A paradigm shift and the way forward

Dr. Suchita Markan, Asst. GM, BCIL, speaks on the compelling need to integrate IT into healthcare to foster and deliver efficient healthcare, Asst. GM, BCIL, speaks on the compelling need to integrate IT into healthcare to foster and deliver efficient healthcare

Healthcare is the world’s largest and fastest growing industry. In India, public healthcare system is responsible for spending of one per cent of GDP (effectively about Rs 1000 per capita). In contrast, approximately three per cent of the GDP (an average of Rs 3675 per capita) per annum is spent in the private sector on healthcare. With the demand for public healthcare far exceeding supply, there arises the need for devising ways and means to increase the productivity of the public healthcare systems with limited resources. The best way to increase the productivity of any system/ sector is its integration with the latest advancements in technology, more particularly Information and Communications Technology and healthcare is no exception. We have a new buzzword healthcare IT.

To define healthcare IT, it refers to the use of IT services, products, software, and solutions by healthcare organisations to integrate and streamline various processes. In healthcare, IT is used to develop a secure environment and maintain a uniform flow of information. It improves the quality and efficiency of the services delivered and helps in reducing errors in the healthcare industry.

To enable healthcare industry to foster and deliver efficient healthcare to cater to the huge demand, integration of IT into healthcare is a compelling need. This need can further be appreciated in light of the following healthcare challenges being faced by our healthcare sector which are also opportunities for healthcare IT sector:

• Huge urban-rural gap: Rural India accounts for 70 per cent of the Indian population but 80 per cent of the health infrastructure is in the private sector. The medical insurance coverage is a mere five per cent, limited almost entirely to the urban, educated, middle classes in India’s larger cities. This gap makes out a strong case and represents a huge opportunity to deliver healthcare services from urban to rural areas through use of IT tools such as Telemedicine as India has very good mobile coverage in the rural areas.
• Inadequate trained and skilled manpower: As per WHO report, India is placed in the category of critical shortage of health service providers with 0.7 doctors and 1.5 nurses per 1000 people. The WHO average mandate is 2.5 doctors per 1000 people. According to the Planning Commission (now NITI Aayog of India,) we are short of 1.54 million doctors and 2.4 million nurses to match the global patient to doctor ratio. This offers itself as an opportunity for integration of IT with the healthcare ecosystems wherein limited skilled manpower in Indian healthcare sector must be IT-enabled to increase their efficiency for effective healthcare delivery to the patients in remote locations.

Fragmented Health Information Systems

To strategise, develop and implement any healthcare solution into the system, requirement of reliable and adequate data is the starting point to appreciate the quantum of unmet needs and market opportunities. The data about disease burden, birth and death rates is not up-to-the mark in India. Getting quality, clean, up-to-date data is difficult in the health sector in our country. This is despite the presence of many agencies ranging from NASSCOM to the Registrar General of India to disease-specific programme-based systems to survey malaria to HIV. Data is incomplete (in many cases it excludes the private sector) and many a time, it’s duplicated. This embarks another opportunity for the IT sector to bridge the gap.

Weak primary healthcare sector

Although the public healthcare sector has made strides in recent past with various new initiatives and schemes to benefit the patients, there is a huge shortfall of primary healthcare centres and community health centres viz a viz the population. Healthcare IT sector can take this as an opportunity for public and private sector alike wherein IT enabled solutions can deliver efficient services to make-up this deficit.

The Indian healthcare IT market has a huge potential. It is valued currently at $1 billion and is expected to grow 1.5 times by 2020 as per NASSCOM. The rising number of healthcare institutions and the emerging need to modernize the same is contributing to the growth of healthcare IT. Today, IT is being used in most of the hospitals in work force management, patient record keeping, billing, finance, administration and pharmacies. In large corporate hospitals, IT is being used in telemedicine (in some cases), hospital management information system, electronic medical record keeping etc. Next wave of IT adoption in healthcare sector will include data management by cloud computing, wireless technologies, BIG data, teleradiology, picture archiving and communication systems(PACS), real time monitoring systems etc.

