The investigational medicine is not an antibody but an ACE2 receptor decoy, according to a research in Science Advances. Unlike antibodies, the SARS-CoV-2 virus cannot evade the ACE2 decoy because changes that would allow it to do so would impair its capacity to infect cells. Dana-Farber scientists figured out how to make this medicine more potent in COVID-19-infected animals and safe for patients.

This report comes as the antibody medicines used to treat COVID-19 have lost their potency due to an altered viral spike protein.

The researchers uncovered traits that made ACE2 decoys powerful and long-lasting. The collectrin-like domain of the ACE2 protein made the medication cling more securely to the virus and last longer in the body. ACE2 decoys exhibit significant efficacy against the COVID-19 virus because they pop the viral spike protein so it can’t attach to the cell-surface ACE2 receptors and attack cells.

Spike proteins allow SARS-CoV-2 to infect cells. The spike protein attaches to the cell’s ACE2 receptor and refolds, allowing the viruses to enter. ACE2 decoys pop the virus before it can enter cells by luring it to attach to the decoy instead of the cell. This explains the drug’s potency: it’s a competitive inhibitor and permanently downregulates the virus. Versions can alter, but they must continue to attach to ACE2 for infection; hence, the medicine is active against all variants.

The medicine disclosed in this study could be used to treat novel coronaviruses that could infect humans in the future. Many coronaviruses that could infect humans employ ACE2 to infect cells.

DF-COV-01 has not yet been tried in humans, but manufacturing development is virtually complete, and preclinical investigations are continuing for regulatory approval.

This work was supported by a CDMRP Technology/Therapeutic Development Award. The National Institutes of Health, Evergrande MassCPR, and COVID-19 FastGrants contributed additional funding.

A passionate advocate of positive partnerships and purposeful business, Dawn Bruce is Services & Solutions Delivery Lead for Philips. An originator of the Operational Intelligence approach and backer of people-powered progress and soft skills, she has extensive experience of outcomes-driven business transformation and healthcare system change management.

“There are two main mindsets we can navigate life with: growth and fixed. Having a growth mindset is essential for success. It’s also key to transformation and so if we want to transform healthcare, we need to look at our individual mindsets, their role in our motivation and self-regulation, and their impact on achievement and interpersonal processes.” 

Dawn Bruce, Services & Solutions Delivery Lead, Philips

Transformation is a term that is synonymous with healthcare and yet all too often the mere mention of word strikes fear in our hearts. Fear that healthcare is so complex and fragmented that we’ve failed at change before we’ve even started, or perhaps fear because the solution is so often outsourced to technology and ignores the fact that value-based transformation, while enabled by process and technology, can only be enabled by an intangible and inconsistent element: people.

Strategies are lofty, solutions are many and yet few discussions around the pursuit of successful healthcare transformation pay more than lip service then to the psychology of its key players and the importance of believing that change is possible.

A pioneer in the importance of believing that improvement is possible, American psychologist and professor at Stanford University, Carol Dweck^[1] found that humans approach a challenge with either a fixed or a growth mindset. In a fixed mindset we believe our talents and abilities are fixed, we are who we are. In a growth mindset, by contrast, we believe there is always room for improvement. In a fixed mindset, feedback about suboptimal professional performance is threatening as it confronts ourselves with our own shortcomings. In a growth mindset, feedback is a gift, as it helps us to further develop.

Recent advances in neuroscience go even further, revealing that the brain is far more malleable than we ever knew. Research into brain plasticity^[2] has shown how connectivity between neurons can change with experience. With practice, neural networks grow new connections, strengthen existing ones, and build insulation that speeds transmission of impulses. These neuroscientific discoveries have shown that we can increase our neural growth by the actions we take, such as using good strategies, asking questions, practicing, and following good nutrition and sleep habits.

At the same time that these neuroscientific discoveries have been gaining traction, researchers have also started to explore and better understand the link between mindsets and achievement. It turns out, if you believe your brain can grow, you behave differently. This supposition has resulted in numerous interventions and studies that prove that we can indeed change a person’s mindset from fixed to growth, and when we do, it leads to increased motivation and achievement^[3].

Healthcare transformation is perhaps the ultimate mindset challenge; an industry where complex change is required and yet even the best hospitals have a work culture that is populated with setbacks, challenges and hierarchy and constraints.

As the Harvard Business Review has reported in its article, ‘Positive intelligence’, “research shows that when people work with a positive mind-set, performance on nearly every level – productivity, creativity, engagement – improves.” New research from MIT also bears this out. In fact, breakthrough research by a team at MIT’s Picower Institute for Learning and Memory has documented one type of environmental feedback that triggers plasticity: success. Equally important and somewhat surprising: its opposite, failure, has no impact.

Is a positive mindset, then, perhaps a missing factor in achieving the Quadruple Aim in healthcare? And, if so, how do we unlock the growth mindset of healthcare transformation?

Dawn Bruce, Services & Solutions Delivery Lead for Philips believes that a great place to start is in Operations, the backbone but also the brain of a hospital and where a range of departments and disciplines come together and where strategic and structural change can be most effective.

In fact, Operations, she believes, has the ability to be the driver of change if it can build the new capabilities and behaviors that modern healthcare needs. Not only does it enable new, integrated ways of working, it also has the potential to enable its disparate workforce to believe that change is possible but also to have the resilience to realise it. This is especially vital since research indicates that resilience, originally studied in young children suffering major traumatic events, is an essential quality in healthcare and that for an environment to facilitate resilience it needs to be both high in challenge and support.

It’s a quality that has never been more in demand within long term teams, facing unprecedented challenges, such as those presented by the COVID-19 global pandemic, as Dr Helen McGill, Medical Director and Responsible Officers, NHS Professionals, has recognized stating: “Resilience is needed in the NHS now more than ever – at an individual, organisational and systemic level. We all need to work together to prepare for, respond to and adapt to both ongoing change and major unexpected disruptions. This is not just about surviving, it’s about minimising crises and identifying improvements, both personally and professionally^[4].”

Dawn Bruce also believes that unlocking a growth mindset offers opportunities for innovating procurement and governance as well as developing future-fit healthcare training that will attract and retain a millennial worker.

