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Editor’s note.... Contents
02
DIGITAL ENGAGEMENT PUTS
PATIENTS AT THE HEART OF
Artificial intelligence (AI) is disrupting the way HEALTHCARE - NETCARE
healthcare is practiced – if you don’t adapt and LAUNCHES MOBILE APP
adopt it you may just find yourself left behind
choking in the dust with far fewer patients all
wearing health assistive devices and plugged in 04
to GPT 4 for instant knowledge and advice. PLANNING FOR
SUCCESS
A great introduction to a superb review article by
colleague Chris Bateman, taking stock of the many 06
developments and prospects pertaining to AI’s
relentless impact on medical practices and RELAX ABOUT THE NHI
procedures. – IT’S A VERY SLOW WORK IN
PROGRESS
Also happens to be an apt summary of the
dominance digitisation of health care has assumed 08
in terms of current thinking on the business of
health care. KNOW THE APPROPRIATE ACTION
TO TAKE WHEN RECEIVING A
Some might argue that the National Health MALPRACTICE CLAIM.
Insurance (NHI) Bill has earned top spot when it
comes to health business topicality. From a public 12
viewpoint, maybe, but from a healthcare
professional viewpoint, maybe not… Q&A WITH SAPPF CEO, SIMON
STRACHAN
Many of the articles in this, our maiden issue of
Health Business Review, will help you decide on 14
this. MEDICO-POLIT ICAL MATTERS
What you will no doubt glean from the content,
however, is that healthcare in South Africa is once 16
again going through a buoyant period. Every HOW AI IN THE HANDS OF DOCTORS
headline tells a story and every story has an IS TRANSFORMING MEDICINE'S
influence on the area of healthcare management LANDSCAPE
and medical practice it covers.
26
All that is left now is for you to enjoy the benefits
of what we have to offer in the first of what will be THE IMPORTANCE OF TAKING CONTROL
a regular digital publication reviewing pertinent OF YOUR PRACTICE FOOT TRAFFIC
developments in the interests of the business and
related practice of healthcare. Roy Watson
Healthcare Business Review 2. Powered By:
Digital engagement puts patients at the heart of
healthcare - Netcare launches mobile app
“Digital engagement can significantly enhance “One of the primary features that was
person centred patient care, helping to developed on the Netcare app is a contact
overcome the challenges and complexities that button for Netcare 911, which also includes a
so many people experience when seeking 60-second call back option, and which allows
healthcare. The Netcare app will further support the emergency medical response operator to
our digitally integrated person centred patient immediately geolocate the exact position of the
experience, as we as a group move from user without the need for any additional steps,
traditional siloed and episodic-led care to an such as text messages.
ongoing engagement-led model of care.”
“This will allow for even faster response times in
Speaking about the newly released Netcare cases where users may not be able to give their
mobile application, Dr Richard Friedland, chief precise location over the phone. The app also
executive officer of Netcare noted that digital includes an ambulance tracker, providing
development is the route to placing people at regular updates on estimated time of arrival
the centre of care, by integrating and allowing greater peace of mind to the user in
streamlining processes in a way that has not yet what is inevitably a stressful time,” she said.
been done by any South African hospital group.
Winter notes that key to an empowered patient
The first release of the Netcare app, is a journey is immediate access to consolidated
development that provides users with a broad medical records, which the app provides
based feature set designed to enhance the through the Summary of Care functionality.
patient journey and empower users in the
management of their healthcare. “Netcare 911 is the first of our operations to
provide a digital Summary of Care – a digital
“We are of the firm belief that when it comes to record summarising the emergency care they
your health, no decisions should be made about received – to our patients, which can be viewed
you, without you – in other words, you as the on the Netcare app. Patients will be sent an SMS
patient should be at the very heart of your and/or email after receiving emergency medical
overall healthcare experience. Empowering you care, prompting them to download the Netcare
to participate in your care is therefore app free of charge, to view their Summary of
imperative and now more achievable than ever Care anytime they wish to.
before with the instant digital access that this
app provides,” he said. “This is the beginning of providing patients with
more integrated and lasting informational
Broad based feature set access, with the Netcare app becoming the
central repository of their medical records. This
According to Sonja Winter, chief marketing and functionality will also extend across other
communications officer at Netcare, the Netcare divisions in the Group.
app brings a new dimension to the healthcare
journey and includes enhanced emergency Continued on page 11...
response features, digital medical record
management and streamlined hospital admission
processes, to begin with.
Healthcare Business Review 4.. Powered By:
Planning for Success
If you fail to plan, you plan to fail.
Some may question the validity of this age-old adage in the context of the practice of
medicine, after all the sheer dynamics of demand and supply mean most doctors and other
healthcare professionals simply need to ‘show up’ and they will be assured a busy practice
and financial success.
So, why the need for planning? Or, as put to me recently by a young cardiologist, “Plan for
what?”
Business planning, no matter what the business may be, must always start with pondering
what success looks like for you. This is the first and most fundamental of stepping stones on
the road to fulfilment.
The need for planning starts to become evident when you take the time to consider what you
really want to achieve and start asking yourself the following:
What kind of practice do I want?
What kind of patients do I want to see?
What kind of work will I do?
Where will I live?
How many days will I work per week?
What relationship do I want with my family?
How many family holidays per year and for how long?
What are my other passions outside of medicine?
How will my business model inform my financial and lifestyle success?
What does retirement look like and what role will the value of my practice play in achieving
this?
It seems to be that many practitioners don’t even ask the questions let alone work on the
answers. But good business planning is all about posing these questions, working out the
answers then documenting and managing the actions required to achieve the desired results.
It all starts with a vision and then, with a bit of guidance and the implementation of robust
systems and risk-management strategies, all can be achieved.
There is a challenge facing healthcare practitioners, however, and that is the mental shift
required to start running their practice as a business and to begin to work on it as well as in it.
There are no short cuts here, just as there were none for your clinical training.
Register now for the South African Health Business Academy course programme and learn
how to build the practice of the future, that meets the evolving needs of the patient as well as
the unmet and underserved needs of you and your family.
