The healthcare industry is mired with numerous challenges—budgetary constraints, ageing population and rise in lifestyle related ill-health. The current and impending challenges are making it imperative for the sector to deploy new technologies for meeting the rising demand of services through fewer resources.
By: Ankush Kumar
India’s healthcare industry is currently valued at $99 billion, and is growing at the rate of 12% annually, to reach $139 billion by 2017 [source: PwC Analysis]. Hospitals have a share of 71% in the sector, while the Pharmaceuticals segment contribute 13%. Despite the growth that the sector has been witnessing during the last few years, the healthcare space continues to be under considerable pressure. Shortage of medical staff and the modern infrastructure to cater to the healthcare needs of a large country like India is a major problem that the sector faces.
As per the PwC estimates: “The ratio of doctors per 1,000 people is just 0.6 in India whereas in Brazil and China, it is 1.8. India has only 1.3 hospital beds per 1,000 people—significantly lower than the guideline of 3.5 beds defined by the World Health Organisation. To meet the desired outcomes interms of hard and soft infrastructure capability, the healthcare delivery system will need to add 3.6 million beds, 3 million doctors and 6 million nurses over the next 20 years. This would require an investment of around US$ 245 billion through traditional means.”
During the last decade roughly 100,000 hospital beds have been added annually. If India continues to maintain this rate of additions, it will still be short of 1.6 million beds by 2034. The healthcare organisations will have to make massive investment for getting the required manpower and infrastructure in place. Considering the paucity of healthcare infrastructure in the country, it is essential for the sector to leverage innovative solutions, which can lead to the maximisation of productivity of the systems that are already in place.
Leveraging Innovative Technologies
India is on the verge of becoming the heart disease capital of the world—it has been predicted that by 2020 cardiovascular diseases will be the cause of over 40% deaths in India as compared to 24% in 1990. Diagnosis in the early stages of cardiac-related illness can help slow the progression of disease, and it can result in a significant lowering of the healthcare costs. Companies like Philips are in the forefront of developing new systems for diagnosing and treating cardiovascular conditions. Recently the company introduced a cardiograph that measures and displays 12-channel ECGs in both inpatient and outpatient settings.
Srikanth Muthya, Director- Patient Care and Monitoring Solutions, Philips HealthSystem, says, “Connected care and mobility solutions, which are cost effective and simple to use, are gaining more traction. But the best results can only be achieved when the systems are in tune with the local conditions. We have kept the local conditions in mind while developing the 12 channel ECG, which is very simple to use. The device connects with cardiologists via the 2G or 3G networks.”
Sankara Eye Hospitals, a nonprofit organisation, which is a part of the Kanchi Kamakoti Medical, has devised an innovative way of using an ordinary smartphone as the ophthalmoscope. “The smartphone can be used to diagnose most of the common eye problems. Images taken on the device can be transferred through social media, MMS and emails, and can also be archived in a simple and affordable way.
Although it cannot totally replace a real ophthalmoscope, it will help in seeking the opinion of eye specialists, even if they are away from the patient. Anyone with the basic understanding and knowledge of ophthalmology can use it,” says Kishor Joshi, Country Head, Business Development, Sankara Eye Hospitals.
With the growing popularity of wearable technologies, healthcare is on the cusp of a new digital revolution. Wearable technology, coupled with cloud and big data, can lead to tectonic changes in the way healthcare is delivered. Wearable sensors can monitor movement, heart rate, blood pressure, glucose levels and other health-related statistics. Such information can be recorded, reported and analysed through smartphone apps, watches, and other wearable devices.
“Our care management platform captures critical patient data points through clinical devices and wearables and helps patients in preparing for clinical procedures. With the patient data being easily available, the caregivers can respond quickly in case of medical emergency,” says Madhavan Satagopan, Chief Technology Officer, Altimetrik.
Apps & Analytics Gaining Momentum
Fuelled by the widespread availability of smartphones and tablets, mobile apps have become ubiquitous in many aspects of our day-to-day life. Apps for managing a variety of healthcare tasks are already available in the market. There are apps for electrocardiogram (ECG), monitoring blood pressure, monitoring blood glucose, and much else.
The use of healthcare apps has the potential of bringing efficiency in the overall healthcare system. The apps can lead to reduction in the frequency and cost of the direct interactions between healthcare professionals and the patients. A patient’s vitals can be recorded remotely and shared in real time with healthcare professionals. This is already being practised in India. The patients are able to consult the pharmacists, physicians and nurses without having to physically meet them.
