Rajneesh Bhandari, founder, NeuroEquilibrium, a chain of vertigo and balance disorder clinics, believes that like all virtualisation, virtual health requires flexibility, creativity, and the ability to see what healthcare can be, not what it has been
“Pandemics press the fast-forward button.” This statement by Yuval Noah Harari, the writer of the bestseller book ‘Sapiens,’ is what we are witnessing as COVID-19 has expedited the transformation from physical to virtual across the world. A year ago, we would consider an online consult only if we could not visit the doctor. Now, teleconsults seem to be the new normal and will disrupt the hospital OPDs in the future.
A recent McKinsey report states that telemedicine will replace at least 30 per cent of OPD. It is projected that by 2025, 50 million households will be doing virtual consults, mostly under a subscription model. Today telemedicine brings medical care to the doorsteps of patients who have difficulty accessing it due to distance or disability, but in the future, the adoption will be far more due to inherent advantages of virtual health and not because it solves the issues of distance and time.
This will dramatically impact the hospital business models. The advent of digital medicine represents a tectonic shift both in the administration of medicine and in the venues where it’s provided. We need to radically adapt our thinking about what a hospital can be and what it should deliver.
One such concept is a hospital without walls – a hospital as a digitally connected community and platform rather than a maze of rooms and corridors. A hospital that is ubiquitous, seamlessly embedded in our lives. It will essentially become a care delivery platform with increased collaboration with specialised doctors.
There is an acute shortage of super-specialist doctors. The top 10 causes of death in India require treatment by a super-specialist doctor. For 72 million diabetic patients, we have 800 endocrinologists, of which 500 are in just eight cities. As per the US or European standards, we require 30000 endocrinologists. Similarly, we have 4000 neurologists, while we need 40000 neurologists and have 1200 nephrologists for 1.3 billion people, and we need 40000.
Technology and business model innovation will have to be a force multiplier to solve both problems of accessibility and affordability. The marginal cost of providing super-specialty services can be reduced dramatically.
NeuroEquilibrium is one such super-specialty remote diagnosis platform for vertigo and balance disorders providing service in over 125 hospitals across India and a few centers in Europe. Super-specialist doctors assisted by computer vision and machine learning help in diagnosis, treatment planning, and rehabilitation of these patients, thus reducing cost and increasing access to super-specialty healthcare.
Another example of reducing the marginal cost of super-specialty service is teleradiology. The market for teleradiology is over $ 4 billion, where the MRI and CT scans from the US and Europe are read and interpreted by doctors sitting in countries like India. The marginal cost in teleradiology, telepathology, etc., will soon fall to zero with the integration of computer vision and machine learning.
Diseases like diabetes are multi-organ diseases that require a multi-disciplinary approach. Diabetes requires treatment by an endocrinologist, cardiologist, nephrologist, etc. Digital platforms like NeuroEquilibrium not only enable a multi-disciplinary approach but force this approach through the algorithms.
In India, hospital infrastructure is overstretched, with only 0.7 beds and 1.5 nurses per 1000 population. “Home healthcare,” enabled by technology, would be a preferable choice as it is 40 per cent less costly than hospitals. More importantly, with the love and care of family and a comfortable environment, patients have a faster recovery cycle. It also reduces unnecessary hospital visits by 65 per cent. Home healthcare is a $12 billion opportunity in India, and home care should reach 90 million households by 2025. Platforms like NeuroEquilibrium leverage cloud technology to provide specialised and customised rehabilitation for their patients at home.
The complexity of modern medicine exceeds the capacity of the human mind. There are over 10000 human diseases and more than 8000 FDA-approved drugs. It is impossible for a human brain to process all drug interactions and adverse drug reactions, especially in patients with pre-existing medical conditions. Adverse drug reactions and interactions between drugs are the 6th leading cause of death, with over 1,00,000 deaths in the US alone. In a 2012 report, McKinsey concluded that the cost of preventable adverse drug reactions exceeds $115 billion annually. Platforms like NeuroEquilibrium deploy clinical decision support systems with algorithms that help prevent adverse drug reactions.
The adoption of wearables and digital therapeutics is at the tipping point. They offer connected data and continuous monitoring. For the first time in history, we have access to patients in their real-world as they work, walk or while asleep. It shifts the responsibility for health care onto the individual patient, increasing their self-awareness, adherence, motivation, and accountability for their own progress based on objective data and real-time feedback. Further wearables and smartphone accessories can measure various health parameters like ECG, pulse, oxygen saturation, sleep parameters, gait parameters, etc. The list is endless.
Given today’s technologies, it is not difficult to imagine that instead of spending two hours for a doctor’s visit, the patient does an online consult sitting in her home. The doctor prescribes blood tests which are forwarded to a pathology lab online. The pathology lab sends for blood collection at the patient’s home and forwards the report to the doctor who sends the prescription to the patient with a copy to the e-pharmacy. E-pharmacy delivers the medicines to the patient every month. Each of these steps will be augmented by artificial intelligence. What we are witnessing is virtual 1.0; the impact of virtual 3.0 will be far-reaching. It is difficult to comprehend that we’re in the middle of a paradigm shift.
Like all virtualisation, virtual health requires flexibility, creativity, and the ability to see what healthcare can be, not what it has been. Instead of trying to ape the physical world, we should reimagine the future of healthcare where we move from sickness to wellness, from reactive and episodic to proactive, preventive, personalised, and data-driven care.
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