Dr. Chandrashekhar, an anaesthetist serving as an intensivist at Tumkur District Hospital, has a unique job. One of his primary roles as in-charge of the intensive care unit, or ICU, is to collaborate with an intensivist at Columbia Asia Hospital in Bangalore. His team uses inputs from Columbia's Tele-ICU team to treat patients, many of whom are serious cases of organophosphorus poisoning and snake bites. They have handled over 250 critical cases over the past seven months with significantly improved survival rates. They have also developed and implemented training and treatment protocols to standardise health-care delivery. All this is part of a Tele-ICU pilot executed by the Karnataka government, Columbia Asia Hospital and GE Healthcare. Such initiatives are slowly becoming commonplace.
Years ago, things were different. In health care, information technology started by focusing on processes - automating tasks such as accounting and payroll, and then moved to support B2B processes such as supply chain. There was not much focus on patients.
However, advancements in digital technology have ensured that health-care providers become more comfortable in using digital solutions/services. Today, digital health means the use of advanced analytics based on multi-modal data such as Healthcare Internet of Things, which uses sensors, apps and remote monitoring to provide continuous clinical information, apart from cloud-based solutions that enable doctors to access the information they need to care for patients from their home, their office, or even 500 kilometres away. All this means accepting the machine as an integral part of the team, use of learning platforms to provide tools at the point of care so that doctors deliver better outcomes, and provision of customised care while also caring for millions simultaneously.
Indian scenario
The question is, what potential does digital hold for health care in India? Health care in India is characterised by scarce resources and massive needs. One way to solve these problems is to make things affordable and build more infrastructure. However, there will always be problems of scalability, financial viability and how much physical infrastructure can be created over a period. And that's where digital has a big role, as digital interventions are usually asset-light, not dependent on heavy physical infrastructure, and easily scalable. Digital solutions can overcome fundamental barriers to access and quality
Building a strong and equitable health-care system is an important landmark in a developing country's journey to becoming developed. That can happen only if we provide quality health care to large segments of the population, which today is not the case in India.
Take an example. In 2014, over five million people in India suffered a heart attack. Three million of them did not survive. Out of the other two million, several suffered irreparable damage to the heart. In spite of the alarming rise in the number of cardiac cases, India lacks immediate diagnosis and coordination systems, especially in smaller towns. The likelihood of surviving a heart attack is over 80 per cent if action is taken within the "golden hour" or even within the first two hours. However, the average time between symptom and treatment in India is over six hours. Many lives can be saved by just reducing this time. While heart attacks can be detected by a quick and inexpensive test called ECG, we continue to be victims of two critical issues - 1) most primary care clinics are not equipped with ECG machines; and 2) many health-care providers at primary care centres do not have sufficient training.
That is why Tricog, a Bangalore-based start-up, has partnered with GE Healthcare to develop cloud-connected ECG devices that are placed at under-served locations to help doctors detect heart complications. Within minutes of an ECG test, cardiologists at Tricog's centre complete the diagnosis and share the interpretation with both the patient and the local doctor in real time. The system is designed to additionally enable continuity of care at a tertiary centre through timely referral. Patients can also see their records and show them to doctors in future.
Use of this cloud technology is helping in quick, accurate and affordable diagnosis, leading to significant reduction in mortality. Over 350 centres in Karnataka, many in places such as Kolar, Chanapatna and Mandya, have screened over 1.3 lakh people in the past one year. Over 8,000 critical patients have been identified and provided care. Imagine the impact of such a solution if adopted at a large scale.
The situation is no different in critical care. In India, over five-million patients require ICU care. Only 70,000 ICU beds are available; also, less than 15 per cent patients receive dedicated intensivist care. A study by Leapfrog Group shows that intensivists bring down the chances of patients dying in the hospital by 30 per cent. The Tele-ICU we talked about at the beginning is fast emerging as a reliable and cost-effective way to connect ICUs in remote hospitals to those in metro centres. It enables hospitals in remote areas to provide advanced consultation, care and monitoring to critically-ill patients. This also reduces costs and risk of clinical deterioration.
