How digital intervention is playing a key role in Acute Care Management

Dr Sumana Arora, Vice President, Clinical Services, DayToDay Health India (DTDHI) talks about the crucial role of digital healthcare in acute care management

Many years ago, when I was working at a senior management position for one of India’s best-known hospital groups, I was woken up at 2 am by the duty manager informing me about a patient brought dead to the ER. This was a patient who had been discharged just 2 weeks earlier post a very successful surgery. The ER doctors informed me that the patient had jumped off the 15th floor of his apartment building, most likely had developed post-op clinical depression and suicidal dispensation which had gone unnoticed by the family. I remember spending the following week in distress thinking of how such eventualities could be prevented since the clinical team doesn’t go home with the patient and the family may not be adequately equipped to identify and escalate such concerns.

Years later, as the VP, DayToDay Health India I saw a similar case last year where our clinical team providing care to a post-op patient on the digital platform picked up signs of clinical depression and suicidal ideation in the patient. This was picked up by the clinical psychologist who is part of our multi-disciplinary team of doctors, nurses, nutritionists, clinical pharmacologists, physiotherapists, and respiratory therapists. The immediate intervention was done by getting the patient appropriate care and the operating surgeon was kept in the loop. It was years later, that I found a solution to the problem that had nagged me for almost a decade.

The possibilities of digital healthcare are immense, many of which we cannot even imagine right now. Doctors would agree that the practice of medicine is not black and white as patients would prefer, and doctors would do too. Pre and post-hospitalization are areas where the clinical care is left entirely to the patient and his/ her caregivers. The clinical team in the hospital has very little visibility and direct control over what happens in these phases. In fact, appropriate care in both the pre and post-hospitalization phase has the potential to improve clinical outcomes, decrease morbidity, prevent readmissions, and thereby reduce the overall cost of treatment. Digital interventions play a critical role in bridging the gap which exists in these areas. For optimum clinical outcomes, hospitals need to consider everything from what could have been done before the procedure to the entire continuum of care including post-recovery and rehabilitation.

Acute care management has emerged as a prominent area of interest. It offers huge potential for healthcare service providers to leverage their expertise in this domain. With digital interventions, patient care management, specifically acute, post-surgical, and out-of-hospital care, has evolved systemically. According to Industry ARC’s report, the global acute care market is expected to reach $214.3 billion by 2025, growing at a 6.8% compound annual growth rate between 2020 and 2025.

DayToDay Health (DTHDI) has emerged as the world’s first and only digital-first, end-to-end acute care Management Company. The Boston-based health tech startup offers a tech-enabled human-driven end-to-end postoperative acute care management solution, which is duly monitored, tracked, and supervised by a multidisciplinary team of clinicians, researchers, and data analysts. Some of the senior leadership is from world-renowned institutions like Harvard, MIT and INSEAD.

The DayToDay solution currently uses advanced data analytics and Natural Language Processing (NLP)-based AI technologies, delivered through a mobile app The digital interventions offer a seamless process, beginning with the registration of the patient on the app, taking and documenting informed consent and uploading of patient medical records. The patient’s hyper-personalised care plan then kicks in. This care plan is formulated by a highly specialized team in consultation with the primary clinician. The patient is guided through each day and taken through what he is supposed to do on that day, how he is supposed to do it, and when he is supposed to do it to ensure daily progress. For the patient, it is like having the entire clinical team accessible to him/ her at any given time of the day or night and in the language that he or she speaks. The clinical team closely monitors the patient and picks up early warning signs if any and ensures appropriate and timely interventions which could’ve otherwise been missed. The team also has a detailed clinical dashboard that is maintained for each patient. In simple terms, this is nothing but medical records like you would see during hospitalization when the clinical team would fill in the case sheet on daily rounds. Further, when the patient goes in for a routine follow-up to the hospital, or even otherwise when required, the patient’s primary clinician has access to these records at the click of a button! The DTDHI’s acute care program includes more than 30 procedures in cardiology, cardiac surgery, orthopedics, oncology, urology, and obstetrics, and gynecology. In fact, as regards surgical cases, we even monitor wound health through the digital platform! Our clinical team recently picked up early signs of surgical site infection through surgical image monitoring on the digital platform. Early intervention prevented a catastrophe since it was a case of an implant.

More recently, digital interventions have shown their potential during the ongoing COVID-19 crisis. In April 2021, as the second wave of COVID-19 swept through India, the Remote COVID-19 Care Program of DTD, which had been developed and made widely available, was in high demand. One of the most significant lessons learned from the pandemic was that a sizable proportion of COVID-19-infected patients could be successfully treated at home using a combination of intelligent technology and a trained clinical team. We have had tremendous success managing asymptomatic and mildly symptomatic COVID cases on the digital platform since the pandemic began, even having saved lives by picked up early signs of deterioration and ensuring timely medical attention. In fact, we saw over a threefold rise in our patient numbers during the first and second wave of the pandemic. Very recently, the startup has also introduced the COVID long haul care plan to handle the post COVID sequelae that we are seeing and are likely to see increasingly as we go forward.

In fact, over the past year, after the national telemedicine guidelines came into force, we have seen what a boon digital health can be. Routine OPD visits can be managed via the digital platform. With digital devices like stemoscope, doctors may be able to hear heart, lung, and bowel sounds virtually. Further, in a country like ours, where rural medical care is found lacking; digital healthcare can help make medical care to the remotest areas. With many advancements like wearable devices. Artificial intelligence and machine learning, it will be safe to say that will soon be seeing a paradigm shift in the way medical care is delivered. It is maybe safe to say that we can have access to not just the doctor sitting in our homes but an entire medical team. There will of course remain situations and cases which need to be handled within the confines of a hospital, however, we may increasingly see a large number of cases being handled through the digital platform. This will help reduce the burden on our stretched healthcare infrastructure if done right. The days of, “the doctor will see you now” may just well be changing to, “the patient will see you now”! And like Eric Topol said, “the digital world has been in a separate orbit from our medical cocoon, and it’s time the boundaries be taken down.”