Healthcare Business Review 6. Powered By:
Relax about the NHI – it’s a very slow work in
progress
By Chris Bateman He described the NHI as an attempt to “fix a
very messy expensive, complicated and highly
Within five to seven years, litigation-willing, unproductive dual health system which has 72
initial NHI benefits will be modest, covering medical schemes with 308 different options
mainly primary health care services - nowhere on one hand - and 10 health departments,
near the basket of services that medical Correctional Services and the SA National
schemes will still be offering. Defence Force, which all work independently,
duplicating one another, on the other.”
This emerged in a Business Day-hosted
webinar featuring NHI Deputy Director He said that in the private sector, patients
General, Dr Nicholas Crisp, Webber Wentzel only found out what cover they had when they
law partner and Health Sector Lead, Prelisha fell sick and were spending more and more out
Singh, Chief Visionary Officer, ASI Financial of pocket because they cannot afford to pay in
Services, Anthony Govender, Government advance for healthcare.
Employee Medical Aid, (GEMS), Principal
Officer, Dr Stanley Moloabi and Managing He added, “none of us gets what we should in
Director of Netcare Plus, Teshlin Akaloo. a very unequal society where wealth and
income are highly concentrated. Private
The NHI bill, passed in the National Assembly providers will be possible in an NHI, but you
on June 12th this year, is currently before the and I will no longer suffer the stress of not
National Council of Provinces, (NCOP), where knowing whether we’ll be treated when sick
it will be subjected to extensive scrutiny by with a particular condition. Not because I have
the provincial legislatures as the content of money or a nice warm bed in some rosy
the bill affects their interests, concerns, and suburb or that I’ll be treated differently
capacities. because I’m on the street. We have a bill of
rights which is what the NHI is addressing.”
The bill is also facing intense backlash and
legal stalling from private-sector stakeholders However, implementation would be gradual
who argue it is unrealistic and unaffordable. and slow
Less than a handful of NHI implementers “We will progressively increase the benefits
paid for from the fund. So, on Day One, what
Crisp revealed that just a handful of people can I pay for from the fund? I can pay for
were currently driving pre-implementation of primary health care, for this and for that.
the bill. Where do I get that money from? Well, I get it
from the provincial equitable share and the
“Essentially, we’re just three or four people in conditional grants, I get it out of what’s
the office. We’ve been trying to recruit 44 currently spent in the Correctional Services, I
people but have been in court with Solidarity get it out of wherever it’s sitting in the public
who are trying to stop us recruiting people to service. But there comes a day when I say OK,
do the work. So, who’s going to talk to you? now I’m covering everybody for this package,
Me. And me and me. It’s crazy!” these set of benefits. Where do I get the
additional R10 billion from? Well, I start with
tax credits!
Healthcare Business Review 7. Powered By:
Why pay me as a medical aid member to try Govender cited the independent, successful,
and incentivize me to be on a medical scheme and efficiently run Government Employees
when you should be spending that money on Medical Schemes, (GEMS), saying government
getting poor people better health care? And possessed the right skills, competency, and
that’s a decision we must take.” leadership to lead such funds – even though it
had failed dismally in many other areas.
Singh who provides legal advice to
government and the private sector, said there “Cadre deployment doesn’t work. If we want
was a very real fear that in trying to achieve Brand SA to succeed, we must get the
universal healthcare, the government would politicians out. We cannot have them running
destroy “one of the best healthcare systems in our assets,’ he said.
the world.”....“But I really challenge that
statement. Both health sectors are equally Questioning what would happen when Crisp
dysfunctional with huge inbuilt inefficiencies,” went back into retirement, Govender called
she stressed. for public-private collaboration in a blended
model to realize equal access to affordable
Singh questioned whether an NHI was the healthcare.
optimal solution in levelling the playing field
and providing universal access to quality “We have great skills and competence. Just
healthcare. look at Momentum Life and Discovery. We
need to be able to rely on them to support the
“Massive change to both systems is needed. collaboration,” he said.
I’m not sure an NHI will ruin healthcare, but
I’m also not sure we’ll be improving access to Govender said that for the past 30 or more
healthcare for all.” years, South Africa had moved too slowly on
the health agenda.
Bill 'ill suited’ to SA context
“Yet the moment we put a bill together people
She said the bill was ill suited to the South say we’re moving too fast. We’ve got to decide:
African context by virtue of SA’s history, huge are we moving too fast or too slow? The only
capacity constraints, a limited tax base and a issue we really have is that when change
high disease burden which put an NHI system happens it doesn’t suit certain commercial
at a major disadvantage compared to other and personal interests. That’s the crux of it.
countries where it was tested and found to The issue is not what we’re trying to do as a
work. national health agenda, the issue is how it
impacts business, what the transition looks
“I also have reservations about its like, giving certainty and clarity.”
constitutionality and harbor concerns about
whether it will be affordable. There’s distrust, Addressing Crisp directly he said,
suspicion, and fear mongering on both sides. I “unfortunately; Nick, I think that’s the part you
don’t want to get into the cynical debate and the minister have to work on - giving more
around corruption and concentration of clarity to HCP’s and business, so they feel
funding. All this public versus private, rich included”.
versus poor stuff - I believe that’s just ‘noise.’
We all want to see people treated equally. Crisp rejected criticism that the NHI was
Both public and private can work on a blended hugely restrictive, saying universal healthcare
solution that might be slightly better than in all other Western countries was every bit as
what the NHI is proposing so far,” she restrictive as SA’s model – but in the best
suggested. interests of their populations. To page 10
Healthcare Business Review 8. Powered By:
Know the appropriate action to take when receiving a
malpractice claim.
Receiving a complaint, letter of demand or
summons can be a stressful and daunting
experience, but taking immediate action can
help protect your interests.
Some insightful steps to consider:
Contact your insurance broker or insurer
as soon as possible. Respond to the complaint or summons.