ICICI Lombard in India has launched its mobile application ‘IL Insure’ in 2013. The mobile application empowers new and existing customers to buy insurance cover through the app.
“Customers can use the ‘IL Insure’ app to purchase health insurance and locate the nearest hospitals, OPD centers and pathology labs. The interface allows the customer to track the status of their health claim. The application also provides access to one’s health card. We are seeing steady growth in numbers of people seeking quotes on health policies through the app,” says Girish Nayak, Chief – Service, Operations and Technology, ICICI Lombard General Insurance.
With analytics, the healthcare companies can explore the possibility of the occurrence of a serious health issue without incurring any additional cost or performing physical experiments. In the United States, based on the hospital’s rate of actual to expected re-admissions, penalties are applied to all Medicarebased diagnosis-related group (DRG). Dr. Manish Gupta,Vice President, Xerox Corporation and Director, Xerox Research Centre in India, says, “Through analytics, healthcare providers are able to derive insights that help them make more informed medical decisions and gain operational efficiencies.” Healthcare accounts for $2 billion of Xerox business in the US alone. In the US, Xerox helps in the administration of the medicare programme in 37 out of the 50 states.
“Advanced algorithms for predictive analytics on re-admissions can analyse real-time information-such as vital signs, lab results and medications-to identify which patients are likely to return to the hospital. Clinicians are immediately alerted, so that they can modify care and avoid the potential financial impact. This new breed of analytics not only predicts patient and financial risks, it also guides clinicians on specific procedures that must be taken,” adds Gupta.
Telemedicine for Better Collaboration
Technology continues to be one of the key focus areas of various super-specialty hospitals. Fortis Healthcare has invested in developing an effective IT backbone and recently the company began the implementation of ‘Project F1’, which is a popular Oracle-based ERP system. The Fortis Escorts Heart Institute (FEHI), New Delhi, has deployed electronic intensive care unit (e-ICU) that blends critical care skills, technology and innovation to deliver 24×7 intensive care to patients in remote locations.
Varun Sood, CIO, Fortis Healthcare,is of the view that there are multiple technologies gaining foothold in the healthcare sector. Cloud is being deployed to ensure efficiency, effectiveness, and flexibility–it ensures a better, cheaper and faster way of doing things. Analytics is gaining a stay now, earlier the focus of analytics was towards the business side, but now it is moving towards gaining clinical advancements and excellence. More and more data is now available electronically from the clinical side as IT experts are working on predictive analytics. Mobility is no more treated as technology, it has now become a reality of life.
Telemedicine is a fast-emerging market in India and most of the modern day CIOs in the healthcare sector have a strong focus in this area. “What people used to refer as telemedicine is now being called ‘Virtual consult’. In my view also, Virtual consult/ Virtual clinics is a much better way of looking at telemedicine,” says Sood. Technology is being used to crosscheck if the right drug is being giving to the patient at the right time and in the right dosage.
A report published by Deloitte reveals that in 2012, the telemedicine market in India was valued at $7.5 million, and it is expected to rise 20% annually, to $18.7 million by 2017. Arvind Sivaramakrishnan, Chief Information Officer, Apollo Hospitals Group, believes that tele-health solutions can greatly enable healthcare access and delivery in the rural sector.
“Robust telecommunication links and good video quality are essential for proper clinical consultation. While the telecom links are available today, the reliability of the service is a point of concern,” says Arvind Sivaramakrishnan. “At Apollo hospitals, we consider technology to be a strategic element of our healthcare delivery model. Our solutions works around eICUs, telehealth, patient health records which is on the cloud, our completely interconnected HIS (Hospital Information System) and supporting solutions. Our mhealth enabled disease management initiatives are giving us positive results,” adds Arvind Sivaramakrishnan.
Kapil Mehrotra, Head – IT and Medical Informatics, Artemis Hospitals, says, “Telemedicine is the key technology for improving collaboration and communication amongst patients, doctors and other stakeholders in the healthcare sector.”
Increasing Role of HIMS
In today’s overcrowded hospitals, an efficient Hospital Information Management System (HIMS) is a must for managing all aspects of hospital management. The HIMS systems ensure that the healthcare professionals at the hospital have real-time access to the right information and there is automation in many of the routine tasks. A wide range of hospital management and administration process are covered under the HIMS.
