By Courtesy Intel/Khalid Farid Doctors in the Ministry of Health and Population’s mobile medical units will benefit from increased contact with their peers in the cities. News Focus Achilles Heel The crisis in Greece, and the collapse of the euro, could scuttle Egypt’s plans for economic growth. River of Strife A new agreement among East African countries may spell the end of Egyptian control over the Nile . On the Block Foreign investors buy up African farmland, sparking fears of a new colonialism. By Omar Mohsen Intel CEO Craig Barrett asks, “You manage your bank account, don’t you? Why don’t you manage your health?” By Andrew Bossone IBM’s mock doctor’s office demonstrates technologies that allow users more control over their own healthcare.

By Andrew Bossone

Some say ignorance is bliss, but don’t tell that to technology titans Intel and IBM. The two computer hardware firms are investing heavily in the concept of patient-centric healthcare, where individuals have better access to medical services and information in their medical records. It’s not just about patient empowerment, though: IBM and Intel believe this is part of the solution to the global problem of surging healthcare costs.

Closer to home, this could well be Egypt’s answer to limited healthcare access. Millions of citizens live in remote and rural areas, where a trip to a big-city hospital means time and money that many just don’t have. The Ministry of Health and Population’s mobile medical caravans rolled out last year to cover the gaps, but these are geared toward general health concerns — the local doc making house calls, if you will. For specialized medical care and consultation, telemedicine may just be what the doctor ordered.

At the end of a five-country tour that took him from the rainforests of the Amazon to a “small” Chinese village of 4 million people, Intel CEO Craig Barrett sat down with Business Today Egypt for an exclusive interview to talk about “digital transformation” and how its application, be it in Downtown Cairo or a village outside Abu Simbel, will revolutionize not just healthcare, but how we communicate as a society.

A 35-minute drive from Downtown Cairo, the town of Ossim is a pilot project for Intel’s digital-transformation initiative. About 200,000 residents live in the rural settlement, where it is not uncommon to see women and children pulling propane tanks off flatbed trucks and kicking them down the dirt roads to their homes.

Because of its remote location, bureaucratic barriers and poor economy, Ossim is able to provide few services to its residents. But now, using the country’s first commercially viable long-range wireless broadband network — better known as WiMAX — Intel has set up infrastructure connecting a mobile medical clinic, a municipal building, a school and an e-government service kiosk. Barrett’s visit to Egypt coincided with the unveiling of the project, which is armed with WiMAX gear that has a 30-kilometer transmitting range. (For more about WiMAX, see sidebar “Cut the Cord!” on page 75.)

It seems like an ambitious project for a small town like Ossim, which still lacks basic infrastructure such as roads and clean water. Critics may well ask why Intel isn’t investing in those essential needs, rather than advanced technological solutions.

“If you spend all your money on clean water or roads for those kids and didn’t give them an education or healthcare, you are basically sentencing them to live a life just as they are today, without any opportunity for the future,” Barrett says.

“I hate to use this phrase, but it’s a very colonialist approach to give them clean water to let them live longer so they can work in the fields longer. That’s certainly not in the best interest of the child.”

It is the e-gov kiosk that really highlights the project’s benefits. Here, the length of time it takes to get any of 400 basic government services has been significantly reduced. One employee at the kiosk, Mahmoud Nedda, estimates he will be able to serve about 300 citizens a day with the new system, compared to 100 with the old.

In the ‘old days,’ a person would fill out paper applications and give them to the kiosk employee. The papers would then sit until the attendant made the trip to deliver them to the central office — a day’s travel. From there, the applications would be shipped to the appropriate approving authorities in Cairo; after about a week, the approved forms would be returned to the central office. The courier would then spend another day traveling to pick up the papers, then wait for the citizen to return to pick up the papers from the kiosk.

The new system cuts out the travel time. Instead of tracking requests with ledgers and reams of paper, the e-gov employee uses a computer connected to a WiMAX transmitter able to send the application to the central office, which has a larger transceiver to connect to Cairo.

Intel, a global leader in microprocessor design and manufacture, provided all the equipment for the pilot project, and Intel’s world-class Platform Development Center in Cairo helped develop the computer systems used in the kiosk and school.

The community PCs used in the kiosks can connect to car batteries for power and have dust filters that are easily removed for cleaning.

Intel has an agreement with the government that after the test period is concluded, Intel will hand everything over to the state for a tender process for a local contractor to continue the pilot project. If the pilot is deemed successful, it could be a blueprint for future public WiMAX stations.

While the digital Ossim may be the WiMAX model for similar villages, the Intel-sponsored mobile-medical unit (MMU) will be rolled out nationwide. According to Tamer El-Shayeb, Intel’s strategist for software enabling in the Middle East, Turkey and Africa, the portable clinics have already proven themselves and the government has issued a tender for about 20 medical convoys.