Adoption of IT into the healthcare systems can have several advantages including the following:

• The quality of service can go up and hospitals can turn more efficient in terms of reach and delivery of service.
• Integrated electronic medical records facilitate quality research as data is made available in structured manner which helps in studying trends and identifying disease outbreaks etc.
• By means of creation of electronic patient record, each patient’s blood group, reports of investigations etc. would be documented and available which prevents manual errors.
• IT also facilitates remote diagnosis of patients through data exchange/ telemedicine. As a result, people in rural areas can also have access to consultation from speciality doctors.
• It can also enable Customer Relationship Management (CRM) as this is a very important facet for specialty hospitals and chain hospitals, in terms of patient loyalty.
• IT also helps patients move seamlessly across different geographical locations.
• IT provides the flexibility to procurement and billing.
• IT also provides accounting framework and therefore help with entire billing, inventory management, store management, laboratory management, etc.
• By virtue of streamlined processes and efficient management, hospitals will also experience better return of investments made by them.

Recognising the immense potential and importance of e-Health or IT in healthcare, Government of India has also launched various initiatives in this sector.

An important landmark in the healthcare sector in the country is formal release of National Health Policy 2017. The Policy has been recognised as a historic milestone in the Indian healthcare sector as it has been finalised after lot of deliberations and brainstorming, fifteen years after the issuance of earlier policy in 2002. It demonstrates the endeavour of Government to create a healthy India where everyone has access to quality healthcare and the policy specifically mentions about commitment of government towards setting-up digital health technology ecosystem in the country.

Recognising the integral role of technology (eHealth, mHealth, Cloud, Internet of things, wearables, etc) in the healthcare delivery, a National Digital Health Authority (NDHA) will be set up to regulate, develop and deploy digital health across the continuum of care. The policy advocates extensive deployment of digital tools for improving the efficiency and outcome of the healthcare system. The policy aims at an integrated health information system which serves the needs of all stake-holders and improves efficiency, transparency, and citizen experience. Delivery of better health outcomes in terms of access, quality, affordability, lowering of disease burden and efficient monitoring of health entitlements to citizens, is the goal. Establishing federated national health information architecture, to roll-out and link systems across public and private health providers at State and national levels consistent with Metadata and Data Standards (MDDS) & Electronic Health Record (EHR) will be supported by this policy. The policy suggests exploring the use of ‘Aadhaar’ (Unique ID) for identification. Creation of registries (i.e. patients, providers, services, diseases, documents and events) for enhanced public health/ big data analytics, creation of health information exchange platforms and national health information network, use of National Optical Fibre Network and use of smartphones/ tablets for capturing real time data are key strategies of the National Health Information Architecture.

The policy advocates scaling of various initiatives in the area of tele-consultation which will entail linking tertiary care institutions (medical colleges) to district and sub-district hospitals which provide secondary care facilities, for the purpose of specialist consultations. The policy will promote utilisation of National Knowledge Network for Tele-education, Tele-CME, Tele-consultations and access to digital library.

The policy also envisages to leverage digital tools for generation and sharing of information about AYUSH services and AYUSH practitioners, for traditional community level healthcare providers and for household level preventive, promotive and curative practices.

• Other important initiatives in this direction include initiatives such as E-health initiative which is a part of Digital India drive launched by Prime Minister Mr Narendra Modi in 2015 and aim at providing effective and economical healthcare services to all citizens. The programme aims to make use of technology and portals to facilitate people maintain health records and book online appointments with various departments of different hospitals using eKYC data of Aadhaar number. The broad aim of e-health is to provide effective, economical and timely healthcare services to all individuals, and especially to those people who have little access to healthcare services. An eHospital App has also been launched with an Online Registration System (ORS). This initiative allows us to skip the hassles of registration and other formalities required at hospitals.
• Government of West Bengal has introduced G1 Digital Dispensary which aims to provide people from rural areas access to primary healthcare services.
• A unique initiative for healthcare ‘Sehat’ (Social Endeavour for Health and Telemedicine) has been launched at a government run Common Service Centre (CSC) to empower rural citizens by providing access to information, knowledge, skills and other services in various sectors through the intervention of digital technologies and fulfilling the vision of a ‘Digital India’.
• Various other e-Health initiatives which are being implemented in various states of the country include- Drug Logistics Information & Management System (DLIMS) which handles procurement, storage and distribution of medicines, drugs, injectables, surgical goods and medical equipments, e-Aushadhi- a supply chain management application for bringing transparency in purchase, inventory management and distribution of various drugs, Birth and Death entry application system, E-Olakh, E-Mamta, Blood Bank management system, Beti Vadhaao, E-Mitra, Asha Soft, Pregnancy, Child Tracking and health Services Management System, Computerised Human Resource Information System (CHRIS), Hospital Information System, Mobile Kunji, M-sehat  etc. to name  a few.