Asoke K Laha, CEO, InterraIT, says, “All the multi-speciality hospitals are equipped with HIMS and many of these provides advanced digitisation of Picture Archiving and Communication Systems (PACS). Using PACS complex scan images, such as CAT Scans can be exchanged from hospitals to specialist doctors office and recommended treatment is decided without having ailing patient physically meeting doctors with a bundle of reports and medical records.”
Veera Raghavan, Executive Director & Global Practice Head Healthcare & Life Sciences, Dell Services, says that it is an exciting time for Dell to be a part of the Indian healthcare IT industry. “We are extending Dell’s proven capabilities and global healthcare leadership to India. We have brought best-of-breed combination of Hospital Information Systems (H IS) enterprise resource planning (ERP) and Electronic Medical Record (EMR) solutions to help providers achieve their goal of providing efficient, informationdriven healthcare in an affordable way. We launched the hospital-IT-in-a-box solution in 2014 exclusively for the Indian market,” says Raghavan.
“We are seeing a lot of interest from the mid-market hospital segment for hospital-IT-in-a-box solution as it is enriched with unique capabilities, delivery model and pricing. We believe this solution will be a game-changer for the Indian healthcare provider market where hospitals are burdened by huge upfront capital investments for hardware, and high cost of licenses, big investments in maintenance and support personnel,” Raghavan adds.
Adoption of Clinical Next Generation Sequencing (NGS) applications will drive the re-evaluation of access, privacy, and data retention policies.“Data from medical records is being crunched at a much higher speed than ever before. Most importantly, the insights derived from them are being taken into account with much more wider outlook,” says Amit Mehta, Country Manager, Isilon Storage Division, EMC. This is enabling the doctors to provide a better diagnosis and treatment to the patients, stay updated on the emerging trends and also provide a holistic approach to a certain case. Data crunching at such scale is also helping the medical world to cross reference between patients from different age groups and demographies.
“EMC provides products and services for healthcare providers, payers, government agencies and life sciences to improve patient care quality. 57% of all healthcare data is useful if tagged and analysed efficiently. Keeping that in perspective, EMC offers ‘Advanced Medical Imaging Solutions for Healthcare’ to consolidate, virtualise, and manage clinical and business applications and ‘Backup and Recovery Solutions for Healthcare’ for providers to strengthen their data protection, streamline backup and recovery, and meet a wide range of service levels for even the largest data volumes,” adds Amit Mehta.
The Road Ahead
As the movement for digitisation of health-related data spreads in India, there is the critical urgency to ensure that the data is properly collected and stored. It is also necessary to ensure that the data is in a format that can be accessed by healthcare professionals across the spectrum. “Data gaps, data
quality, compliance with methodological standards and non-availability of disaggregated data are the major challenges that healthcare professionals face while monitoring the health status and health system performance,” says Dr Arun Thapa, Acting WHO Representative to India.
There is the need to encourage innovations in this sector. The successful technology implementations must be well publicised, so that all the stakeholders are aware of the innovations that are happening in this area.
“The government should acknowledge the fact that public investments in the health sector are not going to be sufficient. Incentives for investment and innovation from the private sector must be encouraged,” says C N Raghupathi, VP & Head – India Business, Infosys.
Shibasish Pramanik, Managing Consultant- Healthcare, PwC India, believes that a robust HIS system is most critically needed in India. “Too many HIS solutions are in the market, but not all of them take into consideration the exact needs of the doctors and the nurses. We need efficient HIS systems.”
Robert Bosch Engineering and Business Solutions is working on rural healthcare delivery. There are number of challenges, mostly related to well-trained medical professionals, that the company faces while working in this area, but the company’s vice president, Sri Krishnan, is of the view that all these problems can be resolved through the use of technology. “We are thinking of using new innovations for channelising limited resources to maximise utility. ICT can be leveraged to act as a link and a force multiplier to clinical support systems,” says Sri Krishnan.
Poonacha Machaiah, Founder and CEO, ABOVE Solutions, is of the view that the government should give adequate subsidies and tax benefits to the companies operating in rural healthcare. “Support from the government will ensure that the business models are sustainable. This willencourage large and small industry players to develop new solutions for the market,” he says.
In a nutshell, the challenges ahead are too great for us to keep depending on the older methods of managing healthcare. The sector must welcome the new providers and their potential to lead healthcare to a new digital age. Only digital healthcare can support a future where everyone can access healthcare in the way that it suits their lifestyle and budget.