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With the launch of the Digital India campaign in 2015, India has become the second-fastest adopter of digital services. With about half a billion internet users, the potential to unlock an additional economic value of $1 trillion dollars through inclusive growth is immense. This is also true for the healthcare sector wherein blending the digital approach can help tackle the issues of access, affordability and quality. Indeed, Covid-19 pandemic is a strong reminder of two things – more needs to be done to protect our communities from future health crises and strengthening our healthcare infrastructure is critical for us. It has also made clear that the future of healthcare is digital.
With the ongoing pandemic, the Indian healthcare industry is undergoing a major transformation. While the pandemic has brought inadequacies and pitfalls of India’s healthcare system to the light, it has also opened up opportunities for digital intervention in the healthcare systems which are supposed to alter the healthcare landscape in 2022 and beyond.
The Covid-19 pandemic has reinforced the health sector’s importance and the need to strengthen efforts. In fact, the old schools of healthcare system need a technological push to provide accessible health services to all. The 2021 Global Health Security Index says “all countries remain dangerously unprepared for future epidemic and pandemic threats, including threats potentially more devastating than Covid-19.”
The GHS Index assesses 195 countries’ preparedness for epidemic and pandemic across six categories — prevention, detection and reporting, rapid response, health system, compliance with international norms and risk environment.
Where India stands in healthcare?
Among 195 nations, India ranks overall at 66 with a score of 42.8 and a decline of 0.8 points since 2019 in the GHS index. The study underlines that India has improved in detection and reporting category, but there has been no enhancement of its prevention protocols, health system or rapid response processes. The study says that although countries built new capacities during the Covid pandemic, many of them are temporary.
India scores 29.7, slightly above the global average at 28.4 out of 100 in the prevention category. The detection and reporting category that shows major gaps in the reporting capacities for epidemics of potential international concern, India scores 43.5, 11 points above the global average.
Further, India scores 15 points above the global average in the Health Category system at 46.1 and ranks 56 in the list. India scores at 47.2 and ranks 92 in the Commitments to improving national capacity, financing and global norms category. Moreover, in the risk environment category, India scores slightly above the global average at 60.2 and ranks 73 in the list.
However, the Indian healthcare industry has done a commendable job in managing Omicron-led third Covid wave with aggressive push on establishing PSA oxygen plants in each district hospitals. Online digital solutions like ‘Oxygen Demand Aggregation system (ODAS)’ and ‘Oxygen Digital Tracking System (ODTS)’ have been developed to ascertain the demand for medical oxygen from all medical facilities and to track their transportation. In fact, the government and the private institutions have been quite aggressive in expanding the reach of expert medical consultations through initiatives around tele-medicine.
In fact, the amalgamation of technology with healthcare will open new doors, pave the way to enhancement, and broaden the horizons of healthcare. They will help us build the healthcare infrastructure we require.
The Indian health-tech industry, valued at $1.9 Billion in 2020, is expected to reach $5 billion by 2023 at a CAGR of 39 percent. The country has already seen a rise in healthcare technology use cases. During the COVID waves, government and private/public hospitals used initiatives such as AarogyaSetu app, Telemedicine, Virtual check-ups, online bookings, intelligent diagnosis, mapping of the patients, and online clinical support to curb COVID-19 and provide medical aid to patients in need.
The government also announced projects like Ayushman Bharat (PM-JAY) and National Digital Health Mission (NDHM) to make healthcare more affordable and accessible. They are a promising start towards enhancing our country’s healthcare system, and we will see more such initiatives emerge on both the private and public front. Another use-case wherein technology is helping us is in ensuring 100% vaccination.
The ongoing vaccination drives in India are among the largest in the world, wherein every individual is required to register through the COWIN app to get access to vaccines.
Digital access and healthcare infrastructure
If we talk about digital access and healthcare infrastructure, the last two years of the pandemic have revealed the inadequacies of the infrastructure in a country. At the same time, it brought about many innovative solutions which have helped India meet the challenges of Covid-19. “Rather India has done well as compared to many developed economies except during the second wave of the pandemic when most of the healthcare facilities got overwhelmed. We need to focus on the present while keeping the long-term perspective in view to improve on the infrastructure and healthcare delivery gaps. While private sector hospitals account for nearly 70 percent of the healthcare deliveries however, most of them are focused on metros and larger cities. Tier-2 and -3 cities and towns are lacking the quality healthcare ecosystem; while the rural areas are quite deprived of the healthcare ecosystem and mostly dependent on public hospitals with limited facilities and presence,” elaborates Dr Harsh Mahajan, President, NATHEALTH, and Founder and Chief Radiologist, Mahajan Imaging.
