Innovations in healthcare has and will always play a key role in shaping the future of this sector. In the past few years, the Indian healthcare sector has witnessed some amazing innovations in terms of technology, medical applications, breakthrough procedures and business models that have been a great contributor to the sector’s progress. Express Healthcare spoke to some experts who share their observations on key innovations and related aspects that will influence India’s healthcare progress in the coming year. These leaders elaborate on how these innovation will impact the live of people in India and how it groom the industry further. Excerpts….
Revolutionising heart care
Treatment of heart disease has evolved a great deal. Options that will become popular in the coming year will involve least trauma, greatest safety and best results.
Transcatheter Aortic Replacement (TAVR): Until recently, the only way to replace a heart valve (in case of severe aortic stenosis, or narrowing of the aortic valve opening) was through a major surgery. This involved putting the patient on a bypass pump, stopping the heart, and cutting the heart open to put in a new valve. Now it can be done non-surgically through a puncture in the groin. In an angioplasty-like procedure, a compressed tissue heart valve is placed on the balloon catheter and is positioned directly inside the damaged valve. Once in position, the balloon is inflated to secure the valve in place. It’s much safer and recovery is quick too. The whole procedure takes just one to two hour. At present, it is recommended only to those patients who have a high risk for surgical AVR as the complication rates are still high. This is a relatively new procedure and affordability remains an issue for a majority of patients. Doctors in India are still getting trained in this procedure. As time passes, more and more such cases will be done once doctors get trained and the cost of valve comes down.
Augmented Reality (AR) in medicine: AR has the potential to revolutionise the way surgeons are getting trained and planning surgical treatments for patients. Doctors and even patients are aware of the fact that when it comes to surgery, precision is of prime importance. AR can help surgeons become more efficient at surgeries as they can use AR platform to plan complex procedures. This will definitely reduce the complications. AR can thus help save lives and treat patients seamlessly.
PCSK9 inhibitors: The PCSK9 inhibitors (PSK9i) are a new class of injectable drugs that have been shown to dramatically lower LDL cholesterol levels. If you need medicine to lower your cholesterol, chances are your doctor will prescribe a statin which is currently the main medicine for reducing cholesterol levels. Some people can’t take them because of their side effects. For such patients, no other medication is available. PCSK9 is said to be more effective than statins, however, we still do not know the long-term effects and the cost is prohibitive. We are hoping that it doesn’t have the statin side effects which include liver dysfunction, muscle pain etc.
3-D bioprinting: With applications in congenital heart disease, coronary artery disease, and surgical and catheter-based structural disease, 3D printing is a new tool that is challenging how we image, plan, and carry out cardiovascular interventions. It can help with planning interventional procedure, placing percutaneous valves, print implantable devices such as cardiac valves that could then be customsised to the patient.
– Dr Ramakanta Panda, Vice Chairman and MD, Asian Heart Institute, Mumbai
Role of prebiotics and probiotics in managing diabetes
Recent understanding of role of gut bacteria in management of obesity and diabetes is probably the most important finding of the century.
The last decades have experienced an exponential increase in the number of people suffering from obesity and its associated disorders such as type II diabetes. Recent research has been highlighting an increasingly more important role of gut microbiota in metabolic disorders. It’s well known that gut microbiota plays a major role in the development of food absorption and low grade inflammation, two key processes in obesity and diabetes.
A recent study published in the International Journal of Obesity, shows that people who have a stable weight over nine years or lose weight, have a large number of different types of microbes in their guts, eat more fibre and have a higher abundance of certain types of gut microbes.
Studies in mice have demonstrated that how the body converts food into energy depends in large part on the different types of microbes a person has in their gut and also on the kind of microbes they carry.
Why is it an innovation?
Research suggests that changes in life style that involves increased food consumption and reduced exercise in addition to gut microbiota contribute more to metabolic diseases.
As a result, better understanding and utilisation of various prebiotic and probiotic bacteria may prove to be beneficial in the treatment of metabolic diseases in the future.
This find will transform the management of chronic diseases through bacterial relocation. If effectiveness of this treatment is established then vast population can be cured of these illnesses.
Food industry will evolve to play therapeutic role in management of chronic diseases.
This is likely to result in healthier individuals living longer. Pharma and food industry may work together for positive health.
– Dr Ramen Goel, Senior Metabolic & Bariatric Surgeon, Director – Center of Bariatric & Metabolic Surgery, Wockhardt Hospital
Augmenting information ecosystem
Story on five innovations (technology, medical applications, breakthrough procedures or business models) that will impact the industry
Role of Big Data
The next big innovation in India in healthcare will not be a miracle drug. It will not be built just with fibre optic cable or new hospitals. It is going to be built with big data, that gets generated by insurers, healthcare providers, medical practitioners, research centres and other organisations in the healthcare ecosystem.