For more insights into unlocking the growth mindset for healthcare, read Dawn Bruce’s follow up article in the next issue or visit www.philips.com/Operational-Intelligence

References:

[1] Mindset: The new psychology of success, Dr. Carol S. Dweck Ph.D, 2007
[2] Positive intelligence, Harvard Business Review, https://hbr.org/2012/01/positive-intelligence
[3] Success gets in your head – and changes it, Harvard Business Review https://hbr.org/2010/01/success-gets-into-your-head-and-changes-it
[4] The importance of resilience in the NHS right now, Dr Helen McGill, Medical Director and Responsible Officers, NHS Profession, https://www.nhsprofessionals.nhs.uk/en/joining-nhsp/latest-news/detail?Id=the-importance-of-resilience-in-the-nhs-right-now

That said, the global pandemic has, however, accelerated the transformation. It has clarified the need for interoperability among IT systems facing a deluge of patient data – data often fragmented among various specialties, departments, and sites. According to a McKinsey Global Report inefficiencies like these have cost hospitals over $300 billion each year.

Undoubtedly, the challenge has led to opportunities. In the healthcare sector, a new breed of CIO is galvanized by the challenge to reinvent systems and processes. Clinicians also recognize that with improved data management, health networks will be able to streamline patient views and make care more effective than ever. Such advancement will enhance healthcare systems’ efforts to achieve the quadruple aim of improving the patient experience, achieving better outcomes, reducing the cost of care and improving staff experience.

Health systems are looking for enterprise-wide strategies that will achieve end-to-end data integration, driving precision care across the continuum. Such a vision does not come too soon for CIOs like Henning Schneider of the Asklepios Hospital Chain, which is one of Germany’s largest.

Says Schneider, “As of now, I would say that the IT department, and especially the head is the lonesome rider who has to persuade a lot of people to use and to focus more and more on digitalization and to believe in it.”

He has had to serve as “some kind of evangelist … to bring digitalization into the healthcare system.”

It is an exciting time to take the lead. Forward-thinking leaders like Leo Bodden, Chief Technology Officer at New York-Presbyterian, understand that and embrace the challenge.

“I think this is the best time for someone to be in healthcare IT,” he says, “because of the level of disruption that we are in the middle of, I find this to be the most exciting time to be in my
current business.”

Drivers That Transform

The rise of healthcare consumerization was a force for change before the pandemic too. And this continues today.

Another key driver is the pandemic itself. Frost & Sullivan Jan 2021 report suggests that the pandemic has resulted in a marked increase in virtual visits, remote monitoring, and the use of patient engagement tools:

• Nearly 35% of patient interactions will be digital in 2021, a 20% increase from last year
• 20%-25% is the expected growth rate this year in patient engagement management solutions

Group Chief Digital Strategy Officer for Singapore Health Services Private Limited, Benedict Tan, agrees that the pandemic has accelerated digital transformation, and calls COVID-19 “the transformation officer.” The outbreak has fostered a need for greater interconnectedness, indeed.

Frost & Sullivan foresees as much as $2 billion being invested into enterprise imaging workflow efficiency, interoperability, and analytics.

On the national government front, the United States’ 21st Century Cures Act, which loosens regulations on data exchange and interoperability, goes into effect on April 5.

France’s new healthcare act, which was passed in 2019, also focuses on streamlined governance.
Additionally, French President Macron has promised “a massive investment plan and an upgrade of the career paths for our hospital system,” according to Reuters.

Germany’s Future Hospital Act earmarks €3 billion for digitalization as it seeks to modernize its hospital system.

Collectively, there are many positive forces to help leaders overcome IT networks that are fragmented, especially in the interfaces between diagnostic imaging examination systems, PACS, patient management systems as well as analytics.

Roadblocks To Transformation

Under the COVID-19 pandemic, the stagnation of the healthcare ecosystem was exposed. While IT innovations were available, the shortcomings of care models and regulations were hardly addressed. Transformation was seldom prioritized, due to the immediate need for cost containment.

And more data generation will only lead to more data governance and this can be addressed by melding big data’s power with self-service through data lakes, or by broadening access to enterprise data. However, further investment and vision will be necessary.

Another key barrier is the traditional preference for best-of-breed solutions, as opposed to an integrated suite. A best-of-breed approach may create advantages but also result in far greater challenges with data sharing, IT infrastructure, clinical and operational workflow.

Ultimately, the lack of a fully integrated, interoperable, and secure set of harmonized systems keeps data, clinicians, and workflows soiled and inefficient. This challenge is exacerbated by the shift from point-of-care transactions to care delivery.

Devising a strategy to manage a mix of virtual and in-person engagement, and management tools remains a significant barrier to digital maturity.

Let The Transformation Happen Together

“Healthcare transformation does take a village,” Bodden says. “If I’m asked whether I’m the mayor or an unsung hero, I would say neither. I would consider myself more of a poll reviewer of healthcare transformation. Now the question is gonna be, do we transform ourselves or does someone else transform us?”

In the healthcare space, this transformation is built upon aggregating data from various devices and systems to the point of care. Once data is captured and contextualized from all sources, effective care pathways can be achieved. Only when the silos are shattered and every shred of information is accessible, can clinicians do their best work, delivering care to patients.

“The IT systems now hardly talk to one another,” Tan says. “So what we all need to do is to modernize the architecture for the IT systems and make sure that it can talk to one another and support a more efficient workflow and processes for the patient.”

Forward-thinking leader Tan says “I’ve always emphasized that healthcare, has to be a high touch, and high-tech industry, and we can do a lot of digitalization, to then use digitalization to improve the efficiency of our doctors, our nurses.”

While many CIOs share this bold vision, tomorrow’s leaders are the ones acting on it and leading the way to greater quality care.

“What I find most pivotal with COVID-19 is the fact that we were able to do so many things, so fast,” says Leo Bodden. “We eliminated all barriers, regulatory barriers, physical barriers, and logical barriers.”

Bringing Healthcare IT Leaders’ Vision To Act

With interoperable solutions and deep clinical expertise, Philips helps healthcare IT leaders bring to life their vision of precision care.