The MMU is staffed by 12 people, including technicians, engineers and four doctors, two of whom are local general practitioners. The mobile clinic can stay in one town to reach populations that otherwise would have no access to a hospital, or it can deploy to emergency scenes as needed.

El-Shayeb says the units started off using different technologies, but are now WiMAX-capable through Intel’s investment. The older equipment used a satellite connection, which is cumbersome and requires a large dish at a central location in addition to a larger staff of engineers. Accessing the satellites is also expensive, as they charge by the minute for the uplink.

Now, using the same medical equipment, the technology is much lighter and smaller: Everything connects using a laptop and digital interfaces for the medical devices. The unit is configured with a low-cost terminal that provides video-audio conferencing, plus a software stack that can also connect to medical records in a central database (more on this later).

For patients with complicated medical conditions, the audio-video conferencing will make a huge difference.

“In the remote areas, if the patient has a chronic disease, what will he do?” says Dr. Ossama El-Gameel, a general practitioner at Qasr El-Aini Hospital and medical consultant for local software company Shadi Systems, which partnered with Intel on the design of the telemedicine program. “He will go to the remote consultant, and they give him advice on his condition, but they’re just junior doctors. There are no specialists; most of them are junior and their experience is low.”

Using telemedicine, local doctors — who often lack the tools and expertise of their big-city counterparts — can connect with experienced practitioners and specialists in Cairo, or even around the world, to consult on diagnosis and treatment. El-Gameel says this will provide them with support that gives them on-the-job training while preventing common mistakes in village healthcare.

“You don’t have to be in the hospital to get that proactive care,” says Mike Svinte, IBM Healthcare and Life Sciences vice president for global innovation and information-based medicine. “From the patient view, you don’t have to, in a remote location, travel a long distance to get the care. Those kinds of examples — those are game changers. It will really change the area where care is delivered.”

Consultation by telemedicine only works when all the physicians are on the same chart. Healthcare practitioners need to have access to the patient’s complete medical records, which can be a problem when the clinic doctor’s notes are scribbled on a paper in Ossim and the cardiologist is in Sixth of October City.

And what about the patient himself? Over the past couple of decades in the West, patients are encouraged more and more to be actively involved in their treatment, but here most people still have little input on the care they receive, let alone access to their own records.

All that will change as medical records move to digital form, which will link everyone involved in the healthcare process. But is everyone capable of managing his or her own health?

“You manage your bank account, don’t you? Why don’t you manage your health?” asks Barrett. “Your bank account is a day-to-day activity because you spend money on a daily basis. And the unfortunate thing about healthcare is people tend to get interested in managing their healthcare when they’re sick.”

Most healthcare systems have traditionally centered on the provider, such as a hospital or doctor, or the payer, such as insurance companies or state welfare systems. But a relatively new trend puts the patient at the center. The new hospital runs more like a business, at least in terms of operating efficiently and making better use of resources. This could improve planning and treatment of diseases, and will involve the patient not just in the hospital or clinic, but at home as well.

In the United States, digital medical records have been implemented at some hospitals and medical networks for at least ten years, allowing healthcare providers throughout a building or at affiliated external clinics to quickly access patient data and coordinate his or her care.

Intel, along with four other major US corporations, is taking the concept one very large step further. The group is funding a non-profit institution to develop Dossia, a web-based framework through which employees of the participating companies can manage their own health records and those of their dependents.

The patient receives more information about health choices and becomes essentially a consumer of healthcare, making the decisions about his or her care just as he or she would make about a purchase. Control over personal health records is another added advantage.

With Dossia, expected to launch in mid-2007, the employee can decide which parts of his health record are made public. The records link up to a standard system accessible to important players like doctors and pharmacists.

There are some substantial advantages to digital records. For one, there’s no more illegible handwriting to deal with (at least in theory), ensuring more complete and accurate information. This should cut down on the number of life-threatening problems resulting from misreading a doctor’s note or prescription. The software that controls the medical records even has the ability to recognize two medicines that conflict with each other, helping doctors and pharmacists prevent adverse reactions.

“In a day of electronic stuff, that you still use handwriting is amazing,” Barrett says. “Either the pharmacist can’t read the prescription — you get the wrong medication, the wrong dose — or there is a negative reaction of this medication with another medication another doctor has prescribed.”

Another benefit is seen with emergency medicine. Many people have allergies to latex, penicillin and iodine; all substances are frequently used in emergency medical care. According to Barrett, a digital record system linking a government record with a medical record could alert first responders to a victim’s allergies so they can avoid administering care that could kill the patient.

“The policeman or the ambulance comes up behind the auto wreck and they see the license plate or they see your driver’s license,” Barrett says. “They know everything about you but your medical history: They know if you’ve been arrested, they know what your insurance is, they know where you live, they know your family, they probably know where you work, they probably know where you bank, but none of them know anything about you. They don’t know blood type, they don’t know allergies — they don’t know anything.”