Enormous data is already being generated across the ecosystem– though mostly in silos and is non digitised – from insured applications and claims information, electronic medical records, treatment costs and outcomes, and clinical trial results. However, the biggest innovation is not the amount of data, but what is done with it. There is a need to build a health information ecosystem that looks at capturing the data electronically and allows data to flow through and interact with various permitted stake-holders.
Bringing all of this data together with different stakeholders will help every stakeholder draw significant insights on how to better manage various aspects of healthcare using their respective business models.
Preventive aspects
The vision of the government is to give India’s citizens a wider access to healthcare and guarantee the best quality treatment at an affordable cost. This necessarily calls for a system that looks at both the preventive and curative aspects. While the physical infrastructure of primary, secondary and tertiary healthcare facilities will deliver the last mile care, the digital and data infrastructure would help in preventive side as well as bring greater efficiencies in the curative side.
The efficiencies would come from standardising treatments, cutting unwarranted costs due to frauds or abuses and create a platform of preventive care that addresses not just wellness and social priorities but also helps prevent or control epidemics or other communicable diseases. This would also be a great social leveller. The innovation also lies in the fact that organisations aligned to healthcare are capable of using the data to create wider benefits like research on drug efficacies to better penetration of health insurance to a wider angle of population health management.
Impact
It is apparent that India’s healthcare is on the verge of a digital transformation, able to deliver personalised care, underpinned by a data-rich and data-driven ecosystem.
With the increasing amount of data being generated in healthcare as a result of advancements in biomedical technologies and data standardisation at the point of care between health insurers and the providers, it is important for stakeholders such as health insurers and healthcare companies to capture, as well as engage with, the new data sources and appropriate technologies.
Analysis of this big data will help the sector deliver better patient care, develop innovative methods for improving healthcare, as well as make payments faster to the providers and decrease the fraud, waste and abuse in the health ecosystem, thus easing out the cost burden.
Common ground for data governance
While the move towards creating an information technology infrastructure for healthcare was first started by the government in 2002, it has not been a sustained endeavour.
The imperative for health analytics today is that all the stakeholders must establish common ground for data governance and usability, and invest in capabilities to share and work with data. It all adds up to acquiring capabilities for data analysis, data management, and data systems management.
In order to harness this innovation, all healthcare stakeholders must invest in technology, which today is a major hurdle in standardising and consolidating data. We need to see an accelerated move towards creating electronic records of all data generated, making the stored data usable, searchable, and actionable by all the stakeholders. Data on a common, open platform will enable stakeholders to analyse the data for obtaining relevant insights.
– Abhijeet Ghosh, Director, Vertical Market (Health), Insurance, India LexisNexis Risk Solutions
Boon for IVF treatment
Egg freezing technology is a technique by which eggs can be preserved to create an embryo at a later date. It allows a woman to take control of her reproductive life, she can plan life and pregnancy and need not be bogged down by the ‘biological clock’. Egg freezing empowers a woman by allowing her to postpone child bearing till stable in her career and or in her relationship.
Only in 2012 did the American Society for Reproductive Medicine lift the label of experimental technique from the art of egg freezing, though the first healthy birth from a frozen egg was documented in 1986.
The information about this in general public is lacking and dissipation of availability of egg freezing will allow women the option of planning their life. This will allow the career woman to have well planned breaks thus allowing increase in self potential and also beneficial for the team she works with. For employers, this may translate into effective work force planning and thus positively affect productivity.
Companies like Apple and Google have already a funded for their women employees to freeze egg, much like a life insurance policy this is a fertility insurance for the staff.
INVOcell — innovation
INVOcell is a patented medical device where the eggs collected in IVF are mixed with sperm in a receptacle that can then be placed inside the woman’s body so that embryos form. The job of the incubator of a IVF lab is instead done by this device inside the woman’s body.
All steps are same as for IVF except the incubation. This reduces the cost of incubation from the IVF procedure and is aimed at offering a cheaper option for the patient.
Studies have shown that for the correctly selected patient this is as effective as IVF and keeps cost low. This has worked very well in the African setting offering affordable IVF there.
INVOcell was introduced in India but has not gained popularity due to its cost structure. It is as costly as a standard IVF cycle in the urban setting or even more so considering the costing in second tire cities.
Training to identify the right patient who can benefit from this innovation and reduction in the cost of it will be a boon for the industry and may allow for cheaper IVF to be available.
Affordable IVF — business model
IVF cost can be divided into cost of medication, cost of lab procedures and surgeries and cost of freezing. Though certain chains of IVF are aiming to keep the costs low, IVF may not be within reach of everybody.