As an HIMSS-certified partner, Philips co-creates a customized roadmap that will ensure clinician success in an ever-evolving digital world. Philips works as a trusted partner, helping healthcare IT leaders adapt and advance digital health transformation at defining moments in a patient’s journey, which paves the way for precision care.

Philips offers flexible business models and managed services through Software as a Service (SaaS), which can be extended to everything from Technology as a Service, Infrastructure as a Service, and beyond, through a subscription model or fees per study.

According to Jacob Visser, CMIO at Rotterdam’s Erasmus Medical Center, “If you have a low caseload, let’s pay per case. If you have a very unpredictable caseload, then you may think about a license model.” Philips is making this tailored approach possible.

That’s why they are partnering with each customer to guide innovation, co-create business models, and adapt to the local need of a community. With one primary goal in mind: Improve 2.5 billion lives by 2030. Together, we can make this a reality. For more information Click here

Or so John Ngoh, Customer Service Delivery Leader Singapore.

Every piece of medical equipment in a hospital is vitally important. Each solution allows healthcare providers to offer reliable and effective care, efficiently diagnosing and treating their patients as fast as possible; supporting the work of their clinicians and staff, while keeping their standards of care high and costs low. Keeping them working efficiently and effectively is a delicate balancing act. Large fleets of MRs and X-rays all require attention through careful monitoring and maintenance to ensure they are fit for purpose.

Critical medical equipment such as MRIs and CTs are incredibly complex, serve very specific health needs and are expensive to operate, with the cost of maintenance borne by both parties. Healthcare providers already face immense, and growing, financial pressures; wide spread digital transformation has been slow and equipment that risks their ability to deliver care and can significantly impact their operations. This translates into a need to get more from medical equipment and a culture of zero downtime, to avoid patient treatment delays and additional costs.

With less time to calibrate and fix important equipment, diagnosis of equipment failure needs to be proactive and predictive; no longer reactive. Which is why maintenance is now of increasing strategic importance: hospitals need fast, confident and proactive responses to equipment downtime to enable it to be always available and first time right fixes of any issues.

John Ngoh, Customer Service Delivery Leader Singapore provides his predictions of the innovations and changes rapidly transforming maintenance beyond break fix . His highlights to note encompass proactive and predictive maintenance, to AI, knowledge management, flexible service agreements and beyond: 

Future trends transforming the landscape of healthcare equipment maintenance

The shift to proactive maintenance

Through the advent of AI and data-driven technologies, the shift has begun from reactive to proactive maintenance, and, in time, to predictive maintenance.  Through remote monitoring, engineers can proactively assess equipment and respond before it degrades. Increasingly, more predictive capabilities will enable engineers to know when a system is going to degrade and automatically order the necessary parts for repair. Making the future of maintenance more predictable and proactive and keeping unplanned downtime to zero.

How the COVID-19 pandemic boosted remote monitoring

Of course though, the shift towards more remote monitoring of medical equipment was also fast-tracked early in 2020, when hospitals were forced to minimize access to personnel during the Covid-19 outbreak. One of the pandemic’s side effects was the instant boost it gave to connectivity. With critical equipment needed to diagnose patients with Covid-19, hospitals that had delayed digital transformation were suddenly forced to adapt.

Why predictive, proactive maintenance is already a game-changer

The great leaps forward in maintenance and supply chain management were led by the aviation industry where manufacturers monitor an engine’s performance in real-time but the health care industry had until now, lagged behind.

Since 2015, Philips maintenance has been able to intervene before systems degrade. Rather than waiting for upkeep, medical equipment with increasing numbers of sensors will self-diagnose an issue faster and act to prevent future performance issues.

Predictive maintenance is such an exciting prospect because a piece of medical equipment which understands its own lifecycle, can self-assess its own health and degradation, and communicate with other devices — or fleets of medical equipment — will give hospitals the option of a proactive, automated maintenance model.

For field service engineers, the future will be more and more visual. Rather than searching for answers and waiting for documents to load, they will increasingly have access to an ever-growing repository of information from thousands of other maintenance cases at their fingertips.  Field service engineers will become experts in everything, because whenever they don’t know something specifically, they can connect with someone anywhere in the world who does have the knowledge and quickly close the gaps.

Knowledge Management and AR applications in healthcare will also help patients and doctors in ways we couldn’t imagine a few years ago, making complex tasks easier to achieve, visualizing medical information for surgical procedures or enhancing medical training. AR will also guide engineers as they diagnose and repair equipment and devices, giving them access to a wide range of information and knowledge in real-time.

From “spare part”, to invisible fix. How service parts are undergoing a significant period of innovation.

The process of diagnosing a problem, ordering a service part and having that service part arrive in a timely manner has historically been subject to various barriers. Getting products from a factory or warehouse to distributors or hospital sites around the world as quickly and economically as possible is critical for hospitals, yet fraught with challenges. However, the landscape for service parts has been rapidly transforming, with automated logistics optimization and digital technology making the process far more immediate and less manpower intensive.

Looking into the future. What will AI-enabled maintenance look like?

As data volumes in hospitals continue to grow, with information from more digital platforms, medical devices, wireless sensors, and billions of mobile phones; understanding how to connect fleets of equipment and ensure their performance is strategically advantageous. By leveraging more algorithms in hospital equipment fleets, opportunities will arise to design and develop new operating models such as pay-by-use or subscription-based services, where service activities can be dependent on the number of patients a hospital is treating. The advent of more AI-enabled maintenance will alter future product designs and operating models and, as AI capability grows, it will in time influence the way products look and respond; self-diagnosing will be the norm.

Contracted to win. Unlocking “lock ins” through the evolution of maintenance contracts

The evolution of maintenance, of course, is also about the evolution of the service agreement, also known as the maintenance contract. Gone are the days of signing on the dotted line and being tied into to a service agreement that might not grow with your needs, as part of its partnership model, Philips Maintenance Services is innovating service agreements to encompass shared risk and increasing flexibility.

Interested to know more?

Let’s talk. Even better, let’s collaborate

Philips Maintenance Services helps you drive performance, usability and interoperability by keeping your technology reliable, up to date and cost effective.

For more information, Maintenance 4.0 | Philips Healthcare

Today healthcare faces juxtaposing forces. It relies on a workforce that views quality healthcare as a right and the profession as a vocational calling, while it faces pressures to reduce costs, optimize performance and deliver care as efficiently as possible.

