Remote Care

Seventy three-year-old M.P. Subramanian hails from Narikunni, a small town in Kerala's Calicut district. A diabetic and a heart patient, Subramanian has to visit his endocrinologist once in every two months. All was going well until the lockdown made travelling to the hospital, around 20 kilometres from his home, difficult. Fortunately, two months ago, the hospital introduced telemedicine consultation. "I booked an appointment, logged in, showed my test results, explained my alignments and the doctor made necessary changes to my medicines, through my mobile phone," says Subramanian. "I did not have to travel and get exposed to the virus, but still could get my routine check-up done at the click of a button, thanks to technology," he adds.

At Sri Chitra Tirunal Institute for Medical Sciences and Technology, Thiruvananthapuram, 400 km from Calicut, Syngo Virtual Cockpit, a remote scanning software from Siemens Healthineers, helps technicians and doctors perform scanning while maintaining social distancing. "Usually, for MRI studies, we need to have three personnel in the console room - the radiologist and two technologists. Now, with a remote-scanning assistance in place, only one technologist with protective gown stays in the console," says C. Kesavadas, Professor and Head of Radiology. "The solution ensures social distancing by enhancing a remote-work environment."

The healthcare segment is adopting remote and virtual-care technologies, including telemedicine, rapidly and in a big way. "Remote technologies, including telemedicine, were here for a long time. Many companies started experimenting with telemedicine solutions four-five years back. But they didn't go mainstream," says Daisy Chittilapilly, Managing Director, Digital Transformation Office, Cisco India and SAARC. Four years ago, Cisco did early pilots in Maharashtra and Chhattisgarh to showcase its telehealth offerings. "However, pre-pandemic, medicine was a face-to-face business, and largely a physically dependent sector. Telemedicine was neither accessible nor affordable, and so it was difficult to scale," she says.

Booming Market

Covid-19 has created a necessity for these remote solutions, and has changed the dynamics of the market. Customer adoption has increased significantly in advanced geographies, and is catching up in emerging markets as well, leading to solution providers scaling up their offerings. According to Report Ocean, the global remote healthcare market will be worth $66.5 billion in 2030, from $6.7 billion in 2019. Research agency Frost and Sullivan (F&S) says the US experienced a 200 per cent jump in the use of telehealth platforms in the first quarter of 2020, and 70 per cent physicians started using the same during Covid. It was 15 per cent before the pandemic outbreak.

In India, the telehealth market, including remote monitoring, virtual visits and mHealth, is expected to grow from $201.3 million in 2019 to $679.2 million in 2024, at a compounded annual growth rate (CAGR) of 27.5 per cent, according to F&S. For instance, video consultations and remote consultations, otherwise restricted to patients with chronic diseases, are now finding takers in other areas, including gynaecology, general medicine and dermatology. "Telehealth would have taken more than five years to become scalable. However, it has reported a significant growth in the past six months," says Sowmya Srinath, Director, Transformational Health Practice, F&S. "Virtual visits have also found big takers among the youth during the lockdown period in India," she adds.

Apart from this, the use of other remote technology solutions in the healthcare management segment such as virtual desktop infrastructure, business continuity planning (BCP) and security solutions have accelerated since the pandemic outbreak.

Telemedicine And Other Tools

A seamless and safe diagnostic environment is leading to a sharp rise in the adoption of telemedicine platforms. Technological advancements in the segment are also spearheading the change. According to data from online consultation platform Practo, teleconsultations have gone up by 10 times over the last six months - around 80 per cent of them being first-time users, and around 50 per cent from non-metro cities. "Telehealth has multiple applications. Optimal care and virtual care is possible with these platforms and is extremely helpful in a pandemic scenario like Covid," says C.M.A. Belliappa, a Bangalore-based general physician.

With the market expanding and gaining traction, vendors are offering new tools and bringing in technological advancements. From mere conference calls, telemedicine tools now allow doctors to monitor vital signs such as blood pressure, take x-rays and even assist in operations. Siemens' teamplay myCare Companion, for instance, helps healthcare providers design telemedicine programmes. The solution has a smartphone app for patients to enter their vital parameters and a special workstation for doctors. "Initially used for patients with chronic heart issues, the solution has now been customised to help manage workloads and avoid high patient footfall in hospitals during the pandemic," says Gerd Hoefner, Managing Director and President, Siemens Healthineers India.

