Will the UAE’s digital medicine boom steer us away from hospitals?

The beige walls, the overpowering scent of disinfectant – even in the UAE’s cushioned world of five-star private hospitals, the prospect of a doctor’s visit can be daunting. So a life where they can largely be replaced by a few gadgets in the comfort of your own bedroom sounds tempting.

This is part of the vision that leading digital medicine proponent Brian de Francesca envisages for the UAE, and his hope is the country will forge new frontiers for the rest of the world to follow. But do consumers need to be wary of this new revolution?

De Francesca, CEO of company Ver2, says growing medical problems in the country are rapidly outpacing the not-insignificant infrastructure that exists to support them – and “the solution is not to be found in only building more hospitals, importing more doctors or building more medical schools.”

The UAE health market is worth billions of dollars, and de Francesca says management of the country’s biggest killers like diabetes and cardiovascular disease could be treated through digital patient-doctor, doctor-doctor, doctor-pharmacy and doctor-laboratory relations.

“There is a mountain of evidence showing that programs such as remote patient monitoring combined with tele-consulting will have a significant and sustainable positive impact on chronic illnesses. In diabetes alone, we can increase care plan compliance, reduce blood glucose levels, reduce emergency department visits and lower care costs tremendously – this is much, much more important than constructing more buildings.”

He says digital medicine will save “millions of lives” worldwide through timely intervention – not to mention preventing amputations, blindness, brain damage and a host of other medical complications.

“Broken” health systems

De Francesca has a business background but has worked exclusively in health care around the globe, including for the preeminent Johns Hopkins organization. He says he established Ver2 in the Middle East about a year ago because the “broken” health systems of the U.S. and Europe are caught up in regulations and unions and hindering improvements in access, quality, efficiency and cost of care and patient safety.

“All our projects are really the first significant ones in the whole region – we have 36 in various stages [but] we’re going to have a lot of competition really soon.”

He says the revolution has been made possible by things like ubiquitous, cheap internet; smart, affordable computers and biosensors which compile medical information; the widespread digitization of information; and a better understanding of genomics allowing for unprecedented personalization in treatment.

“The greatest single positive impact on the health of the public has not been provided by doctors but by engineers,” he declares.

“In the Victorian era, the construction of comprehensive sewage systems along with providing access to clean drinking water greatly improved the general health of everyone – much more than any one medicine, or surgical procedure. Everything since then has been incremental, until now.”

De Francesca says adoption of digital medicine has been progressing in “fits and starts” for decades, hampered by regulations and suspicions.

But high-profile problems with digital medicine could also account for the slow embrace. In 2002, Seattle Children’s Hospital sued digital medicine company Eclipsys claiming it had missed installation deadlines and failed to fix software errors. Then in 2006, the Children’s National Medical Center in Washington, DC discovered an eightfold increase in dosage errors for high-risk medications after introducing an electronic health record system.

Quality and the high cost

A 2009 New England Journal of Medicine study showed a two per cent uptake of hospitals using electronic records largely due to doubts over quality and the high cost of systems.

De Francesca says technology failures may be a valid concern but would not prove fatal – unlike some traditional treatment practices.

“Hospitals are horrid, dirty and unsafe places. The more you can stay away from other sick people, the better.”

Currently about 10 percent of U.S. hospital beds fall under the category of digital medicine, while regionally that number is zero with only about one percent of cases using some form of digital medicine. But de Francesca says that will grow exponentially.

“Huge hospitals are wasteful and unsafe. Networked, smaller facilities and personalized medicine is the way forward; better, faster, cheaper, everywhere.”

The UAE tends to have a high number of “visiting doctors” – specialists from overseas who drop by to treat patients in the region on an annual or monthly basis. UAE hospitals are not busy enough to hire many specialists in areas like radiology, he says.

“The end result is that these generalists, who are not trained in sub-specialties, make a certain amount of errors when one of these specialty cases comes their way.”

Digital medicine can ensure continuity while the doctors are out of the country.

Laws and protection

This all sounds like a brave and potentially frightening new world. What laws are in place to ensure treatment is up to scratch?

Al Tamimi Head of Regulatory Law Andrea Tithecott says laws governing digital medicine – or ‘telemedicine’ – are burgeoning, but regulations are still being developed federally and by emirate health authorities.

“It’s one of the most rapidly developing sectors…it’s generally estimated to be globally valued at $160 billion…of which the GCC is expected to have a very large proportion.”

Tithecott says the Health Authority – Abu Dhabi (HAAD) has published a telemedicine healthcare standard, while standards governing tele-radiology have been incorporated into a recent Dubai Health Authority document.

“Lying behind the new telemedicine standards which are in the process of being rolled out in the various emirates...is a very established system of healthcare licensing and supervision at all levels which mean that the right people are looking at this information and delivering the right advice back to the patient. A telemedicine center wouldn’t be the same as a call center for example.”

Medical malpractice is a concern, but regulations in Abu Dhabi, for example, outline the “home jurisdiction doctor” carries the liability for any advice acted on from an out-of-jurisdiction consultant.

“From the patient’s perspective that’s a good thing because they know exactly who they need to go to get their remedy…the home jurisdiction doctor will be insured [and] the insurer will have a mechanism of dealing with any claims that arise.”

If such claims became an expensive exercise it may impede doctors’ willingness to engage in telemedicine. That’s where contract law may come into play, she says.

“I think it would be possible to weave into the commercial contract between the home provider and out of jurisdiction provider for an indemnity or warranty given in relation to the advice.”

Technology failure could also lead to legal issues.

“It is always possible wherever data is held that a server could be interrogated or unauthorized access gained to a cloud-based system…but through proper security systems the risk of unauthorized access should be reduced.”

HAAD, for example, requires certain sensitive information to be stripped or coded if it is to be sent.

In time, the same data encryption and protection standards that apply to sensitive areas like the military would flow into other sectors, she says.

“It’s very important to protect patient confidentiality…to get patients’ buy-in.”

The risk of human error still applies, but “that has historically been the problem from the very beginning of any interaction between a healthcare provider and a patient.”

Because the system is predicated on widely-shared digital information being accurate, it would be doubly crucial to ensure a robust system of checks and balances is implemented.

“If [there is a mistake], the patient has all the typical remedies they would have for a paper-based error.

They would still be able to complain or ask a health authority to investigate and they’ll still able to bring a medical malpractice case or ask the courts to bring a criminal action.

“It’s not a huge leap for the UAE to now support a telemedicine framework,” she concluded.