If we talk about quality and accessible healthcare, the government has to focus on these areas for building primary and preventive care. The basic system like CHC, PHC and District Hospitals in these areas are still there, but are dysfunctional in most of the cases and not at par with their counterparts in large cities. Government must look into methods to galvanize them to serve in their area so people don’t have to rush to large cities or tertiary centers for basic ailments, he adds.
The private sector has shown that it can do a great job in tertiary and quaternary care settings especially in the organized healthcare settings. However, majority of the private healthcare segment accounts for clinics and small nursing homes. “While the organized tertiary and quaternary hospitals offer healthcare delivery at par with the world standards, the same can’t be said for the smaller unorganized private players with inconsistencies in quality of services and healthcare facilities. That’s something we need to confront. It needsto be taken care by Quality Council of India and NABH to develop ways and standards to bring all the healthcare facilities small or large at par, advises Mahajan.
Making healthcare accessible to all
Government and healthcare providers must work toward a future healthcare system that is more cost effective, equitable and shifts away from ‘sick care’, to prevention and early intervention. “While Ayushman Bharat is currently focused on people below poverty line, mostly through government hospitals and few private hospitals in the ambit, I see this initiative to lead to a much larger scheme of things where eventually we can see something like social security system where every individual gets covered under the health insurance scheme. Although a lot has to be done on this front, this is a step in the right direction. We are already seeing increasing penetration of healthcare services due to these initiatives,” shares Dr Uma Nambiar, Chairperson, DHIndia and CEO, Dalmia Healthcare.
Covid has made us realize the importance of wellness and people are now more aware about Ayurvedictherapies and wellness regimes. “Hospitals have also realized that the focus must be on the primary care and wellness because that’s the only way we can prevent the tragedies in acute and tertiary care as well as reduce the cost of care,” she adds.
Further, telemedicine has made the primary and follow-up consultations an easy task. And it is not only about chronic care and follow-up, it is also being used increasingly to make acute care affordable and has already marked presence in areas like ophthalmology, pathology, radiology, ICU, beyond just tele-consultations, she says.
With the advancements in tele-medicine and government push on digital health are working together, the healthcare scenario will change drastically 3-4 years down the line. “In fact, technology can play a critical role in making healthcare accessible to all. However, we must not just focus on digitizing the processes but to use the technology to make the existing systems more efficient and reduce the workload on people. This way we can also address the scarcity of resources,” concludes Nambiar.
Vision 2030: A glimpse into the future
As cutting-edge technologies combine and accelerate, healthcare is set to revolutionize. What will medical science, global healthcare delivery and access to care look like in 10 years from now?
DrNitiraj Gandhi, Secretary, HIMSS India Chapter says that the next decade will witness new models due to influence of demographic changes which will dramatically impact services and its delivery. “The millennials and younger generation would have greater influence on service deliveries as per their preferences. Stakeholders like payers, insurers and government will have significant impact on healthcare wherein they will push for lower cost of care coupled with greater packaging of services. As the cost of care escalates, these pressures will also dictate the way in which services are delivered.”
Moreover, people are now focused on wellness and are seeking care outside of hospitals. “Over the next decade home care is going to lead the way for disruption of patient monitoring led by technology. On the supply-chain front, we have already seen many new models where healthcare is focused on efficiency and cost-savings. We will see newer models which aggregate the demand and offer generic options through multiple e-health and m-health channels,” he shares.
Over the next few years, we need to start serving customers in different ways using models which will appeal to them and help them ease consumption for different age-groups and preferences. The care will move more towards the patient and digital solutions which will combine e-tail shopping-like experience, care pathways, tele-consultation and integration with IoT monitoring devices.
“As more people adopt insurance, we will see large consumption of healthcare services. That’s why hospitals have to look into different models in which they are looking at delivering acute care, improving the throughput and anything which is sub-acute or –chronic will start moving out of the hospitals thereby the fixed cost incurred due to hospital admissions will get lower. Besides rationalizing the costs, this will enable medical practitioners to address a large chunk of sub-acute patients,” says Gandhi.