And yet in the battle to transform healthcare and deliver the Quadruple Aim (of better health outcomes, improved patient experiences, improved staff experiences and lower costs of care) of value-based care, the poles arguing that healthcare should or should not be considered a business have, perhaps, missed a middle ground possibility. That is that there is an opportunity for healthcare to operate as a ‘responsible business’ which combines the best of these both worlds: clinical expertise with operational excellence. The challenge, of course, is how to bring together these two worlds to create modern healthcare systems that are both fit for purpose and purposeful.

Dawn Bruce, Services & Solutions Delivery Lead at Philips and an advocate of positive partnerships and purposeful business explains why this disruptive approach has considerable merit:

“Business and healthcare have long had an uneasy relationship but a modern, innovative approach to healthcare transformation doesn’t have to be the ruthless commercialization of care. Instead, the adoption of effective business models and business practices can realize the best of organizational and operational strategy and fuse it with the high practice standards of those passionate about the Hippocratic Oath. Clinical professionals should absolutely be focusing their time on the medicine part, but hospital operations have to be run like a business.”

What is responsible business?

Over the past 10 years, multinational companies have made important changes to their corporate social responsibility (CSR) policy, to prioritize purpose as well as profit. The emergence of responsible business can therefore be seen as much an opportunity for healthcare transformation as digitization and new technologies are.

From business to better healthcare: Where to start and what to borrow from business

“Imitation is the greatest form of flattery” and, according to Dawn Bruce, clever borrowing from responsible business starts by considering impact; working out where and what innovative approaches proven to work in business will deliver the most value. She believes that there are several key areas and ways in which healthcare facilities can adopt processes and practices from responsible business and partner to drive improvements without impacting the integrity of care.Here are her ‘share and reapply’ starter recommendations:

        ➢ Start in operations, the control center of any hospital

Dawn Bruce’s recommendation is to focus operationally and apply operational management principles. She explains: “Hospital operations is central to operational efficiency. Hospital operations was transforming pre COVID-19 but now it is in the hot seat as innovation in this area can clearly be seen as offering a new way to deliver value-based care since perceived customer value = total benefits / total costs.”

        ➢ Adopt a holistic, integrated approach fusing people, process and technology

Dawn Bruce and her team help healthcare systems to apply and embed innovative operational management and improvement strategies by using the Philips Operational Intelligence approach of the partnership of continually synchronized people, processes and technology.

        ➢  Innovate the customer experience

“I look to hospitality as a guide on customer-centricity. Think Disney, think Marriot and Ritz-Carlton. Any kind of hospitality organization puts the customer at the center of everything that they do. No matter what the end result is, the customer’s experience is prioritized and we need to think the same way in healthcare,” advises Dawn Bruce.

        ➢ Embrace collaborative leadership, including servant leadership

A well-run organization makes an impact on how care is delivered, and modern approaches to leadership at all levels plays a key part in care outcomes. In healthcare, it can be difficult to step back from the immediate ‘point-of-care’ role and think operationally. Servant leadership inverts the norm. Instead of the people working to serve the leader, the leader exists to serve the people.

        ➢ Adopt highly effective business processes including Lean, Agile as well as systems thinking and design thinking

Waste is a recurring problem in the existing healthcare system. It accounts for $760 billion to $935 billion annually in the US, or 25% of total medical spending, according to the JAMA^[1]. According to Dawn Bruce, healthcare is adopting lean business principles such as Lean Six Sigma to create more operationally intelligent health systems, to focus on their customers^[2] through targeting eight key wastes^[3].

        ➢ Complement KPIs with OKR

“We use both KPIs and OKRs as performance indicators, but in healthcare, we find it particularly useful to track OKRs as they are more specific with quantifiable results.  Utilizing the two offers the opportunity for macro and micro operational visibility. OKRs are tied to business goals and objectives, rather than employees’ work. KPIs on the other hand can be tied directly to an employee’s day-to-day work — they’re designed for achieving success in the workplace,” advises Dawn Bruce.

        ➢ Adopt disruptive innovation

Much of the frustration linked with the scale and pace of change within healthcare is not linked to effort, talent or resources. Instead, it stems from attempts to make the current healthcare model fit the demands now expected of it. Dawn Bruce suggests that one of the most positive learnings healthcare can make from business is to utilize businesses’ own learning from transformation and the innovations processes that have facilitated it.

She explains: “In addition to being a responsible business propelled by our purpose to make life better, one of the most compelling reasons to partner with a company like Philips is the benefit of shared learnings in addition to shared values. We’ve spent the past 7 years transforming to be a future forward health technology organization, working to address many of the operational challenges that our hospital partners are also facing.”

Tools for innovation include the importance of multidisciplinary teams, design thinking capabilities and other systematic innovation processes that prioritize empathy and customer-centricity. These soft skills should be coupled with systems thinking capabilities. 

         ➢ Embrace technology and drive for interoperability but learn from business that achieving this is a cultural, rather than a technical shift

For every healthcare institution, technology is a significant investment and an essential component in quality healthcare delivery.

Dawn Bruce explains how the strategic management of technology can break down some of the misconceptions of technology and equipment purchase, even to the point of highlighting that buying the best isn’t always the best choice:

“Healthcare organizations in Canada and many other parts of the development work can typically want to buy the Rolls-Royce of everything because they don’t know when they’re next going to get funding. It’s a feast or famine approach. And yet a partnership established as equals on the same team makes it possible to open up new ways of thinking about planning, purchasing and maintaining and puts in place a strategic approach to managing technology.

For example, we were able to ask our partners, ‘Do you really need the Rolls-Royce? What if you go for a lower level or a different configuration that frees up budget in order for you to spend somewhere else. You could even buy two of them for example.’

This type of business minded approach establishes the foundation of a different type of problem-solving dialogue-based relationship that unpicks the true challenges and opportunities amid the complexity. It prevents purely transactional relationships, removes ‘catalogue-based thinking’ and drives true vendor agnostic solutions thinking.”

It’s clear that there is a lot that business can offer to healthcare, so long as the partners involved have their purpose and priorities aligned.

