Advanced Medical Technologies in Iraq: Scope, Challenges, and New Horizons
KAPITA’s Research Team
Brief Summary
The MedTech field has been an increasingly important part of healthcare over the past decade. It includes a set of products and services aimed to improve people’s lives through diagnosis, prevention, and treatment. This sector is dynamically evolving with a range of technologies, such as 3D printing, electronic medical records (EMR), and robotics. In Iraq, the healthcare system has been suffering from outdated approaches towards treatment rather than prevention of diseases. The impact of the COVID-19 pandemic has uncovered the necessity of e-health in Iraq to reshape the healthcare system through advanced technologies that would provide efficient medical services. Recently, there have been efforts to introduce new technologies into Iraqi healthcare, yet certain challenges have emerged, threatening the sustainability of these technologies.
MedTech Benefits to the Healthcare System
Easier and more accurate access to patient’s records
The development of Electronic Health Records (EHR) allows patients’ information to be more accessible to healthcare providers, which helps reduce the wasted time spent searching through paper records and permits a smoother workflow between different departments.
Improved access to care
Cost, distance, and physical limitations have affected the universality of healthcare, particularly affecting disadvantaged populations. However, through the evolution of Telehealth, this disparity has been greatly reduced as healthcare providers can treat patients from miles away without the need for a shared physical space.
Reduction in medical errors
Medical errors constitute a major public concern as medical errors are the third leading cause of death. The reduction of those errors is established through a new technology known as The Clinical Decision Support (CDS) system. This system can provide healthcare professionals with relevant information to aid their decisions in diagnosis and treatment, thus reducing medical errors.
Different MedTech Technologies
Medical Education
Medical education in Iraq faces multiple challenges in the form of old curricula, outdated teaching methods, and a need for proper training facilities and centers. The lack of clinical expertise creates a difficult learning environment where students fail to apply the gained theoretical knowledge.
Reformation of the educational system could be implemented in several ways, such as rebuilding the curriculum according to international guidelines. Furthermore, the issue does not lie within curricula alone but also includes outdated teaching methods and teacher-focused learning. Active learning should be encouraged, and teachers need to understand their roles as facilitators who guide students. Technologies can be utilized through the introduction of online teaching, such as massive online course teaching (MOOC) and interactive teaching sessions with peers abroad. On the other hand, advanced technologies, such as simulation and wearable technologies can be used to tackle clinical aspects of learning.
As time passed, the number of Iraqi medical students increased while the facilities witnessed minimal improvement. Additionally, hospitals reached the maximum capacity to accommodate the practical education of students in subsequent years of medical college. The scope of technologies in medical education has expanded significantly in recent years. As for Iraq, the pace is slowly moving forwards yet surely gaining momentum.
Applications in Medical Education
Online Learning Platform
Several universities developed platforms to make it easier for students to access resources, take quizzes, and communicate with educators, making the learning experience more flexible and engaging. These platforms are meant to minimize the dependency on social media regarding the sharing of resources or news.
3D Printing
This technology is underutilized in medical education, although it can solve the shortage of anatomical models. 3D Printing will allow visual representation of complex structures, which will help in knowledge retention.
Medical Apps
Apps can help in providing easily accessible materials for students. These apps can cover a wide range of topics, from basic sciences to clinical subjects. The existing apps are general and are not based on the current curriculum. These apps can extend further to provide telemedicine, allowing students to participate in consultations and virtual clinical experiences.
Electronic Medical Records
Access to patients' data (anonymized and with consent) can prove to be a rich source of experience. Students can use the records to understand the management of patients and clinical courses. Additionally, these records can be used to conduct studies and gain a deeper understanding of public health principles.
Virtual Reality (VR) and Augmented Reality (AR)
The use of these technologies can accommodate the increasing number of students by allowing them to practice clinical skills and procedures in suitable environments. The immersive experience will also help visualize structures or simulate doctor-patient interactions.
Benefits of Technology in Medical Education
It provides easily accessible resources on dedicated platforms, allowing students to access educational materials anytime, anywhere. Lecture notes, textbooks, multimedia content, and practice questions can be conveniently accessed through online platforms, ensuring a seamless and efficient learning process.
By leveraging multimedia elements, students can engage dynamically with the content, improving their understanding of intricate concepts and complex anatomical structures. Visualizations such as 3D models, animations, and videos provide a more immersive and interactive learning environment, fostering deeper comprehension and knowledge retention.
