National Health Intelligence – Opportunity to enable innovation of global significance
COVID-19 is now almost everywhere. Thought leaders at academic institutes and health authorities across the globe have been reimagining the delivery of care by focusing on “predicting” and “preventing”, with an emphasis on catching the disease before it strikes. Aggregation of data analytics, genomic data, population profile, social and family history, wearable device informatics, and pixel intelligence residing in clinical and medical imaging data emphasize the value of predictive analytics, Artificial Intelligence (AI) and Machine Learning (ML). However, before we embark upon considering the application of innovative technologies in healthcare, basic framework, social engagement and infrastructure challenges need to be addressed.
HEALTHCARE SYSTEM CHALLENGES WITH COVID-19:
One of the most disturbing aspects of this pandemic is the manner in which COVID-19 has paralyzed and overwhelmed some of the world’s best health systems. The OECD’s latest Health at a Glance report shows just how much money the countries worst impacted by COVID-19 pump into their healthcare systems each year.
Northern Italy is regarded as having one of the world’s best and most efficient health systems, but it was swiftly overwhelmed by the COVID-19 tidal wave. particularly due to overburdened ICU capacity and a chronic lack of ventilators. Italy’s health expenditure is equivalent to 8.8% of GDP and Spain’s is similar at 8.9%. South Korea is similar once again at 8.1%, though it has completely avoided the faith of both Italy and Spain by moving swiftly to test, trace and isolate its confirmed COVID-19 cases.
In Pakistan, where the GDP spend on health has remained lower compared to other countries in the region, the question then is how can Pakistan cope with the day to day challenges its healthcare delivery system already faces, let alone cope with pandemics and novel viruses, or become a leader in healthcare transformation?
DO WE HAVE A HEALTH INTELLIGENCE STRATEGY TO EFFECTIVELY RUN OUR HEALTH SYSTEMS?
THE INTELLIGENCE WE NEED TODAY NEEDS TO BE SCIENTIFIC: While healthcare organizations across the globe have remained under pressure to deliver cost-effective and high-quality care, the COVID-19 challenge has exposed the basic premise of how health systems in developed countries have been designed, and now facing challenges in the delivery of personalized care and achieving the aim of precision health that has been the hallmark of discussions around care transformation in the western world.
One way to achieve this is to empower public health planners and physicians with fast, easy and direct access to all of a patient’s clinically relevant medical data. Remote access or patient-centred telehealth has remained a silo of its own, which has posed another challenge when it comes to care-continuity, and a broken care-pathway.
What’s needed is a digital health profile of our population, and not just focusing on patients presenting with clinical symptoms. It is time to create a digital twin of our population, data is available, let’s aggregate the available data intelligently to enable visual health profile of our population, and become predictively and scientifically intelligent.
Fred R. Barnard is often credited with the term, “A picture is worth a thousand words”, we can broaden this term further and state, “A medical image is worth millions of pixels of visual health intelligence.” And COVID-19 has once again proved the significance of fast access to diagnostic imaging when RT-PCR testing and availability of kits posed a diagnostic challenge. Progression or regression of such complicated diseases requires precision intelligence – a correlation of clinical presentation, lab diagnostics and medical imaging. How do we then build the framework around digital informatics and the visual health intelligence of our population?
Today, medical images make up the bulk of the healthcare data across hospitals globally, and the volume of the data is projected to grow beyond 2,000 exabytes beyond 2020. Unfortunately, this data remains untapped and not aggregated with medical records. When we consider diagnostic medical imaging as an example, Chest X-Rays account for 40% of all diagnostic imaging worldwide. With Pakistan’s diverse demographics and population distribution, considering the use of AI for remote diagnostics leveraging mobile X-ray machines or for example portable AI–enabled stethoscope of the future begins to make sense.
Proactive fight against unknown diseases and pandemics needs to be based on:
1) Evidence-based medical sciences
2) Understanding of differential diagnosis
3) Multi-faceted statistical intelligence (health, social, environmental, global trends)
WHAT CAN PAKISTAN DO:
Pakistan has a unique opportunity to deliver personalized care and realize the vision of Precision Health that has posed challenges across the globe. Pakistan offers diversity not only in terms of population but also the wider health indicators that this country could provide valuable knowledge to the developed world. Pakistan is a vast data mine of population and health informatics, Pakistan needs to drill this data, aggregate it, refine it, run analytics, digitally enable its healthcare delivery services, and feed this intelligence to its service providers, data scientists, biostatisticians, researchers, engineers and IT experts, to help it indigenously build made in Pakistan technology, medical devices and solutions.
Pakistan can shape a digital health intelligence strategy by creating a framework for precision health by paying attention to the following fundamentals:
- Population Health Focus: Identifying the top population health challenges where data analytics and AI can be leveraged (consider cancer screening, chronic disease like TB, Hypertension, Diabetes, Diabetic Retinopathy, pandemics etc)
- Centres of Excellence: Creating a network of hubs acting as centers of R&D innovation (MOUs between select public hospitals, national and international universities)
- Public-Private Partnership: IT, Telecom, SMEs joining forces
- Collaborative Research Infrastructure: Bringing talented people, knowledge and innovation under a collaborative body
- Governance: Establishing a national eHealth strategy that follows a holistic approach focused on population, disease analytics, social and environmental factors, and talent of its people currently available and in the pipeline
Pakistan can build a health care innovation strategy by focusing on delivering cost-effective quality care that helps improve outcomes. It is an integrated strategy that breaks silos (regional/provincial), fosters collaboration, introduces efficiencies and helps address not only the challenges of today but also provides analytical intelligence to help prepare the system (hospitals, medical equipment manufacturers, pharma) much ahead in time as an opportunity instead of posing a challenge.