For more information on combining care and the commercial and to discover how Philips is partnering with global health providers and systems to apply its innovative Operational Intelligence approach to hospital operations management and innovation, visit https://www.philips.com.au/healthcare/services/operational-intelligence/discover-operational-intelligence

Reference

^[1] JAMA, https://jamanetwork.com/journals/jama/article-abstract/2752664
^[2] Purdue University, Lean Six Sigma Online
https://www.purdue.edu/leansixsigmaonline/blog/healthcare-advancement-with-lean-six-sigma/#:~:text=Using%20Six%20Sigma%20to%20improve,turnaround%20time%20for%20lab%20results
^[3] NEJM Catalyst, https://catalyst.nejm.org/doi/full/10.1056/CAT.18.0193

Long before the global pandemic, in healthcare the days of business as usual were over. Around the world, every health system had been struggling with rising costs, aging populations, chronic health challenges, legacy technology and overloaded staff. And, while addressing many challenges, digital transformation also brought its own; from data and interoperability disconnects to knowledge shortages. Healthcare leaders had worked hard to redefine healthcare by moving to the value-based care model, implementing the six components of the high-value health care delivery system, often referred to as the “value agenda”, and healthcare transformation was until 2019, expanding faster than the economy – growing by 3.9% / year vs. the economy at 3.0%^[1].

And then the COVID-19 pandemic hit. Cited as ‘the major disruptive event of the decade’^[2] and purported by some to be a ‘Black Swan Event’^[3] – the term popularized by former Wall Street trader, Nassim Nicholas Taleb in his book Fooled by Randomness – COVID-19 revealed and created additional vulnerabilities in global healthcare and stalled the profit growth.

Today, the ongoing, immediate health impacts of the pandemic, delays and disruption to other healthcare services and the economic toll is being felt across the world. This current degree of uncertainty in healthcare is unprecedented and while the consumption of healthcare services will likely continue to grow, it is unlikely that the industry profit pools will expand over the next 3-5 years given the impact of the COVID-19 pandemic^[4].

Underlying this cloudy outlook, however, there are chances – and a clear need – to innovate. The good news is that there is a significant opportunity that the innovation in healthcare that has been struggling to take hold, will really happen. As systems around the world are being forced to transform at an exponential, and with anecdotal accounts indicating a rate of 10 years in 5 months, Hefin Evans, Services and Solutions Delivery Lead, Philips outlines the expeditious innovation and rapid advances in technology, policy and procedures he has witnessed over the course of the pandemic and offers his predictions for innovations to come.

Accelerated innovation 1: The rapid shift to remote, proactive maintenance

The shift towards more remote monitoring of medical equipment was fast-tracked early in 2020, when hospitals were forced to minimize access to personnel during the COVID-19 outbreak. One of the pandemic’s side effects was the instant boost it gave to connectivity. With critical equipment needed to diagnose patients with COVID-19, hospitals that had delayed digital transformation were suddenly forced to adapt.

For example, in the Latin America region, the remote resolution of equipment problems stood at 19.6% at the end of February 2020^[5]. Field services engineers weren’t able to visit hospitals due to the COVID-19 outbreak and were instead trained to deliver remote services and tools to customers and began providing remote support. The current rate of remote resolution in Latin America is now 42%^[6].

In Argentina, a healthcare provider partner located 1000kms away from field service engineer support in Buenos Aires, reported one of its MRIs was down during the COVID-19 outbreak. It was a complicated fault, that couldn’t immediately be diagnosed. Using remote monitoring system, REACTS, it took just an hour to detect a failure in the MRI’s gradient power supply working in combination with remote engineers, a field service engineer and the hospital’s biomed. The faulty part was identified, and a replacement was ordered.

Before the pandemic some hospitals were reluctant to have remote connectivity,  or indeed any remote operation, due to perceived privacy and security risks. Now it is a must. It is demanded and they understand that, by partnering with Philips Services, we can deliver industry leading cybersecurity and privacy, leading compliance and standardization. One of the immediate – and we predict, lasting – effects of COVID-19 was a boost to the digital transformation of hospitals, enabling them to become digital and more connected. At Philips, We are now doing much more work remotely — equipment resolution, fixing, troubleshooting — rescheduling maintenance as required while also having the ability to control systems at a distance. And we are not sending engineers to a site if it is not needed. For COVID-19, it is much better to do it remotely.

Accelerated innovation 2: The virtualization of care

The pandemic kickstarted a boom in virtual care by immediately altering the way doctors and patients interacted, and reducing traffic inside hospitals. Medical appointments went online, workers began remote work, equipment monitoring was adopted, elected procedures were delayed or cancelled. Remote monitoring technologies such as telemonitoring, telemedicine, mobile monitoring all grew very fast. Telehealth adoption rates lagged around 11% in January 2020 in the US—but spiked amid the coronavirus pandemic to 36% August^[7].

The revolving door of the hospital was already a big problem before COVID-19. In 2018, there were an estimated 142 million visits to emergency rooms in the US, up from 100 million in 2008 (CDC). The pandemic highlighted that hospitals are too overloaded: covering too many different clinical specialties, accepting a wide spread of low-to-high acuity patients. The bandwidth for hospitals to plan was reduced to zero during COVID-19. Patients also stopped going to hospital – delaying procedures, non-urgent clinical work, elective work and staff quickly moved towards COVID-19 response.

Experts expect to see a future determined by which clinical services make sense for a hospital and the speed of innovation around new care models that allow more space and ‘bandwidth’ for hospitals to focus on acute care. Separating patients out is quite a new trend in healthcare. For too long hospitals have been accessible to everyone. There is a strong case for selecting certain activities which don’t necessarily need to happen inside a hospital. An injury from a ski accident, for example, can be managed through a GP surgery and a local diagnostic center for scans.

Accelerated innovation 3: The virtualization of continuing learning and the environmental benefits

The clinical workforce accounts for between 60 and 70 per cent of hospital expenditure. Yet the The World Health Organization (WHO) predicts a shortfall of up to two million healthcare professionals (or 15 per cent of the workforce) across the EU by 2020^[8].