Moreover, it enables a flexible learning environment that accommodates diverse learning styles and preferences. Students can progress at their own pace, revisit challenging topics, and access personalized resources tailored to their specific needs.
Integrating technology in medical education also brings cost-effectiveness and sustainability. By reducing reliance on physical resources like textbooks and infrastructure, digital alternatives can be employed, leading to significant cost savings. Additionally, the ability to continuously update and enhance educational content without the limitations of physical resources ensures the sustainability of cutting-edge medical education.
It acts as a catalyst for innovation and inspiration among students. It exposes them to the latest advancements, research breakthroughs, and real-world case studies, stimulating critical thinking and fostering creativity. Collaborative learning opportunities enabled by technology connect students with peers, experts, and researchers globally, nurturing a broader understanding of the medical field and inspiring novel ideas and approaches.
Challenges Ahead
Limited resources and infrastructure are some of the challenges hindering the employment of these technologies. Medical education technologies require investments to develop and have constant improvements; the infrastructure (mainly the internet) may pose a significant challenge to fully utilize the potential of these technologies.
Medical education follows the traditional education method, and integrating technologies will require investments in developing the skills of faculty members and staff.
Greater access to technology requires greater attention to the privacy of both users' and patients’ data.
It is safe to say that content quality is trusted as the current educational system is rigorous. However, developing a unified content that is approved by all universities is challenging and will require considerable collaboration and effort.
As with every technology change, some will resist the change. Nevertheless, increasing awareness and training on these technologies will make them acceptable to the majority of users.
Electronic Managing Systems and Medical Records (EMR)
As healthcare is becoming more complex, paper-based patient charts have become an outdated method to maintain patients’ records, especially when there is a massive load on hospitals totaling 20,000 patients per month. Because paper charts are limited to a single location at any given time, they cannot be shared between multiple physicians at the same time, which has negatively impacted the quality and productivity of the healthcare provision. The development of electronic medical records will allow for information to be shared between different departments and institutes, allowing for more integrated and harmonious interaction while still ensuring the patient’s privacy, reducing medical errors, and minimizing time spent on writing and interpreting patients' notes.
The number of pharmacies in Iraq has grown significantly in the last few years, reaching 22,120 registered pharmacies. Therefore, a digitalized pharmacy management system can unify their work while also notifying physicians about possible side effects and toxicities of drugs prescribed. In addition, it allows for better and more efficient time management as it reduces time-consuming manual tasks, such as verification and making inquiries about physician orders. In laboratories, this system will manage requests and sort test results in electronic health records. Furthermore, the finance and billing system can issue bills and finalize costs rendered to patients.
Benefits of Electronic Systems
The integration of advanced medical record systems ensures high accuracy in data management as information can be easily stored and retrieved, promoting precision and minimizing errors during multiple patient visits. The use of voice recognition technology allows for faster data entry, enhancing efficiency and streamlining the documentation process.
Additionally, the adoption of cloud storage enables the easy accessibility of patient data regardless of time or location. This accessibility ensures that healthcare providers have the necessary information at their fingertips, enabling prompt and informed decision-making. Moreover, the richness of data is enhanced as systems can store various formats such as videos, images, and previous reports, facilitating comprehensive and detailed patient records.
These advanced systems contribute to a reduction in medical errors by employing intelligent models that can alert healthcare providers about potential drug interactions or identify trends in patient data, promoting patient safety and improved outcomes. Furthermore, the high level of security ensures that access to sensitive patient information is limited to authorized individuals involved in direct medical care, safeguarding patient privacy and confidentiality.
The integration of medical record systems enhances the overall performance of healthcare institutions. Seamless integration between different departments, such as the receptionist, doctors, laboratory, pharmacy, and finance officers, enables better coordination and communication, leading to improved workflow, patient care, and operational efficiency.
Challenges to the Technology
Convincing providers or stakeholders to transition from paper-based systems to electronic systems can be a challenge. Resistance to change, concerns about data security, and the need for training and adaptation may hinder the acceptance and implementation of these software solutions.
Cost is another factor that can pose a barrier to adopting electronic medical record systems. The initial investment required for purchasing and implementing the software, as well as the associated hardware and infrastructure upgrades, can be substantial. This financial burden may be a deterrent for some providers, especially those with limited resources.
Busy clinics with limited human resources may find it difficult to allocate time and manpower for data entry and system implementation. The additional workload required to input and manage patient data electronically can strain already stretched resources, potentially leading to resistance or delays in adopting these systems.
