In need of critical care

Driven by innovative technology, India’s critical care sector needs an infusion of skilled personnel and a robust policy framework to ensure equitable accessibility and availability

Critical care sector in India started as a designated area of the hospitals to treat the life-threatening diseases. However, with time, need and emergence of various new diseases, it has evolved many folds in terms of its expansion as a speciality offering expertise for better clinical outcome and patient care.

The criticality of the critical care sector saw acceleration during the pandemic especially the need and availability of the Intensive Care Units (ICUs) and critical care equipments like ventilators. The sector is now witnessing the rise in innovation and adaptation of new technologies. The Union Budget 2022 also saw the announcement of a new centrally sponsored scheme PM AtmaNirbhar Swasth Bharat Yojana with an outlay of about Rs 64,180 crore over six years under which establishing critical care hospital blocks in 602 districts and 12 central institutions is one intervention among others.

Sharing his views on the evolution of critical care in India, Harsh Kapoor, Partner, Deloitte India said, “The growth of the field of critical care medicine in India is a great story of how the economic changes in a country can lead to the evolution of a scientific subspecialty.

From a time when many top hospitals lacked a separate critical care department and had broad/all-purpose ICUs, we have reached an age where several hospitals have highly specialised critical care offerings. Today, several large hospitals, both government and private, have separate medical, surgical, pediatric, cardiac, cardiothoracic, neurology, pediatric and neonatal ICUs.”

Dr Preet Pal Thakur Co-Founder, Glamyo Health highlights, “The importance of critical care accelerated when the pandemic hit in early 2020, wherein people realised the need of critical care. Despite this growth, the critical care faculty in India still lags way behind the total requirement of the practice and related equipment in India. This imbalance between the demand and supply during pandemic gave new light on the branch of critical care and the consecutive market in India.”

Market overview: Investments & technology adoption

The lack of elective surgeries which was one of the main challenges during the pandemic impacted the growth of the critical market globally but it is now gaining back the momentum and on a rising side. The market experts predicts that apart from the emergence and increase in the number of chronic diseases as key drivers of market growth, several innovations being introduced in ICU units like CT Scanner and IRT will make a significant impact on its overall growth.

Vinay K Mayer, Director-Market Research & Consulting, Asia Research Partners highlights that, “Globally, the Critical Care Equipment market is expected to reach USD 976.2 million by 2027. The key drivers for this growth include the increasing incidence of chronic diseases, the increasing geriatric population, and an increasing number of motor vehicle accidents. Over the past few years, there has been a shift in focus towards geriatric patients as they account for a major chunk of the critical care market.”

He also explains that, “The evolving market of critical care in India is witnessing several innovations being introduced in ICU units. These include Acute Care Unit (ACU), Critical Care Unit (CCU), and Trauma Center. The CT Scanner and IRT are two examples of key innovations making a significant impact on the critical care market in India. In India, chronic diseases are the leading cause of disability and premature death among the elderly. According to WHO, chronic disease prevalence was expected to rise by 57 per cent by the year 2020. This is necessitating an increased focus on preventive measures and improved treatments for these diseases. As a result, the critical care market is witnessing an increase in demand for advanced equipment and therapies that can help patients with chronic conditions. Furthermore, escalating healthcare costs are driving critical care pricing upwards. The growing number of critical care patients requiring specialised and immediate medical attention is resulting in the evolution of the critical care market in India. Augmented Reality (AR) and virtual reality (VR) are some of the newest technologies that are being used to improve critical care patient care.”

Talking about the investments in the sector, Kapoor said, “Critical care services are some of the most profitable non-surgical services a hospital can offer. Earlier, hospitals used to focus on improving their surgical vs non-surgical patient mix. Given their profitability, critical care services are emerging as a major revenue driver for corporate hospitals in India. Nowadays, hospitals have begun looking at their critical vs non-critical patient mix as well. Therefore, we’ve seen an increasing willingness among hospitals to invest in critical care technology to attract patients. Leading Indian hospitals are therefore increasingly investing in technology to improve critical care workflows, and to more accurately monitor and diagnose critically ill patients.”

Arvind Sharma, Partner, Shardul Amarchand Mangaldas & Co believes, “The critical care market is poised for tremendous growth, including on account of India becoming a destination for affordable and reliable healthcare solutions. The pandemic has launched digital healthcare into the limelight and has initiated the much-needed discussion regarding India’s readiness to adapt to emerging healthcare technologies. Implementation of the existing and upcoming policy decisions can be ground-breaking for ensuring access to state-of-the-art critical care and treatment.”

 

Technology & innovation in critical care sector

Lack of oxygen supply, ventilators and intensive care units posed a major challenge during the second wave of the COVID-19. The elective surgeries were on a halt and treatment of other critical diseases was also impacted. All these challenges lead to the rise in local manufacturing of the critical care equipment’s, highlighted that importance of innovation and focussing on the adoption and scalability of the technology in the sector for better patient outcome.

Stressing on the rise of technology adoption, Sharma said, “Since the onset of the COVID-19 pandemic, India’s critical care sector has undergone massive strain through episodic surges of COVID-19 cases seen over the last two years. The increase in the number of patients requiring intensive care substantiated the need for a robust healthcare infrastructure and adoption of advanced technologies in the critical care sector.”