We’re leading a shift to a mix of blended learning (virtual/e-learning and in-person) training and continuing learning for customers and staff going forward post pandemic. In Australia and New Zealand, we delivered thousands of virtual hours in demos, clinical and applications training. We have also established local, technical training for Biomeds and internal field staff to reduce interstate and cross border travel and enable our customers to learn and avoid expense and time required to travel outside of their states.

While the age of the classroom isn’t necessarily completely over, new technologies coupled with the global COVID-19 pandemic have marked the ultimate shift to e-learning, enabling more cost effective and results driven possibilities for provision, such as the fact that it reduces the need for travel and can be more budget friendly.

E-learning in itself is a more equitable model too since it It allows the entire staff to gain the same level of knowledge directly at their workplace – and enables every member to deliver safe, effective, and high-quality patient care. Research has also shown that e-learning proves to be an excellent way to achieve quality results in a short timeframe. Learning which is delivered online, within the context of continuous education, should therefore be considered a strategic part of training and education plans for healthcare professionals.

Philips Education Services provides access anytime and anywhere to comprehensive education programs via a blended learning approach, embracing the very latest in e-learning, data and analytics alongside behavioural insights to ensure knowledge retention and enjoyment. With over 1,700 comprehensive programs and spanning traditional and non-traditional models, pre-learning, hands on, on site and virtual methods.

For more information on healthcare operations innovation and to discover how Philips is partnering with global health providers and systems to apply its Operational Intelligence approach to hospital operations management and innovation, visit Philips.com/Operational-Intelligence

References

[1] Global spending on health: a world in transition, 2019, World Health Organization
[2] https://www2.deloitte.com/us/en/insights/topics/digital-transformation/digital-transformation-COVID-19.html
[3] https://corporatefinanceinstitute.com/resources/knowledge/finance/black-swan-event/
[4]https://www.mckinsey.com/industries/healthcare-systems-and-services/our-insights/the-future-of-healthcare-value-creation-through-next-generation-business-models
[5][6] Philips internal data, Case Resolution Dasboard in Qlikview. (Direct operations countries only)
[7]Business Insider, ‘The Digital Healgth Ecosystem’ https://www.businessinsider.com/digital-health-ecosystem?international=true&r=US&IR=T
[8] https://www.who.int/health-topics/health-workforce#tab=tab_1

A global leader in developing genetically modified mice, ingenious targeting laboratory has generated a new genetically humanized mouse model to assist researchers working on COVID-19. This has been made possible, thanks to a grant awarded by the National Institute of Allergy and Infectious Diseases (NIAID) of the National Institutes of Health (NIH). This new ACE2 humanized mouse will be vital for researchers working to understand the SARS-CoV-2 virus that causes COVID-19.

As soon as the severity of COVID-19 was understood and the SARS-CoV-2 virus was identified, researchers from around the world leapt into action. Work to develop new vaccines and screening methods has been a focal point as well as the creation of antiviral drugs to combat SARS-CoV-2. To aid in this endeavor, researchers have been able to take advantage of genetically modified mouse models that were created to study SARS-CoV: humanized ACE2 transgenic models.

Laboratory mice are a preferred species for studies of human diseases because their biology is similar to ours in many ways. However, a key difference between mice and humans meant that mice initially couldn’t be infected with SARS-CoV-2 in the same way as humans. To circumvent this, scientists had to create new genetically modified mouse lines which express the human ACE2 gene sequence so thar SARS-CoV-2 can successfully enter mouse cells. These mice greatly contributed to our understanding of the virus as it pertains to human infection.

The existing ACE2 transgenic mice that are available will undoubtedly be used for years to come, but as with any early developed system, the current models have limitations. One aspect is that the human gene is not expressed in its normal pattern. Because of this, SARS-CoV-2 may not infect mouse cells to the same degree as seen in humans, which limits therapeutic research. A model that mimics more of the human ACE2 expression pattern is a crucial tool for studying the virus more effectively.

To achieve this, the large-scale humanized ACE2 mouse model that has been developed by ingenious targeting laboratory has the advantage of keeping more natural features of the modified ACE2 gene. Ingenious’ model aims to express the modified humanized gene in the correct tissues and at the correct level, making it an excellent tool to fully understand the gene’s function.

In recognition of ingenious’ track record of successfully creating complex mouse models, the NIH awarded an SBIR grant to support this project. Drs. Wei Weng and Arielle Bryan are using the strategy of replacing a large portion of the endogenous mouse ACE2 gene with the corresponding human genomic sequence. The modified gene will have human sequence coding for the extracellular domain of the protein which is the region targeted by SARS-CoV-2. As for the virus, the mice will have human ACE2 which the virus requires for docking. Retaining the mouse sequence in other protein domains should allow the protein to function normally in the context of mouse cells.

“ingenious believes that the ideal mouse model will have its own gene disabled and only express the human version of ACE2,” says Dr. Arielle Bryan who is the Director of Technology Integration at ingenious targeting laboratory. She continues, “We have generated a highly targeted humanized ACE2 mouse model and are now collaborating with researchers from NYU Langone Health and Stony Brook School of Medicine to determine how different factors may impact the disease progression in this murine model of SARS-CoV-2 infection.”

The strategy used by ingenious has three main advantages over the methods used previously to create ACE2 transgenic mice. First, the modified gene retains more natural sequence elements compared with an artificial genetic construct, including promoter elements and the natural intron/exon gene structure. These features contribute to gene regulation in subtle ways that can be significant when studying an infection or disease.

Second, the genetic modification is made at the site of the mouse ACE2 gene. The previous models integrated their genetic construct at random locations in the genome which has unpredictable effects on the gene’s function. Gene expression can be boosted or repressed, depending on where the gene is located on a chromosome, and keeping the modified gene in its natural location helps ensure it will retain its natural expression pattern.

The third and final advantage of the large-scale humanization strategy is that the mouse ACE2 binding domain is eliminated, with the human sequence taking its place. Other transgenic approaches add a new sequence to the genome without removing the mouse sequence. With the approach taken by ingenious, the mouse gene sequence is gone, so only the human ACE2 sequence is available for the virus to dock with.

The advantages of the ingenious mice provide a more precise model for studying SARS-CoV-2 infection. There may be years of hard work ahead to understand this virus. Ingenious’ humanized ACE2 mouse model provides a new tool for researchers who will be investing precious time into finding new treatments to combat COVID-19.