Your insurance broker or insurer will provide There are timeframes applicable in terms of
guidance and assistance on how to handle which you must respond to the complaint, letter
the complaint, letter of demand or summons of demand or summons.
and can connect you with legal counsel if
needed. Failure to respond may result in:
aggravating the incident that could possibly
Collect and review all relevant have been resolved outside of court or a
documentation. formal forum;
an adverse finding against you;
Gather any documentation related to the a fine against you;
incident, including medical records, consent increased legal costs to appeal a decision;
forms, and communication records. Your and/or
insurer will most likely request copies of all a default judgement.
the documentation related to the incident to
assist you in handling the matter effectively Cooperate with your insurer.
and efficiently.
Your insurer will be investigating the incident
Read the complaint, letter of demand or and will require your cooperation in the process
summons carefully to familiars yourself with as you have firsthand knowledge of the incident.
the allegations being made against you.
Should you have any questions or require To assist with the matter being investigated and
clarity on the complaint, letter of demand or attended to efficiently and effectively it is
summons, write this down to ask your advisable to assist and work with your insurance
insurance broker and insurer. broker and insurer in providing requested
information, feedback etc. in a clear and
Do not admit fault or liability. timeous manner.
It is important not to admit fault or liability If you would like to know more about the
without first consulting with legal counsel. correct procedures please reach out to our
team via our site www.genoa.co.za or e-mail us
Most insurance policies contain conditions on [email protected] and we will get back to
regarding admission of fault or liability, and you.
it is thus of the utmost importance to not
admit fault or liability as this may impact
your insurance cover and or be prejudicial to
you.
Healthcare Business Review 10. Powered By:
Redirecting funds, not raising more tonsillectomies and gromets, the highest C-
section in the world, we duplicate X-rays, lab
He said South Africa currently spent results, and re-open a file each time we see a
substantially more of its GDP on health (8,5 patient. It’s madness. Instead, under the NHI
%), than its’ peer countries (on average 6,5%), we’ll have one budget.”
whereas the United States spent 20% of its
GDP on healthcare, which made up 43% of the Crisp said there was more than enough money
world’s healthcare spending. available in the healthcare system.
“Yet SA has the same infant mortality as “But what do we do with it? We pour it into
Ghana who spend a fraction of their GDP on holes, it gets wasted with fraud and
health - much less than ours. The question is corruption, patients steal from medical aids
what do we do with that percentage of our and so do doctors, we have a massive medico
GDP, and what is it worth?” legal bill, about half of which is trumped up via
collusive practices. That’s why the Special
He said South Africa spent R265 billion across Investigative Unit is investigating. It’s not a
all its public health departments (about 4,1% matter of public or private, but of both. We
of GDP or 15% of government spending) to must collaborate with the hospital down the
serve 85% of the population. road. People mustn’t get stuck with one
element of the NHI bill. It’s big and
“I don’t believe assertions that some 25% to complicated and needs to be done
35% of the public use the private sector. They systematically over a long period of time,” he
don’t go to private hospitals, yet on the other, said.
(private), side we spend some R275 billion to
R277 billion. Some 85% of that is spent through Singh said there was currently a golden
prepayment to medical schemes. The rest is opportunity for the government to consult
out of pocket payments and one percent is on with its opponents and refine the bill to avoid
these unregulated insurance products which a plethora of litigation that would hold up
we don’t like. Administration is incredibly implementation.
expensive, given the 308 packages which
people can switch between. With NHI you have “In short, I believe there could be arguments
one package, and everybody qualifies for a around an unjustifiable limitation on certain
single set of benefits. It removes all these constitutional rights to this act. The meat of
administration costs.” this framework act comes in regulations and.
Unfortunately, there’s a principle to
He cited Indonesia’s 260 million population constitutionality which requires the act to give
where their NHI cost just 2,8% of healthcare sufficient guidance to those regulations. That’s
costs to administer. a real shortcoming in the bill.”
“The NHI will cost us 8,5% or less of GDP - This story appeared in AxessHealth on
that’s what we must spend. I mean, if you take 22 August 2023. To get these stories
the current spend in the private sector and as they happen, register a free profile
multiply that by SA’s entire population we’d on AxessHealth today.
need R1,3 trillion rands. To continue to spend
R5 200 per capita per annum in the public
sector and R27 000 per capita in the private
sector per annum makes no sense. We have
four times the global average of africa.axesshealth.org
Healthcare Business Review 11. Powered By:
Continued from page 2...
“The app furthermore provides interactive And, in answer to the growing demand for a
elements, enabling users to make an centralised healthcare experience, the app also
appointment with a healthcare provider, via enables patients to purchase gap cover from
the appointment booking feature. This NetcarePlus, further increasing healthcare
provides a new level of convenience, as the access and convenience, with more features like
app is integrated with doctors’ schedules in this to be added in time.”
our primary care division.
Dr Friedland concluded by saying that the first
“The app based booking system allows the release of the app immediately begins to
user to view available slots and book to see a enhance the patient journey across numerous
primary care practitioner via a secure platform aspects of the Netcare ecosystem. “The Netcare
that enables online consultation as well as app is indicative of our continued commitment
digital medical certificates and prescriptions, to meeting the healthcare needs of our patients
at affordable set rates,” she explained. and the people of South Africa through cutting
edge, patient centric innovations. We are most
“Those needing to book with a specialist can excited about the benefits that it will offer users.
also interact with Netcare Appointmed via the
app, for assistance in finding the most “We look forward to further developing the app
appropriate healthcare provider to address in this constant evolution of a more nimble and
their concern.” integrated healthcare system. It is through such
innovations that Netcare is able to provide the
Winter notes that the Netcare hospital level of person centred care for which we are
admissions process, which has been known, a responsibility we take most seriously as
increasingly simplified in recent years, is now we chart new paths in South African healthcare,”
made all the more straightforward with the he concluded.
introduction of the app, which allows for quick
and easy digital pre-admission, including The Netcare app is available across all four main
uploading medical scheme information and device platforms, including IOS, Android, Huawei
identity documents. Users who have and Microsoft.
downloaded the app and obtained their Wi-Fi
credentials during hospital admission will also
have access to the dedicated free patient Wi-
Fi.
“Upon arriving at a Netcare hospital or Netcare
Medicross day theatre you need simply visit
the online admissions desk and present your
digital admission card on the app for a faster
and entirely paperless process,” she said.
