How regulators and healthcare providers can work together for post-coronavirus recovery

Healthcare regulators, however, are faced with the challenging task of ensuring that the lessons learned during the worst of the pandemic in 2020 are not forgotten and that the clock is not re-set to the pre-coronavirus default way of delivering services to patients.

These lessons include the role of digitalisation in aiding efficiencies, the utilisation of technology in avoiding harm and the value that big data collection adds in providing optimal and personalised healthcare.

In the wake of the pandemic, governments need to create a future-facing landscape where the smart tech health innovation policies made this year are maintained and developed to ensure continuity of care and improved outcomes.

Supported by Edwards Lifesciences, the final panel in Arabian Business’ three-part webinar series Rethinking Arabian Healthcare, which was held on December 9, brought together thought leaders from across the Gulf and internationally to discuss how the healthcare sector can work with regulators to ensure continuity of care, and unlock the issues of backlog arising from restrictions on elective procedures.

Coronavirus disrupted the global healthcare sector, accelerating digitalisation and data sharing to maximise impact as well as giving rise to opportunities that have the potential to push the industry forward exponentially post-pandemic. The panellists all gave examples from their respective country’s experience to highlight the positive disruptions the pandemic has caused or accelerated.

“Covid was a very positive disruptor for the healthcare system within the UAE. The coronavirus crisis was a catalyst for major changes in our policies and regulations in relation to telemedicine and the utilisation of virtual platforms for the delivery of healthcare,” Dr Omniyat Al Hajri, director of community health at the Center of Public Health Abu Dhabi.

“That has been in the pipeline for many years and we’ve had small projects that were on the ground but Covid coming and disrupting the whole healthcare delivery model resulted in a very positive adaptation,” she continued.

Al Hajri gives the example of how, early in the pandemic in March, the department of health in Abu Dhabi authorised all healthcare workers to use the remote digital platform it had developed to interact with their patients in everything from scheduling their appointments to delivering their medications and even having telemedicine appointments.

“Another interesting change was the ability for healthcare professionals to support other institutions that they had not been licenced to work in previously. So we had that fluidity of healthcare professionals from one institution to the other, based on the goodwill and agreement between institutions to deliver the best services where they are needed,” said Al Hajri.

Consultant surgeon and senior advisor to the Minister of Health in Kuwait Dr Salman Al Sabah said the difficult times the healthcare sector was facing with coronavirus could also be seen as opportunities.

Dr Omniyat Al Hajri, director of community health at the Center of Public Health Abu Dhabi (left), and Dr Salman Al Sabah, consultant surgeon and senior advisor to the Minister of Health in Kuwait

“One of the technologies we used when re-engineering the hospital to make sure patients and healthcare providers are safe in surgery was augmented reality where one surgeon would be in the operation room while the others would be using augmented reality to guide that surgeon,” he explained.

Another example Al Sabah gave to illustrate how digitalisation and innovations played an important role during the pandemic was that of the 3D printing of swabs and testing kits in Kuwait. “This indicates the importance of having multi-disciplinary stakeholders whether its engineers, healthcare providers and leadership all of whom enabled this innovation to happen at a fast pace,” said Al Sabah.

Dr Panco Georgiev, partner, healthcare systems and services practice at global consulting firm McKinsey & Company spoke of the importance of big data sharing which allows for many additional benefits, including predictive monitoring of patients in the operating room (which can reduce complications, hospital lengths of stays and costs overall).

“Coronavirus accelerated the central availability of information across the Gulf. When you think of topics like clarity around supply chain or availability of workforce, the acceleration of information we have in the GCC is amazing. These are topics that a lot of policymakers have wished to have for over a decade and suddenly it is starting to be available,” said Georgiev.

Dr Panco Georgiev, partner, healthcare systems and services practice at global consulting firm McKinsey & Company

While healthcare facilities were dealing with coronavirus, a backlog of elective surgeries was created with one report indicating that 31,000 elective surgeries were cancelled in Kuwait over 12 weeks.

“The backlog of elective surgeries is a global problem. If you look at the beginning of the pandemic, there were reports indicating that 2.4 million elective surgeries were cancelled so imagine the magnitude of that,” said Al Sabah.

Across the Gulf, there were several models of dealing with this backlog. At the beginning of the pandemic, Kuwait paused elective surgeries save for emergency cases but resumed them in July, in order of priority.

“What is unique in Kuwait is that the private sector played a major role. Since they were not allowed to admit Covid patients, they were allowed to be a kind of free-zone hospitals and admitted elective surgeries, after ensuring safety of course,” said Al Sabah.

“We established committees within each hospital and they would decide, based on their own hospital needs, resources and number of Covid 19 cases, when to resume elective surgeries. These reports were presented to leadership to oversee them and make sure we are not overdoing it and risking increasing the number of Covid cases again,” he continued.

The UAE trusted in the resiliency and judgement of its healthcare system to determine whether or not to take on elective surgeries, said Al Hajri.