“Several timely initiatives were undertaken to deal with the challenges posed by the pandemic, and one of the key initiatives was the rapid adoption of telemedicine. Other ongoing digital health initiatives include: ‘e-Hospital’, which is a cloud-based Hospital Management Information System to help connect patients, hospitals and doctors on a single digital platform; and ‘e-Shushrut’, which is a cloud based computerised clinical information system for providing accurate electronically stored medical records of patients. The National Health Mission also provides support to state governments for services like telemedicine, tele-radiology, tele-oncology and teleophthalmology. Other initiatives like the introduction of Aarogya Setu app (for monitoring health status) and the e-Sanjeevani (web-based comprehensive telemedicine solution that facilitates doctor to doctor, and patient to doctor teleconsultations), continue to create a huge impact in the rapidly evolving healthcare infrastructure in India”, he added.

Some of the latest emerging trends in the Indian critical care sector includes remote patient monitoring and tele-ICUs which are getting a lot of attention as far as virtual care is concerned. Other technological advancements include advances in biosensor technologies, AI-based solutions and cloud systems.

Vikram Thaploo, CEO, Apollo Telehealth explains, “Innovations in battery technology and nanoscience are making biosensors thinner, lighter, smaller, cheaper, flexible and consume less power. With this, the precision, accuracy and range of patient data measurements will improve. Presently, biosensors measure vitals like oxygen saturation, heart rate, blood pressure, etc. but work is already in progress to create a combination of digestible and implantable biosensors that will be able to measure the volume of air passing through the lungs, brain activity, blood chemistry, organ functionality and much more. All these critical care data parameters will be sent wirelessly to hybrid cloud-based systems, providing vital insights to doctors to treat patients effectively.”

Talking about the AI based solutions, he says, “AI’s goal in healthcare is to enhance treatment techniques and bring better patient outcomes. So far, AI has been living up to its goal by playing a critical role in game-changing applications. AI technology is helping in the development of precision medicine—customised according to the needs of the patient—by synthesising data and drawing conclusions. AI-based tools are also being developed to predict the deterioration of a patient’s condition well before time, provide timely clinical intervention and optimising patient outcomes. With the passage of time, AI tools will further become more accurate and precise leading to increased adoption and acceptance among healthcare providers.”

Prateek Tiwari, Director-Emerging Markets Group & Strategy, Medtronic India while talking about the ICUs offering virtual care facilities, said, “With improvements and advances in primary care and home care after the pandemic, more patients are being operated outside the traditional hospital setting and in level I/II ICUs. Advanced informatics systems will help intensivists monitor the patients from a centralised monitoring center or from anywhere using a handheld device. This will be complemented by trained nurses stationed at the patient’s bedside.”

Challenges & road ahead

The current critical care scenario in India, though encouraging in certain aspects, still has a long way to go. Only in recent years has the Indian healthcare system understood the importance of critical care practice in its field. While the use technology is increasing, there is a greater need for skill and development. Moreover, the accessibility and availability of the critical care still needs a lot of attention and robust policy framework.

Dr Chandrashekhar T, Director- Critical Care, Fortis Hiranandani Hospital said, “The government should initiate standardised training in various domains, such as Emergency Medicine, Critical Care, Pulmonology, case management, infection control, safety testing, and isolation protocols. This will enhance the comprehensive skills of healthcare professionals to respond effectively and make teams better prepared to deal with health emergencies. All in all, the COVID-19 pandemic could be a massive chance for India to strengthen its social health for the advancement of public health to reduce fatalities and improve patient outcomes.”

Stressing on the shortage of equipment, Dr Thakur added, “The lack of proper equipment for intensive care practice is another significant barrier to implementing a healthy critical care sector in India. It is estimated that at least 50 per cent of ICU beds have for mechanical ventilators. Despite this, the number is way below the essential demand, especially in the event of a pandemic surge. Currently, India relies on imported parts to assemble most of the critical care equipment; hence, to overcome this problem, the government is encouraging Indian companies to manufacture these instruments locally. While the Make in India campaign has come as a boost to the medical devices sector, it is still some time away before India can be self-sufficient in its equipment needs.”

Givin the possible solutions to the most common challenges in the critical care sector, Ashok Patel, Founder and CEO, Max Ventilator highlights, “First, we need to focus on augmenting the domestic production of ICU equipment and machines. The government has made provisions through PLI schemes and clustering facilities for medical devices, equipment related to critical care also needs attention. Second, the healthcare facilities must be regularly inspected and monitored for housing mandatory ICU beds and related equipment. The ratio of ICU beds to number of over-all hospital beds i.e 1:4 ratio must be followed and adhered to. Third, similarly, it must also be ensured that all facilities have allocated mandatory manpower for critical care commensurate with their size and the footfall. Fourth, there must be regular quality audit of these critical care facilities and their machines and equipment by authorities. Fifth, the health personnel including doctors, nurses and paramedics involved in critical care must be trained to handle equipment and machines in the ICUs. Sixth, critical care medicine as a part of the curriculum must be extended to more and more of medical schools in order to prepare a sufficient pool of specialists within the country. Seventh, the hospital administration must inculcate a culture of best practices for ICU and critical care. For instance, sometimes, corrugated tubes – which are supposed to be single use device – are reused on patients. This should be dealt with sternly. Eighth, while the standards and certification systems for medical devices stipulated by developed countries’ regulatory authorities are okay, we need to develop our own certification systems relevant to our own value chains and the strengths and weaknesses inherent in those value chains.”