Healthcare Business Review 12. Powered By:
Simon Strachan, SAPPF CEO, gives Roy Watson
answers to leading questions on current issues
RW Having made your submissions on NHI, what RW Has SAPPF had any input/involvement in the
is still your major concern about private PIMART issues? If so, what? If not, why?
medical specialists’ “survival” in the SS We believe that the proposed Pharmacist-
proposed funding environment? Initiated Management of Antiretroviral
SS When the Bill is fully implemented, and Therapy (PIMART) oversimplifies
private funding may only cover what the NHI comprehensive HIV management and ignores
does not cover. The risk for the private the complexities that go with managing a
specialist is that they will effectively be patient infected with HIV. If patients are not
employed by the state. They will be offering optimally managed according to best practice
services at a fee they were instructed to with appropriate clinical experience, then the
charge, unable to bill individually but rather safety, comorbidity and death rates will
having to bill an all-inclusive fee with hospitals inevitably increase. These services can only be
and other treating specialists and receiving provided by someone with qualified clinical
none of the benefits that a salaried employee expertise, infrastructure, equipment and
would enjoy. The Certificate of Need will allow experience, as opposed to dispensing ARV
the State to exclude specialists form working medication on a positive HIV test.
in certain areas as the state deems the need. The level of competency required cannot be
This means there will not be a private sector. achieved by non-clinicians who have only
We believe the survival of the National health participated in a short period of
Asset absolutely requires the existence of a supplementary training.
well governed, regulated and self-funded
private healthcare sector that can then RW The recent Mediclinic coding story has
contract with the state to provide healthcare brought the erstwhile unresolved issues
services. This is the best way to ensure regarding coding to the fore again. SAPPF and
universal access to quality healthcare for all. the late Dr Chris Archer were prominent 10 or
so years ago in efforts to “clean up” coding
RW Where are you at on the CoN matter? Our last discrepancies and resolving ongoing issues
headline was “SAPPF, Solidarity sticking to between funders and providers on these
their guns on CoN’… issues. Have these been addressed? Are there
SS The Certificate of need is an extremely still problems? Has anything more been
important piece of legislation that threatens done?
the right and ability of healthcare SS Coding is a critical focus for SAPPF. We have a
professionals to practice their profession strong coding division and have a registered
where they chose and infringes on patients’ Not for Profit Company called the South
rights to choose where and from whom they African Classification for Healthcare
access their health care. The High court ruling Interventions (SACHI). This is a multi-stake
that declared sections 30-40 of the National holder, centralised regulatory and governance
Health Act unconstitutional – these are the structure that provides the framework that
sections pertaining to the CoN, was rescinded will provide overarching good governance of
on a technicality. The case will now be heard coding. This will allow us to enhance the
again in the High court and we are waiting for current coding system while working towards
these proceedings to get under way. a value-based healthcare (VBHC) approach.
The members of SACHI will be health care
professionals, coding experts, funders, health
actuaries and regulators.
Healthcare Business Review 13. Powered By:
We currently have the situation where 75% of Schemes advised not to exceed
new codes published since 2015, are not 5% contribution increase
reimbursed by funders. SACHI will allow the
development of a unified and nationally
accepted process for the implementation of To protect medical scheme members from
new codes and revision of existing codes. The further financial distress and the likely risk
benefit is that when a code is identified for of losing health insurance coverage due to
implementation or revision, all involved affordability constraints, the Council for
parties will have sight of this from the outset. Medical Schemes (CMS) has advised
This provides the opportunity for health schemes to limit their cost assumptions for
technology assessments, economic impact tariff increases to 5% plus reasonable
studies, accurate code descriptors and utilisation estimates for the 2024 benefit
regulatory oversight. The result being, codes year.
that are published in the South African
Medical Doctors coding manual have been “Contribution increases higher than CPI plus
through this process and we will know the a reasonably assumed utilisation factor will
funding decision on these codes. Every be evaluated and approved on the strength
attempt will be made to create alternative of the motivation submitted,” the CMS has
reimbursement models and value based explained in a covering note to its Circular
healthcare possibilities. 27 of 2023: Guidance on contribution
increases and benefits changes for 2024*.
“Only contribution increases that have been
RW Question that has been asked a number of approved by the Registrar may be
times: GP representation in the Private
Practitioners Forum – being by far and away implemented by medical schemes.
the largest Private Practitioner grouping…? “Moreover,” the council adds, “it is advised
SS Yes we do welcome General practitioners as against communicating any benefit changes
members. During COVID, GP groups unified or contribution increases before obtaining
under the banner of the UFFP. This umbrella the necessary approval from the regulator.”
organisation provides guidance on GP specific
issues and has enjoyed support. We *Circular 27 can be downloaded at
collaborate with the UFFP in discussion and https://www.medicalschemes.co.za/downlo
when necessary action, on issues of mutual ad/3684/2023-circulars-
impact and interest. current/27449/circular-27-guidance-on-
contribution-and-benefits-changes-for-
2024-benefit-year-final_edited
SOURCE: CMS Communications
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Medico-Political Matters
Solidarity, SAPPF sticking to their Judge Brenda Neukircher concurred with the
guns about CoN’s Department that the Minister was not
properly informed and that he should be
unconstitutionality allowed to defend his position in court. She
argued that Solidarity and its co-applicants
SA Private Practitioners Forum (SAPPF) CEO, didn’t comply with court rules on how papers
Dr Simon Strachan, said that although they should be served on a respondent.
were disappointed with the High Court in
Pretoria’s recent decision to overturn last Apparently, the sheriff of the court who
year’s court ruling declaring the Certificate of served the papers on the Minister was told by
Need (CoN) unconstitutional and invalid, it the receptionist in his office that there was
was expected. no one to receive the papers after which he
left. Neukircher added that emails sent by
He was echoing trade union Solidarity’s the respondents’ legal team to were not
position that this week ruling was only aimed enough to “initiate proceedings under rule
at offering Health Minister, Dr Joe Phaahla, 4(1)(a) of the uniform rules of court”.
the opportunity to state his case in court after
claims by the Department of Health that the Solidarity spokesperson Perriu Marx said the
minister was not properly informed about last organisation’s position remained unchanged
year’s legal action that was brought by and that the decision to revoke last year’s
Solidarity, the SAPPF, Asaipa and individual ruling was part of “the normal process and
doctors. that it was clear that the court afforded the
department a chance to state its position
In her ruling in June 2022, Judge Thembi because a final ruling on the CoN will be in
Bokako castigated the Health Department, the national interest.