The technological literacy of users is also a significant factor influencing the adoption of electronic medical record systems. Some healthcare professionals may view the technology as too complex or unfamiliar, leading to skepticism or reluctance to use the software effectively. Training and support programs are crucial to help users overcome these barriers and develop the necessary skills and confidence to utilize the technology.
Furthermore, limited investment in this technology has resulted in its limited expansion, primarily being concentrated in urban areas or the center of cities. This disparity in access and availability creates inequities in healthcare delivery, particularly for providers in rural or underserved areas who may have limited access to electronic medical record systems.
3D Planning and Printing
3D printing is a layer-by-layer addition approach to turning three-dimensional designs into customized medical equipment and products. A 3D model is developed through computer-aided design with the help of a 3D scanner, a digital camera, or 3D modeling software. This new technology can play a major role in the production of dental implants, prosthetics, hearing aids, and tissue engineering. The rising number of dental and orthopedic malformations is expected to boost the growth of the 3D printing market in the healthcare field. However, this growth is impeded by the high cost of 3D printers and the lack of understanding of 3D printing capabilities.
The emergence of 3D printing technology in healthcare represents a significant advancement in the medical industry. In the early 2010s, international humanitarian organizations, such as Doctors Without Borders, began using this technology to treat children with congenital anomalies and skeletal deformities. However, due to the high cost involved in outsourcing, the use of this technology was limited in terms of scope and numbers.
With the increasing accessibility of 3D printing, the medical community expanded its use into other fields, including dentistry, where it was used to visualize, plan, reconstruct, and print dental models for patients with tumors. While these early printed models were not compatible with tissues, they were instrumental in planning surgical procedures and creating tissue replacements.
Applications of 3D Printing Technology
Today, 3D printing technology is widely used in healthcare to create patient-specific models, implants, and surgical guides. This technology has revolutionized the medical industry, enabling clinicians to provide more precise and personalized care to their patients while reducing costs and improving outcomes.
The use of 3D printing technology in healthcare has brought about numerous benefits, both for patients and medical practitioners, which include the following: reduction of financial burden on patients, decrease in operation time and costs, reduction of complications and use of human resources, and increase accuracy in operations that would result in more predictable outcomes.
Benefits of 3D Technology
One of the key advantages of this technology is the ability to simulate the operation, enabling medical professionals to plan and visualize the procedure beforehand. This not only increases the accuracy of the operation but also enhances patient satisfaction, as they are able to see the planned outcome before undergoing the procedure.
Furthermore, the use of 3D printing technology in healthcare eliminates the need to outsource the printing process, reducing costs and improving efficiency. Medical practitioners can now print patient-specific models, implants, and surgical guides in-house, allowing for a more streamlined and cost-effective approach to patient care.
Challenges to 3D Printing
Poor Infrastructure
At the institutional level, the lack of facilities with infrastructure to support the technology is a significant challenge. Healthcare institutions require proper equipment, software, and technical support to effectively integrate 3D printing technology into their operations. Additionally, the lack of human resources with formal training on the use of the technology, its application in other medical fields, and technical support to troubleshoot issues, pose a significant challenge.
Scarcity of Investment Opportunities
The limited investments by the government, coupled with little interest from the private sector, also presents a challenge to the widespread adoption of 3D printing technology in healthcare. This lack of financial support may hinder the research and development of new technologies and equipment necessary to support the integration of 3D printing technology into healthcare.
Social Unawareness
3D technology is still a foreign concept to healthcare providers and patients altogether. This is mainly due to the lack of awareness, education, and understanding of the role of such technology. Educating these stakeholders about 3D printing technology in healthcare and highlighting its benefits in terms of high accuracy, low operation time, and cost-effectiveness is essential.
Absence of Government Support
The lack of support from technology developers, due to the absence of formal contracts through the government, hinders the integration of 3D printing technology in healthcare. This makes it challenging for healthcare providers to access the latest technology and equipment needed to support the integration of 3D printing technology in healthcare.
Fertility and Assisted Reproductive Technologies (ART)
The fertility rates in Iraq have been in a continuous decline in the past few decades. Those rates have fallen from 6.6 in 1980 to 3.4 in 2022. Social and economic changes taking place in Iraq have inevitably influenced fertility behaviors. As a result, advancements in infertility treatments and technologies are showing rapid growth in the area. There are multiple active centers in Iraq offering different modes of treatment, including artificial insemination, in vitro fertilization (IVF), blastocyst transfer, and intracytoplasmic sperm injection.
