is not complete, while how to categories different genomic sequences and distinct understanding of genomic can change the output. Clinicians and patients should be more informed with the update. However, the system makes it very difficult to ensure the updates is on time before the decision-making point in the clinics. Secondly, we do not have a comprehensive policy and governance for privacy. While lots of information that are related to genomics are new and data computation is needed, we are urgently to develop the law to prevent unsuspected use of this information. Government accessed data might be used by employer or insurance companies, which can reinforce the role of discrimination in society. Lastly, the cost of genomic tests are reducing, but the variation of products is enormous. We have inequality and disparity between the quality of the test result, but we do not have an excellent solution to deal with these yet.
Joe Kimura, the Chief Medical Officer at Atrius Health, is then picked up the talk. He said that 80% of the new practice care comes from capitation domain, which brings the concern of driving the most value from the daily practice. It is necessary to create a learning healthcare system, as we are acknowledged that we do not know the blueprint of the future of healthcare. The current healthcare system requires a long cycle time frame for the medicare givers to learn and adopt changes. Joe also pointed out that the adoption of health informatics can solve inequalities in access to care, especially in primary care.
"What is the optimal form of leadership?" Joe continues to explain, "The best primary care physician enables a patient to believe they are taking control of their health. Technology gives patients the ability to engage in their health also enables care providers to involve in the care delivery process actively." The United States is having an ageing demographics as well as a lack of healthcare staff. Therefore, we should support patients' independence in health, but also enhance the bonds between the patient and the system. Evidence-based care is an essential part of achieving this. It means the appropriate uses of technology can enable patient to know their health better, for instance, home care. It will always be difficult for care providers to adopt the changes between 20 years ago, now and 20 years later, but it is so essential to create values for access to care, access to continuous care.
Declaimer: This article is generated based on a talk given at the 9th US-CHina Health Summit in Boston, the United States in 26th September 2019. The views and opinions expressed in this article only reflect the speaker’s opinion and does not necessarily reflect the author’s official policy or position. All rights reserved.