President and the State Attorney’s office for
not opposing the application or even telling However, he stressed that Solidarity is
the court that they are going to oppose it. She sticking to its position that the CoN is
said it was a strong sign that the law, that will unconstitutional and will make no further
tell doctors where to work, was unjustifiable arguments to the court.
“when the state was unwilling to defend its
legislation and “unaccountably refused to “We have challenged it on four grounds – that
participate in these proceedings”. it is irrational, contravenes the separation of
power, is unconstitutional and that the
The Health Department however maintains criteria are prohibitively vague. That is not
that it was unaware of the application and has going to change, and our seven applicants
come back with blazing guns applying to both will remain exactly the same,” Marx added.
the Constitutional Court and the High Court to The latest ruling on the CoN is another blow
revoke the ruling that sections 36-40 of the for doctors after the passing of the NHI Bill
Health Act should be set aside. The ConCourt by Parliament despite warnings that it could
then referred the case to the High Court to further destabilise the country struggling
decide whether Judge Bokako’s ruling should health system. In an interview on kykNET
be rescinded. earlier this week,
Continued on page 20...
How AI in the hands of doctors is transforming
medicine's landscape
Overcoming Doctor Shortages & Optimising
Skill Utilisation
The scarcity of healthcare professionals,
especially doctors, is a global concern. “In
South Africa, we are working with a doctor-to-
patient ratio of 0.32 to 1,000 which is well
below international standards,” Luis explains.
He goes on to say that while in demand, many
GPs find themselves stuck in a routine of
diagnosing a handful of common illnesses,
which is a gross underutilisation of their skills &
expertise.
“AI can serve as a powerful tool to address
Luis da Silva - Healthbridge CEO
both these challenges. By leveraging AI,
Doctors & AI are a powerful duo. While doctors can diagnose cases more rapidly &
computers can process volumes of accurately. This can help alleviate their
information better & faster than any human, workload & allow them to focus on complex
doctors bring the expertise, nuance & instinct cases that require their expertise.” Luis
that no machine can replicate. When used reiterates that AI's ability to analyse vast
together, doctors & AI’s complementary amounts of medical data & research can offer
strengths can pioneer a new era of patient- valuable clinical decision support to doctors &
centric care. thereby elevate the quality of care.
CEO of Healthbridge, Luis da Silva explains, Revolutionising Diagnostics & Medicines
“AI will never replace doctors, but doctors Management with AI
who make use of AI will be able to work more
efficiently & help more patients, than those AI's potential in revolutionizing healthcare
who don’t.” As a leading provider of becomes particularly evident when it comes to
healthcare technology, Luis continues to say diagnostics & medicines management.
that in a country grappling with a scarcity of Computers can process enormous amounts of
healthcare professionals & the imminent medical images, pathology results & medical
challenge of providing quality health care for records. This can expedite medical research,
all, the rise of AI-assisted medicine is pharmaceutical R&D & the discovery &
inevitable. treatment of time-sensitive rare diseases.
In this interview, Luis shares his insights into “On a primary healthcare level, AI systems can
how & why we should integrate AI for smarter act as co-pilots for doctors to significantly
healthcare. accelerate the diagnostic process. Whether we
are talking about a private medical practice in
an urban area, or a rural primary care clinic run
by nurses, AI algorithms can be used as a
symptom checker for patients & in the pre-
screening process.
Healthcare Business Review 17. Powered By:
This alleviates the burden of volume on We can then ensure that patients are triaged
doctors while augmenting the level of accurately & those in critical condition
accuracy that they can diagnose at,” Luis receive prompt medical attention. In this way,
shared. AI-driven systems can optimise patient flow,
reduce waiting times & further augment the
“At Healthbridge, we are actively using AI to capacity of skilled healthcare professionals,”
support doctors in the prescribing & Luis replies.
dispensing of medicines. Our Clinical “Taking it one step further, by using AI to
software incorporates SmartMeds which is a assist in diagnosis & treatment planning, the
tool that automatically provides a short list healthcare system can potentially reduce
of suggested medicines & related doses to costs associated with misdiagnoses &
treating doctors,” Luis says. unnecessary procedures. Those factors will
make a reasonable contribution to the
He goes on to explain that after analysing sustainability of NHI,” continues Luis.
volumes of prescription data, SmartMeds
works by suggesting appropriate medicines Empowering Patients for Better Health
based on the diagnosis, patient Outcomes
demographics, contraindications with the
patients’ existing medication, as well as the There isn’t a healthcare system in the world
medical scheme & doctor’s preferences. that can sustainably meet the growing
“This alleviates the enormous complexity demand for care. Lifestyle & chronic diseases
inherent of prescribing & the pressure on continue to put significant pressure on
doctors to commit this information to already overburdened, often fragile, health
memory – a superhuman capability afforded systems.
to very few. SmartMeds makes prescribing
simpler for the doctor and safer for the “AI's impact on healthcare doesn't end with
patient – all with the help of AI,” Luis says. professionals; it extends to the patients
themselves. It’s one of the ways that the
Navigating the Challenges of National integration of AI into healthcare can be so
Health Insurance transformative. The proliferation of wearable
devices & health monitoring technologies,
In principle, NHI is a worthy & necessary patients are empowered & sometimes
change to an inequitable health system, but incentivised to make informed, healthy
its long-term affordability & the availability lifestyle choices,” Luis explains before sharing
of resources are, understandably, in his own metrics & why he made the decision
question. So, how can AI bring about the not to go running at 4am that morning.
reality of NHI?
