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In March 2023, Proximie founder Nadine Hachach-Haram delivered the prestigious Gerald Marks Lecture to the Society of American Gastrointestinal and Endoscopic Surgeons (SAGES) 2023 annual meeting, speaking passionately about the need for digital solutions to the problems that are threatening to overwhelm global healthcare.
Dr Gerald Marks was an accomplished colorectal surgeon whose visionary intellect and innovative drive to empower physicians led to him founding SAGES. Dr Marks was a passionate advocate for embracing innovation and pushing the boundaries of what is possible for a greater healthcare ecosystem, without ever losing sight of the ultimate aim of saving and improving patients’ lives.
It was in this spirit that Nadine Hachach-Haram delivered the Gerald Marks Lecture, the key points of which are summarised below. Taken together they outline a very encouraging and exciting case for the positive impact of technology on surgical outcomes and healthcare inequality in the future.
1. Lack of access to safe surgery is a global issue, with 5 billion people lacking access to safe surgery, and 18 million dying every year as a result. The global surgical workforce needs to double by 2030 to meet the growing demand and reduce disparities in care.
“We know inequities in healthcare exist all over the world,” said Nadine. “Today people die unnecessarily without access to simple surgery; in both the Global North and the Global South. Variation in care is a problem everywhere, not just somewhere.”
2. Variation in healthcare and surgical care exists not only in low-income and middle-income countries but also between urban and rural areas of high-income countries. Technology can help reduce disparities in care and improve patient safety by providing continuous learning opportunities and access to second opinions.
“I have witnessed first-hand how variation in care can cost lives around the world,” said Nadine. “The truth remains that the provision of surgical healthcare is sub-optimal for patients in most low-income and middle-income countries (LMICs), and also in many high-income countries (HICs). Today, 84% of the world’s population live in LMICs and most of those individuals lack access to safe, affordable, and timely surgical care.”
3. The chronic under-investment in education and training of health workers in some countries - along with the mismatch between education and employment strategies in relation to health systems and population needs - are contributing to a global shortage of healthcare workers: a shortfall of nearly 143 million surgeries per year.
“The COVID-19 pandemic has further highlighted the deficit in the global surgical workforce and the importance of utilising technology to address the challenges in healthcare delivery, enhance training, and improve patient safety.”
4. The need for travel in surgical training and global health initiatives is unsustainable from both a cost and environmental perspective. Efforts must be made to find alternative, more efficient methods of support and delivery.
“Globally, healthcare is believed to contribute to around 4% of total net emissions from fossil fuel combustion, equivalent to 514 coal-fired power plants,” said Nadine. “Meanwhile, attendance with local surgical teams is all too fleeting due to the logistics of travel. Local healthcare teams are left isolated once the experts leave, often lacking the confidence or the means to do very specific procedures for the first time without a mentor present.”
5. Technology, particularly video recording and telecommunication platforms like Proximie, can play a crucial role in improving surgical training, mentorship, and collaboration. By leveraging technology, surgeons can share knowledge, access expertise remotely, and improve patient outcomes.
“By recording every single surgery,” said Nadine, “we can develop a system to measure the skills of the operating surgeon and the theatre team in the process of that surgery. Doing so can highlight the tremendous variability in individual performance, highlight variation in care, and the different factors that can contribute to any given surgery and its outcome. To support the ongoing training and education of trainee surgeons, Proximie can now analyse all of the human factors at play in an operating theatre, and in time adapt the modifiable factors to ultimately deliver better education that will result in better care.”
6. The use of technology in healthcare, including AI automation, is becoming increasingly important. Digitising clinical practice and leveraging technology can improve workforce productivity, safety, and patient care. It is crucial to embrace technological advancements and explore innovative solutions to address the challenges facing the healthcare industry.
“Linking data sets from the operating room to pre- and post-op data sets from Electronic Health Records presents a unique opportunity to understand the end-to-end patient journey/surgical episode,” said Nadine. “When all equipment is connected and working together under the guidance of AI - shared in a real-time feedback loop to highlight risks and advise on the next steps -outcomes and efficiency levels are sure to improve.”
7. Healthcare is and will always remain a very human occupation. The skills, experiences and empathy of healthcare workers can not be replaced by technology, but they can be used to augment and empower us to deliver better care.
“As surgeons,” says Nadine, “we know that a patient has one chance for a perfect outcome — and it is our job to maximise the likelihood of that perfect outcome. Together, we can use technology to change the face of healthcare and surgical experience for the better, creating a ‘healthier’ world in the process.”
Watch the lecture in full here.
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