Fortis was an early mover in this space. CritiNext, an e-ICU solution developed by it in partnership with GE Healthcare, is Asia's first tele-ICU programme. CritiNext today manages over 350 ICU beds in 10 cities. The programme manages over 150 ICU beds in cities such as Amritsar, Dehradun, Raigarh and Khulna (in Bangladesh), providing the best possible care from its Delhi centre to over 500 critical patients every month. Tele-ICU is a great example of how one can take scarce, quality expertise and through technical innovation extend its reach to people in Tier II/III cities. Geography is now history.
Leveraging Digital
Radiology was one of the first specialties to go digital. Today, hospitals store hundreds of millions of digital images. The number is only growing as we become better at capturing thinner and thinner slices of the body. There is no way humans can turn that much data into useful information. That is why, at the University of California, San Francisco, clinicians are working with GE to develop a library of deep learning algorithms to revolutionise the speed at which scans are interpreted and patients receive care. The collaboration is initially focused on high-volume, high-impact imaging to create algorithms that distinguish between what is considered a normal result and what requires a follow-up. For example, an algorithm under development screens X-rays for pneumothorax, or a collapsed lung, which can be life-threatening. It will focus on teaching machines to distinguish between normal and abnormal scans so that clinicians can prioritise and treat patients with pneumothorax more quickly. This could result in better outcomes, reduced costs and better patient experience. Such a solution will have great applicability in India where the high number of patients puts immense pressure on time for treatment and shortfall in availability of skilled resources impacts effective clinical diagnosis.
Closer home, Max Hospitals is leveraging digital technology to drive greater efficiency and productivity. In a first-of-its-kind digital deployment, it has connected five of its facilities using the Centricity IT platform, enabling significant improvements in operational efficiency, resource sharing and, more importantly, delivering great benefits to patients. Because of this, Max Hospital in Dehradun, which conducts about 125 radiology exams daily, is able to do 40 per cent case reporting, many of them complicated, through radiologists based out of other centres in the network. Linking the centres also helps in managing the additional load that a centre may encounter. Once fully implemented, the 12 Max hospitals will generate over 1.2 million radiology exams every year that its 2,000-plus doctors will be able to access from anywhere, delivering seamless care to patients.
Equipment uptime is another factor driving productivity and patient throughput. Today, digital tools are being used for predictive monitoring of equipment to avoid unplanned downtime. Customers in Europe reported a 32 per cent reduction in unplanned downtime for CT scanners after using predictive monitoring tools. The benefits are particularly high in a resource-constrained environment such as ours.
Skilling the Digital Way
The digital technology can address the skill-gap problem through e-courses and training. In a primary care setting, you have to help health workers deliver the maximum throughput. In secondary and tertiary settings, health-care workers need to hone their skill sets and apply them in ways that they are optimally utilised. How can we use education platforms and on-demand learning apps that can help them become better at what they do? How can we enable and empower them to take the right decisions at the right time? Imagine a world where they have access to expert guidance on clinical diagnosis through tools powered by artificial intelligence and virtual/augmented reality. The possibilities are endless.
With 'Internet of Things', we will see a shift from hospital-centric to patient-centric models where patients will not have to travel long distances and wait for hours to get a doctor's attention. The convergence with technologies such as cloud will drive better clinical analytics. The proliferation of smart phones, better data connectivity and plethora of digital tools and applications are creating a universe of consumers who are opening up to the possibilities of what digital can do for their health.
At a time when technology is making the impossible possible and driving inclusive growth, health care is not going to be left behind, especially with India taking rapid strides in the digital field. However, Indian health care must choose its evolutionary trajectory wisely. The key will be to socialise the use of digital solutions so that more and more people benefit. Digital's true impact on health care in India will be felt only when it fundamentally transforms the way value is created at scale for patients and providers alike. The good news is, we are already seeing that transformation under way in pockets.~