“As with anything healthcare related,
“Without delving into the finer details of prevention is better than cure. Giving patients
NHI’s roll out, AI presents a practical the tools to actively participate in their own
mechanism to optimise the allocation of well-being is a powerful step towards
resources & enhance overall efficiency. AI's preventive medicine & patient-centred care.
capabilities extend beyond assisting In the long run, this is how the current system
doctors. Healthcare professionals like or NHI can achieve better overall outcomes &
primary care nurses & pharmacists can also reduced healthcare costs, ultimately leading
receive real-time clinical decision support. to sustainability,” concludes Luis.
19.
Whats next in the AI revolution?
With the potential of AI in healthcare being so
vast, from assisting doctors in diagnosing
complex cases to optimising patient care & Partner
even empowering patients to take control of
their health, AI offers solutions to some of
healthcare’s most pressing challenges. What with us
are the next steps to harness this undeniably
powerful tool?
Warren Hickinbotham
“Using AI to its full potential will inevitably Founder & Global CEO
bring about change to a very established
system and change can be scary. It’s a natural "In Africa, there are not enough healthcare practitioners
(HCPs) to support patient demand. This is a worsening
human tendency to fear the unknown but situation due to brain drain across the continent and
these emerging technologies give us the increased disease burdens. The only way to stem the tide is to
opportunity to leapfrog over many of our support the HCPs we do have.
existing problems & therefore can’t be AxessHealth is a web platform that gives HCPs free access to
ignored. Not by policy makers, the public or medical news, educational content (CME), digital practice
private sector, medical insurers, or providers tools such as dosage calculators and decision support
at every level of healthcare,” Luis says. software, the ability to connect, and finally, seamless access
to external platforms offering complementary support
services.
Luis goes on to say that there will come a
time in the near future when we will need Ministries of Health, Governments, NGOs, Medical
robust structures & controls in place that Associations, and industry supply companies use the platform
to communicate with targeted HCPs based on geolocation
govern the use of AI – not restrict it – but and therapeutic area of practice. Data is collected across the
guide its use to ensure that we are truly using platform and fed back into our government and medical
it to address the scarcity of healthcare association partners at no cost to strengthen policy and
professionals & ensure the safety of patients. initiative decision-making and prioritisation.
The AxessHealth goal is to create a global community of
He concludes by saying: “As we embrace the connected African HCPs to pool the African medical
power of AI, we stand on the cusp of a new intellectual resource to educate and support these HCPs
era in healthcare, where technology & human through content and digital tools that enhance capability and
expertise converge to create more equitable reach, ultimately resulting in better, more appropriate care to
more patients across the continent.
access to healthcare & hopefully, a healthier
population overall.” At AxessHealth, we believe in partnerships, and as such, I
would love to discuss how we can work together to make
better healthcare a reality."
Healthbridge contact details:
Contact me personally:
0860 200 222 | [email protected] | +27 84 400 5995
www.healthbridge.co.za [email protected]
africa.axesshealth.org
Continued from page 14... Court dismisses IPAF’s
Dr Strachan said anecdotal evidence shows application on PIMART
that South African doctors are leaving the
country in ‘plane loads’. matter
The Pretoria High Court has dismissed the
Speaking to MedBrief Africa last year, he Independent Practitioners Association
stressed that although doctors acknowledge Foundation’s (IPAF’s) application to set aside
that more healthcare providers are required in the South African Pharmacy Council’s (SAPC’s)
the rural areas, the vehicle to achieve it was application to implement its Pharmacy-
not the CoN. Initiated Management of Antiretroviral
Treatment (PIMART) initiative to enable
“If we are going to have healthcare providers pharmacists to treat and prescribe medicine
going into rural areas, the working conditions to HIV and TB patients.
have to change to make them more
favourable. There should be some level of In its initial reaction to the SAPC’s 2021
infrastructure and support and job security application at the time – on much of which it
and opportunities for families. It is a massive based its own application - IPAF submitted
task, but it does start at the ground level to that the proposed approach in terms of the
ensure that patients get the healthcare they notices, i.e. Board Notice 17 of 2021 –
require,” Dr Strachan then said. Pharmacists who provide Pharmacist-Initiated
Management of Antiretroviral Therapy
According to a former SAMA chairperson, Dr (PIMART) services in South Africa (Board
Mzukisi Gootboom, “we all know what needs to Notice 17); and Board Notice 71 of 2021 –
be done, but we’re not hearing each other. It’s Rules Relating to Good Pharmacy Practice
like a dialogue of the deaf. We implement (Board Notice 71) “shall undoubtedly
things that pit us against each other. It’s a compromise the quality of care that patients
reflection of the kind and quality of legal are entitled to receive. Further, the comments
professional advice they, (the NDOH), are demonstrate the inappropriateness and
getting’. potentially dangerous consequences of
increasing a pharmacist’s scope of practice to
“The very intention of improving access may provide sexual and reproductive health
deny it, as doctors suddenly find themselves services to the public”.
without licenses and unable to practice - we
cannot understand why government would Also of concern was the precedent this could
promulgate a section of the law which they set in other areas of general practice.
know is unconstitutional.”. In handing down her judgement, Judge
Elmarie van der Schyff acknowledged that pharmacists & doctors operate in distinct and separate
professional domains, the boundaries of which are closely guarded “and some tension exists”.
“IPA's objection to PIMART,” she added, “seems to be rooted, partially at least, in this professional
tension. This is evidenced by its fear that the decision to implement PIMART might 'open the
floodgates' and 'pave the way for pharmacists to ultimately treat and prescribe other schedule 4
drugs in respect of acute illnesses'”.
She also reportedly made the point that “the need to widen access to first line ART and TPT
therapy on a community level is not a figment of SAPC's imagination, but a dire need that is also
evidenced in other countries".
SOURCE: News24/Med Brief Africa archives
Healthcare Business Review 21. Powered By:
Digitisation in Practice
AI and the physician: awakening to a new reality
By Chris Bateman
Artificial intelligence is
disrupting the way healthcare
is practiced – if you don’t
adapt and adopt it you may
just find yourself left behind
choking in the dust with far f
ewer patients all wearing
health assistive devices and
plugged in to GPT 4 for instant knowledge and video), and speech, and allows its users to look
advice. Welcomed by nearly anybody who at unstructured text.
believes wellness and prevention are the best
way to build healthy populations (though Too few of us use either iteration. It you take
perhaps less healthy private practice bank the entire internet, Wikipedia, a few hundred
balances), AI and precision medicine are two billion books and feed all that data into AI
vehicles that help us do just that. computation, you’ve got GPT 4.