The limited availability of resources, including financial constraints and a shortage of trained personnel, have challenged the development of ART in Iraq. Many couples seeking ART services face a high cost of treatment, which has been a significant barrier limiting their access to these reproductive options.
The growing demand for ART services has presented a great opportunity despite the challenges. Therefore, there has been a noticeable increase in the number of ART centers in Iraq. The success rates of ART treatments in the country, on the other hand, have been fluctuating, reflecting the limitations of technology and the lack of resources. The demand for ART treatment does not match the supply of services in the Iraqi market, which still challenges many couples who wish to get this treatment.
Applications in ART
In Vitro Fertilization (IVF)
A procedure that involves extracting the egg from the ovaries, which are then fertilized with sperms in a laboratory setting. The embryos are then transferred back into the uterus for implantation.
Intracytoplasmic Sperm Injection (ICSI)
ICSI is a specialized form of IVF that involves injecting a single sperm directly into an egg, which can be used to overcome male infertility or other conditions that may affect sperm quality or motility.
Intrauterine Insemination (IUI)
IUI involves the placement of specially prepared sperm directly into a woman's uterus during ovulation, which can increase the chances of fertilization.
Frozen Embryo Transfer (FET)
FET involves the transfer of previously frozen embryos that were generated through IVF in a previous cycle. This allows for the storage and preservation of embryos for future use.
Pre-implantation Genetic Diagnosis (PGD)
It is the technique of screening embryos for genetic or chromosomal abnormalities before they are implanted into the uterus.
Cryopreservation
It is the process of freezing and storing biological materials, such as ova (eggs), semen (sperm), and embryos, at very low temperatures in order to preserve their viability for future use, providing flexibility and options for individuals and couples seeking fertility treatment.
Benefits of ART
By leveraging these technologies, couples facing genetic or chromosomal abnormalities can undergo pre-implantation genetic diagnosis (PGD) to screen embryos and select those that are free of inherited diseases or disorders. This enables couples to make informed decisions about the embryos to be transferred, minimizing the risk of passing on genetic conditions to their offspring. As a result, these technologies offer a compelling solution for families with a history of genetic diseases, providing them with the opportunity to have healthy children and mitigate the impact of genetic disorders.
Furthermore, these technologies also play a critical role in fertility preservation, allowing individuals to preserve their reproductive potential for future use. Cryopreservation of eggs, sperm, and embryos provides means for individuals to safeguard their fertility, particularly in cases where medical treatments, such as chemotherapy or radiation, may threaten fertility. This has significant implications for cancer patients, individuals with certain medical conditions, and those who wish to delay parenthood for personal or professional reasons.
From a business perspective, the increasing utilization of these technologies for purposes beyond infertility treatment presents new opportunities and challenges for fertility clinics, reproductive medicine specialists, and other stakeholders in the field. This includes the need for specialized expertise in pre-implantation genetic diagnosis (PGD), cryopreservation techniques, and other advanced reproductive technologies. Additionally, the demand for these services may drive innovation and investment in the development of new technologies, services, and business models to cater to the evolving needs of patients and clients.
Challenges Facing ART Adoption
The field of ART requires advanced equipment and specialized personnel, yet access to such resources is limited in Iraq. The rapid evolution of ART technologies necessitates continuous investment in state-of-the-art equipment, which may not be readily available in all regions of the country. Furthermore, there may be a shortage of trained personnel with expertise in these technologies, further hindering their widespread adoption. This limitation in resources can disproportionately affect couples in need, particularly those residing outside major cities where ART centers are concentrated. This restricts their access to these technologies.
The cost of ART treatments can be prohibitive, posing a significant financial challenge for many couples. Limited resources and infrastructure in Iraq can drive up the cost of ART procedures, making them financially unattainable for couples with limited financial means. The high cost of ART treatments can further exacerbate the accessibility issue, limiting the options for couples seeking fertility treatments.
The use of ART technologies has been met with cultural and religious reactions that have posed challenges to their acceptance and adoption in Iraq. Even though the use of ART initially faced fierce resistance, education and the spread of awareness have gradually facilitated the acceptance of such technology. Nevertheless, cultural and religious considerations continue to influence the utilization of ART, and entrepreneurs in the healthcare industry may need to navigate these cultural and religious sensitivities in developing and implementing ART solutions.