Two things can help towards making IVF more affordable
Fertility insurance
This has been practically non-existent in India due to a host of reasons. Infertility rates in India are high while the treatment is expensive and hard to find in every hospital. Infertility affects one in six couples, hence, from an insurance company point of view, high chances of claims and pay outs. Fertility is generally not considered necessary for healthy survival. Also, unfortunately despite the first baby born in 1974, most treatments are not considered as time tested by the insurance providers. Hence, funding for infertility insurance is a high-risk proposition. Only recently has the WHO declared infertility as a disease. However, times are changing for the better. Bharatiya Mahila Bank (BMB) has tied up with New India Assurance to offer its women customers insurance to provide cover for fertility treatments.
EMI facility
There are IVF chains that are making the EMI finance options available for their patients enabling a patient to convert their medical bills into no cost EMI finance loan by tying up with a leading finance companies e.g Bajaj Finserve etc. Some features of such finances include easy repayment options, minimal documentation, instant approval and on-spot approval, zero/No foreclosure charges, where and as applicable.
This will greatly change the ease of access to treatment and many couples who may have otherwise postponed treatments till financial security will be able to have treatments earlier with better clinical outcomes. The more a couples age, the poorer the outcome of treatments. Finance options have come as boon for couples struggling due to financial constraints.
– Dr Rajalaxmi Walavalkar, Consultant Reproductive Medicine and Surgery, Cocoon Fertility, India
Capturing real time data
IOT/ Business Analytics and AI will completely take over the healthcare industry in the coming years and change the dynamics of this industry in terms of the process of treatment provided to the Patient. IOT (Internet of Things) will help to capture real time data from all possible medical equipment including wearable devices like watches and blood pressure equipment. Business analytics will help this captured data to convert it into meaningful outputs for treating existing patients and predicting their health for any future eventualities. Artificial Intelligence (AI) will use the above captured data and analytics to prepare robots to diagnose and operate patients.
Impact
The positive impact is that the healthcare industry will be technology driven and diagnosis will be done more on facts and data that has been captured rather than relying on the doctor’s judgement. The innovation will have a great impact as doctor’s can monitor critical/ chronic patients remotely with real time data and do an online consultation, which will eliminate the need and pain to travel. Software applications will be built able to assist doctors in diagnosis. Simple example is a drug master which has the intelligence to analyse drug to drug or drug to allergy reaction. This was not possible earlier and doctors had to use his/ her own judgement/ knowledge to prescribe medicines.
Industry utilisation
Government/ municipal authorities can use this data to create a health information exchange which can be used to analyse and predict any major epidemic or outburst of disease in a particular locality. Insurance industry can utilise this data to determine their insurance policies based on age, gender, locality, disease, etc. This will help to design new insurance policies or alter existing policies to optimise their business.
Doctors can use this data to better diagnosis as they will have data available from various medical equipment and wearable devices which was not previously available. With this innovation, it will be possible for doctors to remotely monitor patients with real time data which is transmitted by wearable devices. Telemedicine will be widely used to connect to rural areas wherever Internet is available and there is a lack of specialised doctors. With this innovation, robots will be used to do basic diagnosis and to conduct various procedures and surgeries. IBM Watson is an example where a machine is able to do a basic diagnosis of a patient.
– Girish Koppar, Secretary, Hospital Information Technology Association and Sr Manager – IT, Lilavati Hospital & Research Center
Technological innovations
Healthcare delivery is increasingly shaped and enabled by technology. We see technology innovations in three primary areas transforming the manner in which delivery and outcomes will be optimised in 2018 and beyond:
Devices/ technologies for better diagnosis, treatment and pain management: The Digital Spine Analysis is used to provide an objective understanding of muscle strength and flexibility, allowing for a more customised and targeted treatment plan. Use of Frequency Specific Micro currents offers pain relief without the side effect of painkillers. Innovations like these lead to significantly better patient outcomes compared to traditional manual approaches.
Precision medicine based on a personalised diagnosis and leveraging algorithms based on extensive case history: This is the future of medicine. Patient management and a knowledge management system has been developed to classify patients into one of over 100 different case types and leverage our learning’s over 50,000 patients to provide treatment plans best suited to the specific condition of the patient.
Telemedicine: Increasing use of video-based platforms to provide remote delivery of diagnosis and treatment allows for healthcare providers to connect with and provide advanced healthcare solutions even to patients in remote areas.
Healthcare leaders of the future are the ones who are innovating and developing technologies across these three areas.
– Anuj Arenja, MD and Ceo, QI Spine Clinic, the Back and Neck Specialists
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