With a database that makes Discovery Health Unsurprisingly, in healthcare, AI programs now
green with envy, the NHI’s Dr Nicholas Crisp conduct clinical diagnosis with a better
would be one sure-fire AI advocate, but it will accuracy rate than their human “colleagues.”
first take some building across the current
patient care, public/private divide. Perhaps its Associate Professor Deshen Moodley, the first
time to break out of our self-protected curative occupant of UCT’s new SA Research Chairs
treatment silos and engage with the power of Initiative in AI Systems, says that when it
virtual reality…Read on for input from some top comes to some doctors’ resistance to both
experts: precision medicine and AI, ‘the train has
already left the station”.
Artificial Intelligence’s burgeoning success had
added a new term to the medical lexicon – one “Physicians will have to scramble to catch up.
that sums up its’ almost incredible utility in the If they don’t adjust, they’ll be left behind.
Fourth Industrial Revolution - ‘Previvor”: the People have access to a whole lot more
person who AI-assisted technology has pre- knowledge today and patients will be the
diagnosed as being in almost certain danger of future drivers of change. A lawyer friend of
developing a serious or life-threatening mine told me in surprised tones the other day
condition. No doctor on their own can do so that his Apple watch said something was wrong
with anywhere near equal accuracy. with his heart. He went to see his cardiologist
who confirmed it and said he was lucky to have
Most doctors will concede that they know only come in,” he says, to illustrate.
fragments of medicine well – well, GPT4, the
latest iteration of ChatGPT, knows a lot of “I’m no health economist, but those are the
medicine well. It’s an even more powerful figures. The measures should be health and
language model than ChatGPT because it’s well-being and not patient numbers in
multi-modal, works with images (including hospitals or operations performed,” he adds.
Healthcare Business Review 22. Powered By:
Besides open-source patient access to the CAS employs not only the result analyses
healthcare knowledge, the tools are already of radiologists and cardiologists but adds in
here to assist doctors with better predictive AI to scrutinise the results of the scan.
diagnoses and preventative treatments.
AI analyses ensure that plagues previously
Here’s how concealed from the human eyes are seen.
Take AI-powered coronary artery scan SA research links
technology, developed by an
American company called Dr David Jankelow, a cardiologist working out
Prenuvo. Among many of the Linksfield Park Medical Centre in
iterations that will Johannesburg and a past president of the
potentially revolutionise South African Heart Association, is working
healthcare through its on AI with the Mayo Clinic in the United
preventive approach to diseases, the AI- States. He confirms that the Mayo Clinic has
powered scan uses magnetic resonance developed an algorithm that works with an
imaging (MRI) to flag and escalate potential ECG machine to predict future cardiac
health problems – ‘seeing’ potential disease - before it clinically manifests.
complications the radiologist and/or Together they’re seeing amazing results
cardiologist simply cannot. predicting atrial fibrillation, the biggest cause
of stroke, aortic valve disease,
So, before the symptoms of any disease cardiomyopathy, and other heart
emerge, the technology predicts it, enabling dysfunctions.
physicians to figure out prevention methods. It
analyses every part of the body and the organs Jankelow explains: “They took a cohort of
from head to toe to detect any anomalies from some 53 000 patients and fed their data into
cancer to liver stones and kidney diseases - all an algorithm paired with an ECG and
forms of pathologies. There are no invasive ultrasound. Then they took a different data
procedures or radiation, and the results are set of patients and fed their ECG readings in
made available to the patient within 48 hours and asked who has a weak heart pump. The
of the examination. accuracy was 93%. They followed all the
computer false positives and the truly AI ECG
Then there’s the AI-powered coronary artery tested patients for several years. The former
scan technology developed by the Fountain had a four-fold chance of developing a weak
Life Health Technology Company in the United heart and the latter remained well.”
States. It can detect
heart pathologies, He said an entirely new term had been added
especially heart to medicine’s lexicon: ‘previvor.”
attacks, a decade
before the symptoms Jankelow is excited about screening for
surface. That transforms valvular, mitral, and rheumatic heart disease,
healthcare from a reactive to an initiative- all of which are abundant in South Africa,
taking domain. The AI coronary artery scan providing rich data to feed into the Mayo
(CAS) is similar to the coronary computed Clinic AI programme.
tomography angiography (CCTA), in use now
for several decades to diagnose heart
diseases. However, the difference is that
Healthcare Business Review 23. Powered By:
In 2013, an estimated one million deaths How AI evolved
were attributable to cardiovascular disease
(CVD), in Sub-Saharan Africa (SSA), Tracing the recent evolution of AI, Dr Isaac
constituting 5.5% of all CVD-related deaths Kohane, of Harvard University, a pioneer in
globally and 11.3% of all deaths in Africa. the AI field, and a paediatric endocrinologist
Between 1990 and 2013, SSA was the only who leads Harvard’s Bioinformatics
geographical region of the world in which the Department, says things began changing in
number of CVD-related deaths increased. 2012.
Prof Athol Kent, a UCT-based medical “We were already pretty impressed with it,
education innovator and but around 2018, we started seeing, in the
obstetrician/gynaecologist, writing in his medical literature, the consequences of
popular Journal Article Summary Service, these convolutional neural networks — that
(JASS), observes; “AI will move us forwards they could actually detect changes in images
and Luddite responses will merely discredit that were perhaps imperceptible to humans,
us. We, the doctors, will have to figure out which would allow them not only to diagnose
how AI works to our advantage and stay retinopathy in the back of the eye (for
informed as to how this is best achieved. We example), but could tell you their BP, the sex
need more healthcare professionals, we of the patients, their age, and what other
need different types of healthcare diseases they had.
professionals and maybe these will be a mix
of humans with communication skills and AI Jankelow cites several studies predicting
technology, we need better ways reaching that by 2040 there will be 640 million
and responding to our patients, we need diabetics world-wide, with a third of them
more time with those we care for, and we women suffering some form of diabetic eye
need better systems to run our practices and disease. The global shortage of
hospitals. All these possibilities can be ophthalmologists, narrowed down to South
facilitated by AI to the clinical benefit of us Africa, comes in at six ophthalmologists per
all.” one million people.