He further adds that the most crucial part is to elevate the patient experience. “It’s not about expensive and fancy buildings; it is about keeping the customer first all the time. Care providers need to think like businesses like Amazon or Flipkart or any consumer-focused organization. In fact, patient experience is going to differentiate what healthcare providers are capable of doing. Forging connectivity and reciprocity between health systems, building a tiered structure wherein institutional health providers, telehealth providers, homecare providers, e-pharmacies, home diagnostics, and IoT services co-exist to efficiently deliver care basis the patient requirement, will be the future of healthcare,” states Gandhi. Indeed, the first-movers in this space who can manage to create this entire ecosystem and deliver a layered experience through specialists in each layer and high efficiency will hold a significant advantage.
Reimagining healthcare ecosystem with emerging technologies
In medicine and healthcare, digital technology could help transform unsustainable healthcare systems into sustainable ones, providing cheaper, faster and more effective solutions for diseases. The need is to re-imagine the healthcare ecosystem with emerging technologies like AI, IoMT, robotics and more.
“The expenditure on healthcare is 1.2 percent of the GDP in value and this can touch $8.6 trillion in the current year. This will get another boost as the government is planning to increase the public healthcare spending to 3 percent of the GDP by 2025. However, despite all the focus and investment we have to understand that India needs to cater to the healthcare needs of 140 crore population. That can only be possible by amalgamating digital technology with conventional healthcare practices,” comments Satyaki Banerjee, CEO, Medical Imaging, Trivitron Healthcare.
There is no reason why healthcare industry should be away from digital. From the data-driven insights of wearables to mobile applications that can help manage chronic conditions, it’s clear that technology is changing healthcare forever. The health data can be used to better predict the onset of chronic conditions among patients. It can also create more effective clinical pathways and improve hospital management operations.
Of the industry which have changed with the impact of the pandemic, healthcare arguably has changed the most. “Remote monitoring, online consultation, digital health records, cloud-based storage and access of patient data, this has become commonplace. AI algorithmsare constantly analyzing information, learning the diagnostic approaches of clinicians and getting smarter by offering care-givers the same exceptional quality of service in time of unprecedented pressure,” he adds.
Banerjee further adds that AI is helping analyze CT scans for Covid patients to detect pneumonia. In addition, digital tools are helping diagnostic labs to perform immense number of RTPCR tests, upload patient reports electronically, and notify health authorities and ICMR for necessary tracking. Such a massive exercise would not have been possible without digital tools.”
In addition, robots are transforming how surgeries are being performed. Robots are also being used on clinical settings to support health workers and enhance patient care. During the Covid pandemic, hospitals and clinical care centers have been deploying robots for a much wider range of task to help reduce exposure to pathogens. As surgical robotics continue to evolve, AI-enabled robots will eventually use computer vision to navigate to specific areas of the body while avoiding nerves and other obstacles,” predicts Banerjee.
Is care at home the future of healthcare?
The implementation of new healthcare technologies, spurred into rapid adoption by the pandemic, are catalyzing new ways of thinking about care delivery, including care for patients at home rather than in a hospital setting.
However, it needs to be seen how virtual care can help redefine the delivery of healthcare overall by enhancing the patient experience, improving health outcomes, lowering the cost of care and improving the work life of care providers.
“The meaning of healthcare is changing rapidly. We are at a point where we are aiming to make people healthier. The idea is to predict and prevent and not diagnose and cure. Eventually, healthcare is moving to the home and it remains to be seen that how are we positioned as a care provider and medical practitioners to deliver home care services,” says Dr A Thanga Prabhu, Chief Medical Information Officer, Apollo Hospitals.
As part of the traction towards care at home, tele-medicine and tele-consultations are increasingly becoming the mainstay. “During our analysis in Medanta Hospitals, we witnessed tele-consultations to zoom 12-times the pre-Covid figures and we are still witnessing 5-times the pre-Covid traction. Moreover, with the deeper analysis we were able to clear few myths. We found that over 55 percent of the patients were of the age 50 or above who were using tele-consultation. We also realized that more than 45 percent of the patients who were using tele-medicine were from smaller cities from Uttar Pradesh, Jharkhand and Madhya Pradesh,” discloses Rajiv Sikka, Group CIO, Medanta Hospitals.
