GUIDE 2016 HEALTHCARE EXPERT OPINION

Today’s health challenges are simply be-yond the control of health systems that were built to solve a completely differ-

ent set of needs. There is an ever-increasing gap between demand for health services and the re-sources necessary to fulfil that demand—glob-ally as well as across the Middle East. People are living longer and governments are facing the growing burden of long-term chronic dis-ease combined with ever-increasing costs for treatment. In addition, lifestyle-related diseases are escalating. Heart disease is the number one cause of death across the Middle East, obesity is prevalent across all demographics, and there is an alarming increase in type-2 diabetes among the young. Finally, the resource gap is not just about tighter finances given lower oil prices. The Middle East has a large clinical workforce gap.

Investing in highly trained professionals has been the traditional approach to closing the clinical workforce gap. But is this the right ap-proach? For example, to gain the full benefits of precision medicine, clinicians need to know what is relevant in a mushrooming evidence base. The number of new studies published each year doubles every nine years and this is com-pounded by enormous amounts of data being generated for each individual patient. Staying current with this explosion of data is completely beyond the capabilities of a human being.

At the same time as health systems are facing this demand/resource gap, citizens in the Middle East are ready to receive Care Anywhere; in our recent report, 67% of those surveyed across the Middle East are willing to access healthcare digi-tally, outside the established clinical environment.

Digitally enabled care is no longer a nice-to-have, but a fundamental business imperative for reinventing how healthcare is accessed and delivered. This is creating unprecedented oppor-tunities to leapfrog western healthcare systems that have been traditionally focused on the clini-cian, the hospital, their legacy infrastructure and incentives to maintain the status quo.

Capacity and capability are in short supply; what should we invest in today?There simply aren’t enough doctors and clini-cians with enough of the right skills to treat the growing demand. Arab Health data highlights that 30,000 doctors, 8,000 pharmacists and over 37,000 specialist staff will be needed in the Middle East by 2020 to maintain its current (un-dermanned) staffing ratios. However, there is a lot that can and is being done very differently today. Three areas on which Middle East health investors can be focusing to get greater returns in the short term are leading edge HR practices, increasing productivity through technology and behaviour change.

HR analytics is being used by many health-care employers to retain staff, spotting those at the highest risk of leaving, and using technolo-gy to mitigate those risks. They are also invest-ing in technology to increase the well being of clinicians and other staff, which increases the likelihood of becoming the employer of choice. A greater sense of wellbeing is also linked to in-creased productivity.

Productivity can further be improved by investing in technology that reduces wastage of valuable clinician time, for example by reducing

Would You Invest In A Digital Doctor?

1 http://www.wired.co.uk/article/kyu-rhee-ibm-watson-ai-doctor IMA

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BY HAMISH CLARK, PWC MIDDLE EAST PARTNER, MIDDLE EAST HEALTH INDUSTRIES

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the time expended in searching for test results and patient re-cords, or in completing necessary documentation. We’ve esti-mated that such an investment can provide savings of up to 4% of total healthcare spent.

Many of the greatest productivity gains that could be made come from investing in changing the behaviour of clinicians. Typical gains from coaching and culture change increase the productivity of clinicians by around 20% in almost all areas of healthcare provision—with direct benefits in patient experi-ence, quality of care, increased capacity and reduced cost.

Are AI and robotics the future for Middle East investors?Most investments in healthcare are made over the very long term. The cost of land and building a new hospital might only begin to generate a positive return after 10 years; and those buildings are all designed with the assumption that the way clinicians work in 10 years’ time will be the same as today.

But dynamic new models of care are already emerging. A hospital without patients—effectively a command centre monitoring (some very sick) patients at home—is currently being built in the U.S. This model of care should make Middle East health investors think. The organisations that will emerge as winners in this new marketplace will be those that can artic-ulate how technology can add value, align incentives, strategi-cally share and analyse data, and redeploy, extend and expand their workforce to embrace digital enablers. Given that 61% of Care Anywhere survey respondents are in favour of home

monitoring, these changes are not in the future or somewhere else, they are now and in the Middle East. The first investor in a patient-less hospital will have first-mover advantage in a dynamic and expanding market.

But there are other ways the pattern of clinical practice may change, and change radically.

Will AI replace the stethoscope? The human ‘face-to-face’ element of healthcare is tradition-ally cited as vital. And yet most doctors probably spend more time going over medical records and interpreting data from tests and other medical interventions than actually spend time with their patients. In addition, the majority of that vast amount of health data is invisible to current systems because it is unstructured.

According to IBM’s Kyu Rhee, it is a problem that “AI doctors” can help address, with supercomputers processing information faster and far more efficiently than human doc-tors. Using AI systems such as IBM’s Watson—a technology platform that uses natural language processing and machine learning to reveal insights from large amounts of unstructured data—data can be translated at the point of care into usable, relevant insight. In fact, Watson has the ability to answer ques-tions, extract key information from documents and reveal in-sights, patterns and relationships across data.1

This may well evolve into a human-like interface for pa-tients and consumers of healthcare services—either remotely or in a clinical environment—where the experience will feel

Digital technology is now fundamental to

reinventing healthcare.

GUIDE 2016 I FORBES MIDDLE EAST 17

like an interaction with a ‘real’ doctor. Already virtual health-care providers like Babylon Health are combining their inno-vative means of accessing the doctor with AI technologies that enhance the power of diagnosis. And given that two-thirds of Middle East Care Anywhere survey respondents are interested in a virtual consultation by smart phone, this technology is likely to catch on in the Middle East very quickly.

Will robots replace surgeons in the operating theatre?In the three decades since robots first began performing sur-gery, the exponential advances in robotic technology are en-hancing a surgeon’s ability to see, feel and do. Autonomous surgery performed by robots, replacing the surgeon, is likely to further the efficacy, safety, consistency and accessibility of surgical techniques. Some experimental studies have already shown autonomous robots to perform higher quality suturing than surgeons.

Deakin University in Australia has developed a robot with haptic technology—human touch and feel that functions as an extension of the doctor’s arm. In other words, what the robot feels and does is felt and done by the doctor, and can be con-trolled from hundreds of miles away from the patient. While this technology is currently undergoing trials and is not being used in the context of surgery, the potential is enormous.

What’s next?The next five years will be critical in making the leap from using these technologies as add-ons to making them fully

integrated tools that allow for lower cost care alternatives and create data-rich insights into real-time care delivery.

So far, we are only beginning to see AI, robotics and Care Anywhere as a means of accessing healthcare. As each of these three areas develop, and more importantly as each combines and integrates, as in the case of Babylon Health, the potential for change and the impact it will have on the role of clinicians is staggering.

But healthcare is personal. As you read this, you will not only be thinking about your business opportunities, you will be thinking about your own personal experience of healthcare, which raises a whole series of questions:

How would I feel if my doctor wasn’t human? What if my doctor was a robotic technology platform capable of learning, diagnosis and treatment that was outperforming my specialist or family doctor? What if that doctor was a robot performing surgery on my mother?

For now, the role of an AI doctor or surgical robot isn’t intended to replace the human component of medicine, but to complement it by augmenting the precision skills and data analysis necessary for the diagnosis and treatment of a broad range of healthcare needs. In addition, the uniquely human capabilities for compassion, common sense, and morality—as well as the ability to abstract or generalise—remain of utmost importance to health outcomes.

One day though, AI and robots may attain these funda-mentally ‘human’ capabilities. So for investors looking towards the future, you may well invest in a doctor, just not one you presently recognise. R

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EXPERT OPINION

Studies have shown that robots can outperform surgeons.

18 FORBES MIDDLE EAST I GUIDE 2016