WHY CAN PAKISTAN DO IT (THE FUNDAMENTALS):
- CONNECTED POPULATION: Pakistan has a population of more than 200 million, and currently, there are more than 165 million cellular subscribers, a significant teledensity of 78.6%. This brings Pakistan to the list of top 10 countries when it comes to cellular phone usage. Considering connectivity and mobility, the country already has the infrastructure to connect and communicate with the population to enable smart health. With the imminent advent of 5G, Pakistan will be in a position to broaden healthcare delivery to remote locations and improve screening, detection and real-time population health intelligence
- LEVERAGING NADRA – CREATING POPULATION REGISTRIES: National Database & Registration Authority (NADRA) has gained international recognition for its success in providing solutions for identification, e-governance and secure documents. With this data, a national eHealth strategy and governance will facilitate the creation of population health registries and unique patient identifiers for universal access to care across public healthcare delivery networks
- FAST GROWING SMEs: Pakistan is expected to be the fourth fastest-growing economy globally through 2030. Driven largely by SMEs (more than 90% of all companies in Pakistan are SMEs), these smaller businesses contribute 40% to the country’s $305 billion GDP. By providing evidence-based population health indicators, these SMEs could focus on solutions addressing the current and upcoming challenges
- ACADEMIC INTELLIGENCE AND INNOVATION: Pakistan needs to reconsider its clinical research and education initiatives, focused and geared towards emerging trends and technological advancements in healthcare. It is heartwarming to see President of Pakistan’s initiative on AI; which is a great initiative and hence the importance of a framework and governance to leverage the talent coming out of this initiative in the actual application of AI/ML into clinical practice, as part of the national digital health strategy
- APPLICATION OF INNOVATION: According to market reports, there are several hundred start-ups across the globe developing AI/ML applications in health informatics and diagnostic imaging with billions being invested. Pakistan, with its 200 million population, skilled clinical workers and experienced physicians, and a vast network of public hospitals, signifies the need for a digitally enabled predictive intelligence health strategy. AI in the healthcare market is expected to reach 31 billion by 2025, growing at a CAGR of 41.5%, over a forecast period, according to a report by Grand View Research, Inc. The strategy Pakistan needs to adopt is to not only create digital health data lakes, but also the opportunity to commercialize the use of this data for AI/ML and the IP rights, which in itself is a multibillion-dollar market opportunity.
FRAMEWORK FOR NATIONAL HEALTH INTELLIGENCE STRATEGY:
Artificial Intelligence alone cannot be the game changer if you do not incorporate human intelligence or clinical sense with it. While new diseases and pandemics are on the rise, with its vast network of the workforce and academic institutes, Pakistan can rethink and seamlessly realign its digital health strategy. Technology is getting sophisticated and faster at doing what humans can do, hence the debate around man vs machine has shifted to the man working with machines and tools.
AI’s transformational benefits revolve around early disease detection, informed decision making, clinical decision support, academic research and training, population health analytics and improving drug efficacy.
EVIDENCE-BASED INDIGENOUS MEDICAL TECHNOLOGY:
- Pakistan is a small, niche actor in the medical devices global value chain (GVC) with US$355M exports in 2016 (0.1% of industry exports) (UN Comtrade, 2018), and is concentrated primarily in one city, Sialkot
- Pakistan needs to adopt new methodologies, leverage the latest technologies, produce new products and engage in an entirely new set of activities that are future proof
- Application of AI, Machine Learning, BlockChain needs serious alignment with a nationally driven smart population health strategy
NATIONAL STRATEGY, GLOBAL IMPACT:
- Pakistan has the population diversity, opportunity to aggregate data, clinical and IT expertise to develop cutting edge clinical applications and use cases leveraging AI and blockchain
- Pakistan needs to come up with a framework to develop evidence-based solutions developed locally, with a global impact
- Investors are sitting on the sidelines waiting to see how things unfold as a result of COVID-19; investments in healthcare innovation are bound to increase
LOOKING TO THE FUTURE – HEALTH 2.0:
Did anyone in the world prepare themselves for the unprecedented challenges faced by the current pandemic? Can anyone in Pakistan predict what health, workforce and capacity challenge the country will face in the next decade, let alone next year?
The race to become the global leader in the health intelligence-enabled workforce has already begun. Frameworks for artificial intelligence already began a couple of years ago. Canada, China, Denmark, the EU Commission, Finland, France, India, Italy, Japan, Mexico, the Nordic-Baltic region, Singapore, South Korea, Sweden, Taiwan, the UAE, and the UK have all released strategies to promote the use and development of AI. The strategies announced by each of these countries are unique, each focusing on different aspects of AI policy – ranging from scientific research, talent development, skills and education, public and private sector adoption, data and digital infrastructure.
According to UNDP, 64 percent of Pakistani nation is less than 30 years of age, and 29 percent are between 15 and 29 (an age group considered as the youth). Pakistan now has more young people than it has ever had, and this is forecasted to continue to increase until at least 2050.
There is a strong need for a governing body that not only leads Pakistan-centric effort to prepare the country with armed (health) forces of the future but also lead a global effort that brings the best of minds and technology together. It’s time to build a National Health Intelligence strategy based on scientific evidence instead of conspiracy theories or invalid claims.
The developed world is not only looking for medical devices or supplies, but it’s looking for data and evidence-based population diverse analytics as well. Pakistan’s dynamic population, intelligent workforce, growing economic landscape, and digital mindset puts it in a unique position to fill the gaps realized from digital transformation experiences of the developed world. This will help put forward a health intelligence and needs-based innovation strategy, that not only addresses pressing health challenges of today but also serves as a framework for enabling precision health and predictively intelligent care delivery models in the near future.
To fix the economy, we have to be intelligent and smart about how we fix healthcare.