“What we decided to do as a regulatory body was to allow businesses and healthcare providers within their institutions to decide [whether to have elective surgeries or not]. This allowed us to better navigate during the critical period and we did not block businesses or ask them to stop elective surgeries but we did was call for the best judgement of healthcare providers on the ground to assess the risks,” said Al Hajri.

“We had robust inspections throughout to insure that maximum measures are taken for safety. We then allowed the community to communicate with their providers through the digital platform and ensured the continuous dialogue between them on deciding what procedures need to be carried out,” she continued.

The backlog in elective surgeries was in part created because of patients’ wariness of visiting healthcare facilities when faced with health issues.

McKinsey & Company’s quarterly healthcare consumer sentiment survey indicated that 47 of patients in the UAE and 43 percent in KSA are planning to delay elective procedures due to coronavirus, said Georgiev.

“When we asked people what would instil confidence for them to go to the hospital or physician they said they wanted to feel safe, to see a clean facility and no crowding,” Georgiev explained.

“Healthcare facilities are trying to reassure them and we have the examples of those that re-configured their waiting areas or pharmacies that were providing 24-hour services in Saudi Arabia. But we really need to continue working on that considering the stark number of people who are not comfortable going back to hospitals,” he continued.

Abu Dhabi relied on connecting the bits and pieces of data they had on their population to create a comprehensive unified database which facilitated communication with senior citizens and those with chronic health issues and essentially allowed for the creation of personalised healthcare.

“In Gulf countries, we were lucky because our leadership stated the priorities from the beginning with human life coming first, second and third. The first question we had in mind was not only how we would deal with the crisis but also what will happen to the rest of the community that needs attention such as senior citizens and people with chronic diseases,” said Al Hajri.

Abu Dhabi Health piloted a project where they communicated with 2,000 senior citizens across the Emirates, said Al Hajri, to gauge sentiment.

“That pilot made us realise that a lot of those patients were delaying treatment because of their fear of catching Covid in the hospital. So we actually identified, from our database, all the citizens above 60 and those that have chronic diseases and we divided them among five major providers and allocated them with the responsibility of reaching out to these patients to identify their needs and support them in either getting the appointments they need or using telemedicine and have their medication delivered to their houses.

In worst-case scenarios, we asked for the mobilisation of healthcare providers to those patients who have needs that cannot be attended to virtually. We learned a lot from this programme and we would love to see elements of it continue after the crisis Inshallah,” explained Al Hajri.

Healthcare regulators, in the post-pandemic world, must also look at what needs to be done to ensure the innovation growth witnessed during the pandemic is maintained and to ensure continuity of care post-pandemic.

The three panellists agreed that it is the frontline workers which should be leading this with the government extending its support and acting as a catalyst.

Healthcare regulators must look at what needs to be done to ensure the innovation growth witnessed during the pandemic

“We need to look at what innovations are needed now and what artificial intelligence tools will make the difference. This needs a lot of data but also energy and leadership from the healthcare providers to make sure it actually continues and flourishes. The role of the government is very important but I do believe we have to work as one team and that was the real lesson from the crisis and the only reason we have succeeded,” said Al Hajri.

“We need to build on these innovations that happened during the pandemic and sustain them and that needs a lot of investment in the workforce,” said Al Sabah giving the example of how more IT specialists are needed going forward.

“Technology is out there, funding is out there but we need to think of what workforce we need for the future and where we will invest more,” he continued.

As the world moves out of the pandemic, the “new normal” in healthcare will continue to involve a lot of med-tech innovations such as telemedicine, AI and virtual communications agreed the panellists. Continuity of these innovations needs to be maintained, however, and that needs investments in the right place. The panellists each gave their perspective on where these investments need to be made.

“One out of three conversations I’ve had over the past nine months is on digital health solutions. Although this is not a new concept, the interest in it has vastly accelerated and we suddenly have a lot of heavyweights which are seriously looking at innovation and establishment of digital health,” said Georgiev.

Investing in R&D is important in order to have more data that would guide decision making among healthcare organisations

Al Sabah stressed on the importance of investing in R&D in order to have more data that would guide decision making.

“We have to invest more in data in terms of how to use data for our decision-making and how to make it more evidence-based. We need to have data to guide us on how to use this technology to our advantage,” said Al Sabah.

“We need to make sure we have enough funding to support the healthcare providers in innovation and let them try. I give the example of the vaccine trials: This is the first time we have that magnitude of clinical research and if we build on this in the future, we will be for sure be a hub for innovation in this part of the world,” he continued.

“We are already investing in human resources: more than 100 nationalities working in healthcare and they are heroes. We have to work on attracting more and ensuring they stay with us longer and provide them with the appropriate resources they need,” said Al Hajri.

At the concluding remarks, the panellists reiterated that the healthcare workers were the true heroes of 2020 and should be leading the region in rethinking healthcare. Coronavirus has put healthcare systems in a unique situation but it has also brought about digital transformations and smart investments that are likely to continue disrupting the industry for years to come.

By applying the right regulations and building smart investments in people-centred innovations, health outcomes can only be improved and quality of life for all will be preserved, concluded the panellists.