Touted as a personal, private and portable medical revolution, digital records are not without controversy. From a purely technical standpoint, critics worry that these records could be destroyed by viruses or abused by hackers, not to mention their susceptibility to theft or unauthorized access. Indeed, hospitals that use electronic records often still have a medical records department to maintain an updated hardcopy of patient data.

To allay technical concerns, IBM is working on a model that keeps medical records on multiple servers, so if one goes down, the record can be accessed from another server.

Others worry that technology will make health providers lazy and overly dependent on machines that could make mistakes.

The biggest issue, however, is privacy. For whatever reason, some people don’t want to share their medical history, whether it is with healthcare workers, government officials or even family members. And although Dossia users will have control over who sees what in their records, it is not clear exactly how much control there will be. For example, there could be instances that override privacy concerns like the need to disclose to family members if you have a genetic disorder or to a spouse if you have a sexually transmitted disease.

Many health organizations are reserving judgment on Dossia; at press time, the American Hospital Association has not yet endorsed the system.

For all the digital system’s problems, paper records are far from perfect. Someone could walk into a hospital and steal records just as easily as hacking into them on a computer. A paper record can be lost, damaged or destroyed; if there is only one copy, it’s gone forever. In the current Egyptian system, patients are issued a serial number for their cases, which some have criticized as being difficult to track.

These issues have been debated for years in the West, and no doubt they’ll be debated here as the technology arrives. For now, nothing can happen until the records move from paper to digital.

There are a few different models to choose from to organize and store the information; the one that IBM has discussed is a regional repository that shares the data among several health institutions and government offices. Unfortunately, given the data entry involved, this will take several years.

“We need the data computerized,” says Svinte. “Getting it in a digital form is really key to get the information seamlessly moving around. It’s a key enabler.”

Another critical step for a standardized record system is getting everyone in the country proper identification. The Egyptian government’s ongoing effort to upgrade the national ID system should address that problem by year’s end.

“The question for Egypt: Is the willingness there to tackle these more difficult challenges we face?” Svinte says. “Healthcare not as a burden, but as an economic enabler. We know there is this call for leadership around the world for healthcare and we are willing to work with different governments and institutions. It’s not just about technology; it’s the underlying process and business model. That’s the work we are doing.”

Compared to the innovations now being developed, the healthcare technology in Ossim is just baby stuff. IBM, which funded a trip for bt to visit its state-of the-art facility near Nice, France, has created a model of a doctor’s office to show off its gadgets.

Chronic diseases are often the most expensive to treat, partly because of the need for continuous observation: It is estimated that more than 70% of healthcare costs are related to chronic conditions. With the cost of keeping a person in a hospital bed at around $800 per day in the West, the use of technology can be a real money-saver. Someone with a chronic heart problem needs to be constantly monitored, but if that person stays in a hospital or visits a doctor every day, the costs become unsustainable for both provider and patient.

In the IBM facility, the model doctor’s office has simple medical equipment like a blood-pressure gauge and a weight scale. After being trained on their use, the patient takes the devices home.

After he has taken a reading, the device connects via Bluetooth to a mobile phone and sends an SMS to the healthcare provider. A doctor receives the data on his computer and assigns a nurse to visit the patient if necessary. Then the information goes onto the medical record, which the patient can access on television hooked up to a satellite.

“We have the opportunity to make more change in medicine in the next 10 years than we have in the last 100,” Svinte says. “That gives a lot of motivation, and we are committed to working with our partners on this.”

IBM and Intel have signed onto a partnership called Continua, which works to lower healthcare costs by standardizing interfaces for healthcare equipment.

“The medical-care industry today is very much like the computer industry 30 years ago,” Barrett says. “Proprietary silos for all the manufacturers: My device doesn’t play with your device you want to use my device, you need a special cable. A $29 cable costs $4,000 because it’s proprietary — that sort of stuff.”

Some of this technology may be years away from places like Ossim, but that doesn’t stop companies from investing in underdeveloped regions. From the perspective of Intel and IBM, they are putting their investment in the areas where it will have the most impact.

“What we do is a combination of corporate social responsibility, on the one hand — philanthropic activities — and then also some business development on the other hand. There’s no question about it,” Barrett says.

Although the internet has highest levels of penetration in more developed areas, the largest untapped market of internet users will likely be rural areas, and these companies want to factor into the equation for the long term. That’s why the Intel World Ahead Program will invest more than $1 billion globally in five years to increase access to computers, the internet and technology for people in developing communities.

“What you’re really trying to do here is effectively show that the technology, the tool, has use for more and more people, and you’re trying to create the next billion users of the internet,” Barrett says. “If you create the next billion or the next two billion users of the internet, that obviously has business implications for us.”  bt