Medanta Hospitals also noticed that Onco, Neuro, and Cardiac patients constituted more than 35 percent of the 30-odd specialties that the hospital offers. “Further, over 45 percent new patients came for tele-medicine consultations over the peak of the pandemic. Hence, tele-medicine is definitely going to stay. And tele-medicine is not a typical video-conferencing solution; it in integrated with the backend systems including specialties, payment gateways, appointment systems and prescription download,” he adds.
Sikka further says that it’s about changing the mindset and getting the same kind of experience at the comfort of your home. While if we talk about critical care at home, it is yet not feasible or commercially viable due to absence of economics of scale, however it’s only a matter of time.
On the other hand, many of the healthtech companies are coming up with MIoT devices including wearables in the form of watch and stickers to enable remote monitoring. “We are actually spoilt of choices in terms of technology and access to data. AI algorithms are now able to predict the length of stay of the patients by analyzing their vital data and it’s getting more precise day by day. However, for care at home to be successful people must also be aware of the basic procedures of first-aid and basic life support. In fact, 80 percent of the things done in a hospital can also be done outside of the hospital,” shares Dr Prabhu.
Seconds Tushar Zade, CIO & CDO, Aurigene Pharmaceutical Services, “As we are seeing digital transformation at never before pace, data is getting enriched significantly. Hence, it’s time now to do the prescriptive analysis and offer timely alarms to avoid any casualty. Moreover, the change management is extremely important at this stage to change the mindset in favor of care at home.”
Care at home is definitely a desirable stage and makes a lot of sense when it comes to preventive and chronic care. “However, providing hospital services at home is something which is still distant thing as the required precision technology is still not available for home use. In fact, many of the hospitals and clinics failed to leverage tele-medicine in a seamless way to deliver clinical services. We should be able to draw a line to identify what is possible now and what will come in the future. So, care at home is coming on the horizon but not here and now,” says Bharat Gera, Founder, Human Centric Health Ecosystem and Digital Transformation Advisor, KIMS Hospitals.
Sharing data and ethical challenges: AI and legal risks
Introducing machine learning and AI into your organization offers a new dimension to care delivery; it also opens up all kinds of doors to legal risks, especially once you start using patient-generated data or implementing the technology into your workflow and decision-making processes. There are important questions your organization needs to ask itself as you start the journey and as you move forward.
“When it comes to the safety and security of healthcare data, India is playing catch up. If you look at the current legal framework, we don’t have a healthcare-specific data privacy legislation. Although we did try to do something a few years ago in the form of what we refer to as DISA (Digital Information and Security in Health Care Act). However, that never came to fruition. What the legislature is currently doing is that they are in the process of implementing a new general data privacy regulation. Currently, I’d say that the entire framework is geared towards protecting sensitive personal data, but not data overall,” elaborates Darren Punnen, Member, Pharma& Life Sciences Practice, Nishith Desai Associates.
We don’t have a specific AI ML legislation today, primarily because the main legislation that deals with data privacy was released somewhere in 2000, and at that time, we were not looking at AI and ML so closely. “Once we move into the new data privacy law, we will definitely see some more specific legislation on this front. But that being said, there are many policies that have already been put out, which directly deal with AI and ML. For example, the NitiAayog has already put out a couple of policy papers which deals with AI and ML, not only in the general context, but also in a specific healthcare context. One place where we’ve already seen an implementation of some regulation with respect to AI and ML in healthcare is with the recently released telemedicine practice guidelines,” shares Punnen.
The bottomline
Practically, India needs an integrated healthcare model, stringing both traditional and modern together, and technology will make it happen. AI, IoT, analytics, and data managing supply chains and inventories and building electronic health records (EHR) for all will aid in-patient care improvement, pathology digitalization, and more, providing the best health-tech solutions.
Technology, especially AI has a huge role to play in the healthcare sector’s growth. Data and AI in healthcare has the potential to add $25-$30 billion to India’s GDP by 2025 as per a recent NASSCOM Data and AI report.
More interestingly, according to the Healthcare Information and Management Systems Society’s ‘Future of Healthcare Report,’ around 80 percent of healthcare systems are aiming to increase their investment in digital healthcare tools in the coming five years.
Indeed, the future of the Indian healthcare system is promising. With the proper integration, intervention, and introduction of technology combined with data and analytics, we can achieve the unimaginable sooner than expected. Utilizing healthtech for adequate management of the patients, documents, changes in treatments, and birthing of new techniques for diagnosis and prognosis is the path we should tread; that is what will take us decades into the future in a couple of years.
