Combating the shortage of  ICU care during COVID-19

Dr Sandeep Dewan, Founder and Managing Director of Springer Health (CritICU), Dr Dhruv Joshi, Director and Co-founder of Cloudphysician and Dr Dileep Raman, Co-founder and Director of Cloudphysician are helping to provide effective treatment to critical COVID-19 patients at hospitals in smaller districts. Dr Joshi and Dr Raman give details to Sanjiv Das on how their start-ups have focused on combating the care giver shortage for ICUs, especially in rural and remote locations, by incorporating technology, to help fight against COVID-19. Cloudphysician has helped over 10,000 patients that total more than 26,000 patient bed days, managing over 300 ICU beds across 20 hospitals in eight states. Springer Tele-ICUs has saved over 450 lives and treated above 5000 patients in the past one year, with a network of over 550 tele-ICU beds spread across 24 districts of India and four countries across the globe. Both projects received grants from ACT Grants, a Rs 100 crore grant set up specifically to fight the pandemic. Cloudphysician received Rs 19.4 lakh whereas CritICU received Rs 45 lakh

Given the acute shortage of ICUs to treat COVID-19 patients in the country, what role did tele ICUs play to combat this crisis?  How does a tele ICU model work? 

Dr. Joshi: The ongoing COVID-19 pandemic has not only highlighted the shortage of ICUs but also further strained India’s pre-existing shortage of intensivists. Further most of the intensivists are predominantly concentrated in the large corporate hospitals of metro cities leaving smaller and rural areas deprived of quality healthcare. Healthcare facilities are understaffed and under skilled to deal with the projected massive influx of critically ill patients. Additionally the increased risk of infection is also a barrier in providing critical care to patients’ admitted in ICUs. Tele-ICU facility is helping with providing effective treatment to critical COVID-19 patients at hospitals in smaller districts and has become a key tool in reducing deaths in these hospitals and keeping the healthcare professionals at a lower risk of catching the infection.

Dr Dewan: Tele-ICUs typically consist of a two-way bedside video chat program that connects clinicians with critically ill patients at their bedsides. Unlike a face-to-face ICU, in the tele-ICU, patients might be miles away from their doctor, or even in a different state. CritICU provides doctors with a live feed of their patients and real time monitoring of multiple patients at once. It provides a solution to scarce critical care resources and growing physician and nurses’ shortage. It’s a clinically proven program to improve quality outcomes & to reduce ICU mortality rates. They provide world class critical care in and Tier II/Tier III cities which enhances the quality & patient safety.

Dr. Joshi: Cloudphysician, using its smartICU platform, RADAR, provides ICU expertise to hospitals for 24/7 access to ICU specialist doctors. RADAR, connects command centres staffed with intensivists 24/7 to hospital ICUs. This allows one intensivist to cater to 60-80 patients in multiple locations as opposed to 1:15 with an intensivist at the bedside. RADAR digitises and analyses patient data and provides clinical decision support to these super specialist doctors at the command centre who then, together with the bedside team, ensure evidence based care of ICU patients thereby saving lives.”

How cost-effective is tele ICU for hospitals and patients?

Dr Joshi: A large majority of hospitals in our country which are treating critically ill patients do not find it logistically or financially feasible to have intensivists available to treat their patients 24/7 in every area or district. In such a setting using tele-ICUs benefits hospitals since the cost of remotely available intensivists is significantly lesser than bedside intensivists. Patients that have access to remote expertise can often be managed appropriately, quicker and in settings closer to home without having to be transferred to large corporate hospitals saving precious minutes for critically ill patients and most often saving them significant sums of money.

Dr Dewan: This service is bridging the quality care gap which is generally faced by non-metro cities. Patients all over the country should have access to critical care for saving lives. This will lead to lower mortality rate and increased recovery rate due to real time monitoring even in remote locations.

How can the medical fraternity be benefited from this service?