The international team examined the impacts of lockdowns on mortality, routine health services, global health programs, and suicide and mental health to try to determine whether government interventions or the lethality and infectiousness of SARS-CoV-2 are to blame for negative health consequences.

“There has been an ongoing debate around whether the benefits of government lockdowns are outweighed by the negative impacts on the economy, social structure, education, and mental and physical health. In a nutshell, whether the cure is worse than the disease,” Mr Meyerowitz-Katz said.

“While it was challenging to determine the causes of harm, we concluded that it was unlikely that government interventions had been worse than the pandemic itself in most situations.”

Mr Meyerowitz-Katz, an epidemiologist and UOW PhD candidate, said excess mortality statistics suggest that lockdowns are not associated with large numbers of deaths in countries, such as Australia and New Zealand, that avoided large COVID-19 epidemics.

“There are no locations anywhere in the world where a lockdown without large numbers of COVID-19 cases was associated with large numbers of excess deaths. This shows quite convincingly that the interventions themselves cannot be worse than large COVID-19 outbreaks, at least in the short term,” he said.

Conversely, places with few COVID-19 restrictions, such as Brazil, Sweden, Russia, and at times certain parts of the United States, have had large numbers of excess deaths throughout the pandemic.

A common claim is that government interventions are responsible for reduced access to and use of healthcare services, which causes harms to health in the long term. While there has clearly been a reduction in attendance for vital non-COVID health services during lockdowns, it is difficult to disentangle whether the association relates to restrictions intended to prevent COVID-19 cases or to the epidemic itself.

The association may be related to lack of capacity of healthcare services during the pandemic, redeployment of healthcare staff and facilities to managing COVID-19 patients, or the public staying away from hospitals because they fear becoming infected by the virus. For example, data from England, and Australia, show emergency department activity was suppressed weeks before stay-at-home orders were implemented and remained suppressed well after they were lifted.

There is robust evidence that government interventions to control COVID-19 have not been associated with increased deaths from suicide, but there is abundant evidence that mental health has declined in the population since the onset of the pandemic.

“The question is whether these declines in mental health were caused by government interventions or driven by the pandemic itself,” Mr Meyerowitz-Katz said. “The relationship between mental health and lockdowns is commonly discussed, but the equally important link between large-scale COVID-19 outbreaks and depression and anxiety is often overlooked.”

Missing school clearly affects children’s mental health, but so does losing a loved one to COVID-19; it is estimated that 43,000 children have lost a parent to COVID-19 in the United States, and 2 million have lost at least one grandparent.

Stringent control measures aimed at reducing disease mortality and morbidity will be accompanied by negative consequences in many sectors of the economy. These harms are real, multifaceted and potentially long term, and are therefore an important factor for policy makers to consider when choosing which intervention packages to implement. But again, it is extremely difficult to separate the potential impacts of lockdowns from those of the pandemic itself.

The review does not conclude that lockdowns cannot cause any harm; there are harms associated with both large COVID-19 outbreaks and government interventions to prevent the disease.

“Governments are not faced with the choice between the harms of lockdown and the harms of COVID-19, but rather how best to minimise the impact of both,” Mr Meyerowitz-Katz said.

In all of these innovations, we have seen the value of healthcare data. Providers have found new value in their electronic medical record (EMR) systems, for example. Having easy access to a patient’s data makes a huge difference to the quality of the experience for both doctor and patient – and the outcomes as well.

The pandemic experience has also increased the willingness and the appetite to change and opened the way for further innovation. Telehealth is evolving into virtual care where more sophisticated technology is providing a better experience and more value for patients and clinicians.

It has become easy to imagine a scenario where a healthcare provider’s EMR system connects to a patient’s remote health monitoring device with an artificial intelligence (AI) algorithm able to raise an alert when it detects or predicts a potential health issue, in turn triggering a workflow to set up a videoconferencing appointment.

As healthcare providers embrace these technology-enabled care models, they will look for innovative solutions from suppliers including healthtech companies and start-ups, medical technology and device companies, pharmaceutical companies and others.

“Disruptive” solutions for better care

InterSystems is working with one company, RxMx®, that develops apps and portals around lab testing to ensure the safety of specialty medications, like those used for Multiple Sclerosis. Built on the InterSystems IRIS for Health™ data platform, RxMx’s Chameleon platform provides automated risk management to keep patients safe throughout complex specialty treatments while integrating with labs and other vendors in real time.

For some patients on experimental new medicines, the careful monitoring of test results can mean the difference between detecting an adverse event and treatment success. Real-time information is of vital importance to patients and care teams alike.

We will see many more “disruptive” solutions that provide better care for patients and make lives easier for clinicians. Health providers will integrate their systems with those of medical device manufacturers and use big data and AI for improved diagnosis and predictive analysis. And we will see more innovative care solutions from start-ups and the use of new healthcare data standards like FHIR® to make them easier to integrate.

Exponential growth in healthcare data

There are still many challenges, however. Healthcare providers often struggle to integrate innovative solutions into their workflows and systems. In addition, there are data management, privacy and security challenges.

If we look at the medtech sector, companies need to manage the exponential growth of both data volumes and the number of data sources that products must integrate with. According to the IDC white paper, “Data Age 2025”, healthcare data is projected to grow faster than in manufacturing, financial services or media, experiencing a compound annual growth rate (CAGR) of 36 percent through to 2025.

Smart healthcare devices and point of care devices located in patients’ homes are just some of the drivers of this trend. This exponential data growth presents a major challenge for data scientists at medical device manufacturers, who often spend as little as 20% of their time on actual data analysis.

Interoperability a “stumbling block”

According to Juanito Doolub, Healthcare Solution Architect for InterSystems, the bulk of medtech data scientists’ time is spent tracking down, cleaning and reorganising huge volumes of data stored in multiple silos and in different formats and standards.

“Unfortunately, the lack of interoperability between systems has been a major stumbling block for innovation,” says Doolub. We are investing a lot of effort into solving this problem to make sure that our customers have clean, compliant and complete data available for advanced analytics.”

Healthcare startups also have their challenges. It’s estimated that 90% of healthtech companies fail in their first five years. And one of the biggest hurdles they face is the need for interoperability.

