Lameck Mbangula Amugongo
The Covid-19 pandemic has stressed healthcare systems, medical facilities and increasingly overworked clinicians. Additionally, the focus on Covid-19 has severely impacted the treatment of non-communicable diseases, according to a WHO survey. Lessons from the Covid-19 pandemic necessitate the need to make speedy decisions on providing the best possible treatment. In critical health conditions, timely decision-making can be a matter of life or death. Personalised healthcare or precision medicine as it is also known presents opportunities to provide quality and affordable care by tailoring individual treatment based on patients’ characteristics, predicted response or risk of illness.
Traditionally, healthcare has been focussed on syndromic treatment, using a one-size-fits-all approach. For example, patients with the same cancer will receive the same treatment and those with diabetes will get the same drugs. However, we know that different patients respond to treatment differently. Today, healthcare is shifting towards personalised healthcare, which accounts for an individual’s genes, lifestyle and environment to determine the best possible treatment for each person. Because treatment is targeted for an individual patient, fewer side effects are experienced if any. The overall aim is to improve patient outcomes.
We are at a critical time in the history of healthcare, made possible by the unprecedented convergence of technology, medical knowledge and data science techniques such as artificial intelligence (AI). This amalgamation is posited to revolutionise patient care and ensure the right treatment is given to the right patient at the right time. This digital transformation in healthcare is providing novel techniques to collect high-quality individual data and connect individual data with data from thousands of patients to create a large repository of data. Once this large data is analysed using AI-based algorithms, it will enable clinicians to understand each individual, differentiate between individuals based on their unique characteristics and these differences can be translated clinically into personalised care for every patient.
According to the report on mortality and causes of deaths in Namibia, non-communicable (chronic) diseases accounted for 38.7% of deaths in Namibia in 2017. Chronic (persistent or long-lasting illness) diseases are generally caused by a combination of lifestyle, genetic and environmental factors. The two most common types of chronic diseases according to the report is cardiovascular (heart) diseases and malignant neoplasms (cancer). Due to changes in diet and lifestyle, chronic illnesses will become more prevalent, overtake communicable diseases and become the leading cause of death in Namibia in the near future. Yet, chronic illnesses can be treated when diagnosed early. AI models can be used to improve screening and speed up diagnosis.
For example, scientists at Johns Hopkins University have developed a computation model of the heart to better understand ventricular arrhythmias (abnormal heart rhythms). Such patient-specific algorithms can be used to predict the risk of sudden heart attack death and outcomes of cardiac procedures. In another example, when a patient walks into Katutura hospital with a stroke sometimes it’s not clear on the scan. An AI model can be trained to analyse CT scans, which can speed up diagnosis and reduce damage to the brain. The same with thing with cancer, a model can be developed to read mammograms to improve breast cancer screening. Also, using big data, hospitals with limited resources, for example, Engela/Nkurenkuru, can proactively predict admission rates, which will enable hospitals to allocate the resources needed to deal with the patients.
The advent of wearable technologies such as smartwatches, present endless opportunities in healthcare because they enable users to monitor their health, sleep quality and chronic conditions 24/7. I believe wearables technologies can transform healthcare from medicine to preventative care by providing just-in-time coaching and encouraging users to make healthy lifestyle decisions through reward-driven tasks such as exercising.
In December 2021, the Ministry of Health and Social Services (MoHSS) launched the national eHealth strategy 2021-2025, committing to a “paradigm shift to enhance health outcomes by improving medical diagnosis, data-based treatment decisions, digital therapeutics, clinical trials, self-management of care and person-centred care as well as creating more evidence-based knowledge, skills and competence for professionals to support healthcare through digital transformation”. This is a step in the right direction. However, good policies alone are not enough, we need action and flexible open-minded leadership.
What must be done? The first actionable step that the MoHSS should take is to harmonise the different health IT systems and ensure there is interoperability between systems (connection and communication between systems). Second, create a comprehensive health electronic record system to automate and streamline clinical workflows. Lastly, the MoHSS should establish clear guidelines for data collection, data governance policies and create data repositories, for example, image biobank for research purposes. Research is crucial to understand how the MoHSS has treated past patients to improve treatment for future patients. The MoHSS can leverage on experts in computing/cybersecurity at NUST to realise the eHealth strategy.
In conclusion, personalised healthcare is not challenging as it sounds. A shift towards personalised healthcare in Namibia is possible and will improve the quality of patient care by optimising clinical workflows, reducing human errors, save lives and money through mobile innovations such as telemedicine.
* Lameck Mbangula Amugongo is a lecturer of Computer Science at the Namibia University of Science & Technology. He holds a PhD in Cancer Science from the University of Manchester. The views expressed are his own