Dr Joshi: Tele-ICU service plugs a major gap in our existing healthcare delivery system where there has been high mortality rates because hospitals do not have access to ICU specialists.  Using a solution such as tele-ICUs addresses the shortage of ICU specialist doctors being available including in relatively resource starved areas, thereby ensuring better outcomes of patients. It has been known that critically ill patients require specialised care.

Dr Dewan: Especially during COVID-19, this service is useful for the healthcare professionals and frontline workers to minimise the risk of infection by providing real time virtual care to the patients in remote as well as tier 2 and tier 3 districts where people have to travel to the metro cities to avail critical care services.

Till now how many patients could Cloudphysician and Springer Tele-ICUs cater to using tele ICU?

Dr Joshi: Cloudphysician has helped over 10,000 patients that total more than 26,000 patient bed days. Today Cloudphysician manages over 300 ICU beds across 20 hospitals in 8 states.t

Dr Dewan: CritICU has saved over 450 lives and treated above 5000 patients in past one year and has a network of over 550 Tele-ICU beds spread across 24 districts of India and four countries across the globe. Springer Tele-ICUs is also focused on training and skill development of critical care nurses and doctors and have trained over 10,000 doctors and nurses in critical care medicine.”

With which state governments have you partnered with? What is your experience working with the government?

Dr Joshi: Currently Cloudphysician is working with the Governments of Karnataka and Maharashtra. Additionally, Government institutions have been at the forefront of combating COVID-19 over the past several months. It is common knowledge that the healthcare delivery system as it existed was not equipped to handle the caseload of critically ill patients. Governments are acutely aware of this and have been very proactive in adopting innovative solutions such as these tele-ICU services to help address this gap. There are dynamic decision makers in these institutions who are openly embracing technology and working with us closely to ensure better outcomes to patients and safety of healthcare professionals in these times.

Dr Dewan: CritICU is in partnership with the Governments of Madhya Pradesh, Chhattisgarh, Haryana and Maharashtra and managing over 325 COVID-19 beds for the government.

You are catering to patients in remote areas. What are the challenges of working in remote locations with limited Internet facilities?

Dr Joshi: To make the tele-ICU model work, internet connectivity is must more than anything.  This can be a leased internet line with at least 20 mbps or a broadband with at least 50 mbps.  In India with government efforts towards Digital India, it has been found that India’s telecom/internet coverage is quite good and hospitals, even in remote areas, are able to get access to good internet. Other challenges of deploying solutions to remote areas include the hospital’s ability to attract, train and retain bedside healthcare personnel. While Cloudphysician does help with training the bedside team before we start providing services, attracting and retaining talent is largely in the hands of a hospital’s administration

What should start-up companies as yours do to capitalise on the business opportunities?

 Dr Joshi: We are on a journey to bridge the gap between healthcare and accessibility in India and due to COVID-19 this gap is much clearer than ever. Furthermore we are developing pure technology solutions to address this problem keeping in mind the requirements and the capabilities of the caregivers in India who would be using them. Given the different resource background in India, customised solution are needed for critical care that enables access, quality and cost effectiveness suited for Indian hospitals and lowers the mortality rate in rural areas. Given the lack of critical care specialists in most parts of the country there are more companies that are working in the same space and providing customised solution to add on to the healthcare infrastructure of the county. With the help of ACT Grants, we are able to fasten this process and contribute towards the fight against COVID-19 and we are looking forward to a pan India reach patients do not have to travel to metro cities for ICU care.

Dr Dewan: Quality healthcare is required not just in metro cities but also in tier 2, tier 3 and rural and remote areas. Every life is precious and keeping this in mind we are working towards maximising the critical care landscape by empowering the intensivists and healthcare professional with our technology. ACT Grants is also working towards empowering the healthcare system India and by the grants provided by them we are doing our best to help hospitals deliver critical care for COVID-19 in various states.

We are tying up with various private as well as government hospitals with the main objective of lowering the morality rate due to COVID-19 and making ICU care accessible and affordable by safeguarding the frontline workers as well as the patients. Start-ups working with the similar goals to make an impact on the healthcare system by using technology and specialised services have scope to grow currently to fight this pandemic and streamline our healthcare delivery system