Jankelow adds: “It’s not prime time yet. “Some form of computer analysis will hugely
There’s a large gap, some call it the digital ease the burden on the healthcare system –
divide. In other words, from research and and that’s just one discipline,” he says.
development of this technology to
implementation in clinical practice. But it’s Elaborating on the evolution of IT, Kohane
hotting up, there’s so much going on behind adds: “So, there were a bunch of these
the scenes. It will streamline workflow in a mostly image-based applications in 2018,
hospital – we’re not doing it yet, but that but also some applications related to time
may well come first. AI will also standardise series and health records, which had
procedures and predict who will suffer an impressive performance. What was different,
adverse event. The dream for me is that it what was characteristic of them, was that
could help democratise healthcare. There they were purpose-built. You train them for a
are areas in SA where there are no doctors, specific purpose: diagnosing retinopathy,
nursing sisters or ECG machines. As far back predicting time to readmission.
as 2016 already we had one cardiologist per
260 000 people. Brazil had one in 23 000, “These were programs that not only were
ten times more than us. That hasn’t changed purpose-built but, because of that, you
much,” he added.
Healthcare Business Review 24. Powered By:
could easily evaluate them and assess their
accuracy for a specific task.”
GPT stands for Generative Pretrained
Transformer, a natural language processing
tool that allows you to have a personalised
conversation with an AI bot. It’s the fastest AI - Equity & Pandemics
uptake of any technology in the history of
humankind, according to Jankelow, with one
hundred million users globally already. Asked whether South Africa could move to
equity with AI, given that it carries the
“It passed the USA medical licensing exams world’s largest Gini-co-efficient, Prof
with no cramming – unlike human students. Moodley replied: “There are two big issues.
We need to remember, it’s not a One is access to AI (beyond just health) –
replacement for specialised knowledge, that drives our AI group at UCT. We need
critical thinking, and ethical consideration in open-source platforms, otherwise the cost
the practice of medicine. goes up. We need to mobilise the use of AI
for open-source applications and reference
But it’s the next step in the Fourth Industrial implementations and platforms to reduce
Revolution where all processing in term of cost. The other is that if you look at our
search tools is going. Every search engine current systems, we’re only using about 10
will have this.” percent of them in terms of innovative AI
possibilities on the preventative side. Google
Quoting Dr Eugene Stead, who paved the Search, Chat GPT and GPT 4 have knowledge
way for cardiac catheterization in the 1940’s that can empower individuals to start
and led the concept of a computerised managing their health. The only difference
textbook for medicine, he said AI was, “the between myself and entrepreneurs is that
art of making machines smart,’ and our public health platforms will be freely
predicted it would shortly render available, whereas they want to make money
radiologists redundant. off it.”
“If you’re a radiologist, you’re already over He said that with Covid, for example, AI had
the edge of the cliff – you just haven’t looked the ability to play out all the response
down yet. There’s no ground underneath. In models in pseudo reality.
five years, deep learning is going to do the
job better than radiologists. They should “It will not just follow an outbreak in real
stop training them now,” Jankelow quoted. time but see it spatially and give you a
completely different real-time decision-
He disagreed, however, with those who said making tool. You can rewind and see what
AI was ‘some kind of magic bullet’: "The happened in the past, scrutinise, and say this
answer is no in the short term, but likely in led to that, whether it be Covid or any
the medium to long term. communicable disease. Now, with that
simulation and modelling you’ve got a much
Imagine a complete overview of patient data clearer idea of which intervention will do
and the reduction in medical errors? Solving what. It’s radical, super-charged for any
medical problems and recommending public health intervention wherein you can
individualised treatment will become the see the possibilities play out.”
norm.”
The Importance of Taking Control Of your
Practice Foot Traffic
In the ever-evolving landscape of healthcare, 4. Streamlining Appointment Booking:
the way we acquire new patients has undergone
a profound transformation. As healthcare In today's fast-paced world, convenience
providers, it is essential for us to recognize the matters greatly to patients. Digital
importance of taking control over how we channels allow us to streamline the
engage and attract new patients, particularly appointment booking process. Online
through the utilization of digital channels. In scheduling systems not only reduce the
this article, we shall explore the pivotal role of administrative burden but also empower
digital strategies in patient acquisition and the patients to book appointments at their
manifold benefits it offers to modern medical convenience, enhancing their overall
practices in an exponentially evolving industry. experience.
1. Expanding Your Reach: 5. Measurable Results:
The digital era has ushered in a world of One of the most compelling advantages of
connectivity where billions of individuals are digital patient acquisition is the ability to
online. By harnessing digital channels, we can track and measure results with precision.
reach a wider and more diverse audience than Through analytics, we can assess the
ever before. Social media platforms, search effectiveness of our strategies, identify
engines, and healthcare directories have areas for improvement, and make data-
become powerful tools for expanding our driven decisions to continually refine our
practice's reach far beyond traditional means. patient acquisition efforts.
2. Building Trust and Credibility: In a survey conducted by doctor.com, it
was found that 80% of patients had used
Establishing trust and credibility is integral to the internet to make a healthcare-related
attracting new patients. A well-crafted online search in the past year, 60% of patients
presence, including a professional website and have chosen one provider over another
a strong presence on reputable review sites, based on a positive online reputation and
can significantly enhance our practice's an astounding 81% of patients will read
reputation. Positive patient testimonials and reviews about a provider even after they
informative content can instil confidence in have been referred.
potential patients, assuring them of the quality
of care they can expect. As technology continues to reshape the
way we access and deliver healthcare
3. Patient Education and Engagement: services, establishing a robust online
presence has become an indispensable
Digital channels enable us to educate and tool for practitioners.
engage with patients in ways that were Content Powered By
previously unimaginable. Through informative
blogs, webinars, and interactive social media
platforms, we can provide valuable health
information, foster patient engagement, and
establish ourselves as authorities in our www.marketmx.co.za
respective fields.