Exchanging data in a completely unambiguous way is important across the healthcare continuum, especially when it comes to caring for patients and for analysing the evidence for new medical treatments. This means that if healthcare startups want to develop new solutions and successfully bring them to market, they will need to build their interoperability capabilities and work with a range of data standards.

Integration with existing data standards

The healthcare industry has a veritable alphabet soup of interoperability standards, including Health Level Seven (HL7®), ASTM International, DICOM (Digital Imaging and Communications in Medicine) and IHE (Integrating the Healthcare Enterprise).

FHIR, HL7’s newest clinical data standard, uses RESTful APIs, which are also the basis of the ecommerce and social media applications. That allows FHIR to be used in different contexts, from system-to-system messaging to consuming innovative new services. It’s likely that most interoperability will be done via FHIR at some point.

However, right now, supporting earlier data standards and APIs, and even interfaces to systems that don’t use standards, make it easier for a new solution to fit into the existing healthcare data ecosystem. Demonstrating this sort of flexibility could be a key competitive advantage for startup companies, and help them acquire more customers.

Better data management = better AI

Data management capabilities are also important. Clinicians and other carers are increasingly looking to leverage healthcare data to understand what is the best treatment for an individual patient, for example.

That could be through access to a complete set of patient data, or through applying AI algorithms trained using large volumes of comparable data. These processes are greatly simplified if data is consistent and flows easily between systems rather than being scattered throughout disparate data silos. Key to this is the availability of normalised data, or what InterSystems calls “healthy data”.

It is quite breathtaking to see how quickly AI is being taken up by the healthcare industry. For example, machine learning – a key part of AI where computer algorithms automatically improve through experience – has been called upon to leverage healthcare data to help deal with many of the challenges COVID-19 has presented.

Public health systems have turned to machine learning to complement their contact tracing and other efforts to control the disease and track outbreaks. Private healthcare operators have embraced machine learning to remain competitive when faced with a drop in demand for elective surgery or, in many countries, a reluctance or inability to visit hospitals or clinics.

The pace of AI and machine learning adoption is also accelerating in hospitals. According to a recent IDC study of 210 hospitals in the US, UK and Germany, half already have an AI framework in place and the rest plan to be online within 24 months. The study found that reading images to assist with diagnoses (30% of hospitals) and early identification of hospital-acquired infection (30%) were among the top three use cases for AI.

For example, Mercy Radiology in New Zealand, working with Ferrum AI, has deployed AI algorithms which use machine learning to improve over time with use. Operating in a second read capacity for radiologists, the use-cases are in lung nodules on CT scans and limb fractures on X-ray. The algorithms have improved the quality of reporting and “there has been positive engagement from clinicians as well,” says Lloyd McCann, CEO of Mercy Radiology and Head of Digital Health for Healthcare Holdings Limited.

Machine learning for smarter triage

One area where we will see widespread advancements with AI is in hospital triage. Most triage systems rely on simple risk scoring systems with a small number of variables to identify which patients need immediate attention or access to higher acuity resources.

Machine learning increases the number of variables which can be taken into account to make smarter triage decisions. At Northwell Health – with 23 hospitals, New York State’s largest healthcare provider – machine learning is making better use of resources and improving patient experience. The technology is used to identify patients who need to be woken up to take their vitals versus those stable enough to sleep through the night.

InterSystems believes it is essential to prioritise healthcare data interoperability and data-cleansing so that it’s usable in machine learning and other innovative, data-driven solutions. The company’s cloud-first data platforms also solve the speed and scalability problems that healthcare must overcome to manage the exponential growth in data it produces.

Providers and their suppliers have an incredible opportunity. To take advantage of it they require systems capable of processing health data in real time, connecting with all the data sources they need, ensuring healthcare data is fit for purpose, and integrating innovative solutions into existing healthcare systems.

Yes, there are challenges to be overcome. But the pandemic has shown us the value of technology and we will only get better at leveraging healthcare data to enable new, more effective models of care.

AYU DEVICES is spun out of BETIC, IIT BOMBAY and is supported by BIRAC, DBT- Government Of India. We have made India’s first Indigenous Digital Stethoscope which can amplify the heart and lungs sounds up to 16 times making it very clear for the diagnosis of Heart murmurs and Lungs abnormalities. Through our Medical Innovation, we have tried to help control the number of cases of misdiagnosis of the heart and lungs problems especially in the rural areas. The stethoscope can also record the heart sounds and can also share it simply through whatsapp. It finds great utility in the Medical field where we find innumerable cases of misdiagnosis and Congenital Heart Diseases due to which so many children die because of untimely diagnosis. The auscultated sounds can be sent from remote periphery locations which lack medical facilities to the best physicians our country has. This can help in proper analysis and diagnosis of the abnormalities faced by people thus bridging the gap between patients from remote areas and the best medical advisors.

Digital Stethoscope AYUSYNK is specifically helping to fight the COVID-19 crisis. With stethoscopes we are promoting Doctor-Patient Distancing, as we can take auscultations even while wearing the PPE protective suit through our Bluetooth connectivity thereby keeping our Health Workforce very safe.

Also in almost all the corona patients, symptoms of Pneumonia are found with a very specific Wheezing and Crackles in the auscultations. Through the amplification feature in Stethoscopes, doctors can amplify the volume and then listen to the lung sounds.

Digital Stethoscope AyuSynk can be used in primary health care centers to record abnormal auscultation sounds which can be sent to expert physicians for further diagnosis, thereby overcoming the problem of low ratio of doctors to number of people in India (1:1800) which is considerably low when compared to the minimum recommended doctor to population ratio of 1:1000 set by WHO.

The recording and playback feature will facilitate inclusion of auscultated sounds in the medical records of patients, and create a repository of recorded abnormal sounds, providing a rapid learning curve to medical students who are the future to a Healthier India. Our device provides the ability to convert an existing stethoscope to smart by just adding an attachment. This makes our device a low-cost solution for early detection of heart and lung diseases. By the detection of heart and lung diseases at the early stages the progression of the disease can be prevented. This reduces the economic burden on the patients, family members and tertiary care hospitals. Thereby reducing the economic burden on the country.