Digital AIIMS – A laudable initiative in public healthcare sector

Although the policy initiatives by the GoI will reap its noticeable results in due course of time, there have been few noticeable success stories in health IT adoption in the country which can be emulated country wide e.g. The Digital AIIMS project, with nearly 45 lakh beneficiaries, has had the highest footfalls of Digital India Projects. AIIMS has been felicitated by the Ministry of Electronics & Information Technology for reaching the milestone of India’s first fully digital public hospital.

The Digital AIIMS project, implemented as part of the Digital India Initiative, has been widely termed as the First Digital Revolution in Healthcare in India. It has two components – the e-Hospital Project and the AIIMS Transformation Project. It has reduced patient wait times by six hours per visit and freed up clinicians’ OPD timings, brought transparency and streamlined patient records. Till date, its online registration has benefitted 45 lakh patients. The Aadhar-linked online registration system enables the patients to develop online OPD cards and has a linkage with Pay Gov portal for making online payments. The Prime Minister in his 2016 Independence Day address commended the Digital AIIMS project and exhorted for its replication on a pan India basis. The Digital AIIMS project can benefit about 3 crore patients if successfully replicated on pan India basis and is in the process of implementation.

DocsApp: Doctor in your mobile

Another interesting success story in the private sector domain is the story of two IIT Madras alumni Satish Kannan and Enbasekar D about DocsApp. DocsApp is an online specialist doctor consultation mobile app. The thought behind the entire concept is to make the healthcare industry more efficient and accessible to the commoners. Their mantra is #NoAppointment #NoTravel #NoWaiting – for doctor consultation. So no more waiting in line, or travelling long distances to meet the specialists. The doctor is just a click away. DocsApp has a lot of features that will make you want to download the app and start using it instantly. They have specialist doctors from depts such as gynaecology, dermatology, general medicine, paediatrics and psychiatry who provide consultations on DocsApp. Other advantages that this app offers include:

• Patients can get consultation through Chat or Call mode and also upload pictures of affected areas or medical reports. It is like Whatsapp for patients and doctors.
• Patients can also get diagnostic tests done at home.
• On DocsApp, patients can consult a doctor from the comfort of the home and receive the same quality consultation.
• Diagnostic tests are also arranged at home through the app and the reports get automatically uploaded into the app. Patients can save time, effort and money by consulting online.

DocsApp is a huge success and it has received an amazing response till now. This app has connected patients not just in cities but from every nook and corner of India to top doctors in Bangalore, Bombay and Delhi. Currently, they have six million patients from all over the country and a team of 1200 specialist doctors from various fields having different specialties. Apart from this, they have partnered with more than 1000 diagnostics lab centres across India to do home pick up of samples and medicine delivery in about 110 cities.

Other noticeable cases include- Technologies Private Limited, a Chennai-based healthcare technology firm which has raised $ 10 million in a Series B funding from Qualcomm Ventures and Norwest Venture Partners in order to expand its digital healthcare solutions from the current 200 hospitals and laboratories to 25,000 such facilities globally. Pluss, a Gurgaon based on-demand medicine and healthcare products delivery service start-up has raised US$ 1 million in pre-Series A funding from IDG Ventures, India, M & S partners, Singapore and Powerhouse Ventures, US. The company would use the funding to upgrade its technology and expand presence in five cities.

Healthcare IT- current status and way forward

IT has become an integral part of healthcare service delivery, patient and operations management in tier-I cities and in private hospitals wherein it has become an integral part of process management, patient record management and hospital management information systems (MIS/HMIS). It is bringing huge efficiencies into their systems and provide necessary avenues for instant information retrieval.

The Healthcare IT sector is facing its own set of challenges including issues related to initial investments, lack of in-house IT expertise, manpower training requirements, reluctance by the staff to change management systems and lack of confidence in adoption of newer technologies etc. Although, majority of the private sector has adopted technology and IT as an integral part of their operations for efficient service delivery and there are also few success stories to cherish, however, there is a strong need to upscale IT adoption in healthcare system in India in both public and private sector alike and full integration of systems to unleash the immense potential that this sector offers. India, being the world’s largest sourcing destination for the IT industry with established legacy in IT sector needs to marry healthcare sector with IT to bring about systemic changes and transform this sector into digital healthcare sector.