Advanced collaboration tools are helping hospitals and healthcare works. Companies such as Microsoft, Cisco, Avaya, Verizon and Zoho are major players in this space. "With social distancing and remote working becoming the new normal, frontline responders and healthcare institutions have swiftly adopted collaborative tools and Cloud-based solutions to ensure continuity in providing quality healthcare," says a spokesperson from Microsoft India. In May this year, Microsoft announced its Cloud offering for healthcare to help hospitals improve workflow efficiencies and streamline interactions with patients. The company also has integrated its solutions such as Microsoft 365, Teams and Fast Healthcare Interoperability Resources to enhance connected care. "The platform brings together chat, voice and video, and allows recording, transcription, scheduling, and managing and conducting virtual visits," adds the spokesperson. Coimbatore-based Ganga Hospitals has used the technology to teach microsurgery live last July, with more than 550 surgeons from 27 countries coming together on the platform.

Virtual Critical Care

Remote technologies are also being applied in the critical-care segment. From real-time smart patient monitoring to virtual ICUs, efficient telehealth solutions are being aggressively implemented across hospitals for Covid as well as non-Covid treatments. Real-time data transmission systems take patient vitals and clinical parameters from one location and transmit to healthcare professionals at another. For instance, Cisco, along with Teslon Technologies, has developed an ICU telecart, which has been installed at Victoria Hospital and KC General Hospital in Karnataka. "The system is helping doctors and healthcare staff provide secure and effective care, enabling them to remotely monitor multiple isolation wards simultaneously for Covid patients, while reducing the risk of exposure and the time of healthcare delivery. Furthermore, with the help of the ICU cart, family members can also lend support and comfort from the safety of their homes," says Chittilapilly.

Healthcare organisations are also using remote solutions for monitoring nursing services and sanitisation activities using location-based network technologies. Integrating ambulances with emergency response systems is also gaining traction. Internet of Things (IoT), 5G, virtual and augmented reality and blockchain are increasingly being used to ensure healthcare facilities benefit patients across a vast country such as India. "These technologies open the door to incredible opportunities, especially among the under-serviced communities in remote rural areas, who previously struggled to access quick and reliable healthcare," says Som Satsangi, Managing Director, Hewlett Packard Enterprise (HPE), India. "The advances we have made for managing urban patients during the pandemic could be used to deliver health services in remote locations. These tools are here to stay post-Covid. With the possibility of delivering most healthcare services remotely, hospitals can now choose treatments that require physical visits," he adds.

Another booming area is the Internet of Medical Things (IoMT) that enhances connectivity and alters the doctor-patient relationship. Data is sent from these IoT devices to physicians via the Internet, but the information can also flow through to broader databases and analytics systems to enhance shared research, and feed the AI.

Monetising Solutions

Experts believe virtual-care technologies and remote solutions are part of a larger trend driven by the digitisation of healthcare, where smart, networked systems will support medical personnel. Patients benefit from personalised diagnostics and therapy. Since most of the solutions have been deployed during Covid, vendors have adopted a consumption-based model to monetise their solutions.

"The world itself is moving from a capex to an opex model. Covid has accelerated the need to go for the opex model since there is a higher need for IT resilience," says Vishal Agrawal, Managing Director, Avaya, India and SAARC. "Earlier, around 70 per cent were capex customers. Now half of our customers prefer the opex model," he adds. It is also helping vendors configure the right solutions, deliver a pay-per-use model and scale up resources whenever needed.

Agrees Satsangi of HPE. "In the post-Covid world, the need for digital transformation will be more critical than ever. This is why we deliver everything as a service, Edge to Cloud," he says. HPE is adopting pay-per-use models for their solutions, including mobile health, telehealth services, AI/ML, IoT and analytics tools.

With the pandemic spreading fast and wide, vendors have reinvented the channels of business delivery. "We revived the accessibility and affordability of our solutions to suit the needs of the industry by accelerating online presence and making the solution bite-sized to incorporate even a single healthcare professional in a remote location," says Cisco's Chittilapilly.

But Glitches Remain

One of the challenges is the need for greater standardisation across healthcare systems. If care providers push for more customised solutions, it will be harder to share healthcare data effectively across systems. "The current challenge is how healthcare systems need to collaborate more and come together to solve bigger problems. Healthcare providers expect a lot of customisation, which hinders the ability to build interoperable systems effectively. Interoperability can help patients have better care and attention, remotely and in real-time," says Hoefner of Siemens.

Mindset change is another issue. For tech interventions to be successful, cultural changes have to happen along with policy regulations, say experts. "Patients have to get more comfortable and there should be regulations on how prescriptions and drug delivery could be done online. It is a combination of infrastructure availability, mindset changes and cultural acceptance," says Chittilapilly of Cisco.

For telemedicine to stay put in the post-Covid world, new technologies need to be in place. "Telemedicine platforms are good for follow-up consultations. But for first-time ones it is a bit challenging since it is difficult to get familiar with patients and diagnose them from at a distance," says R. Surdas, Urologist, AsterMims hospital.

All said and done, experts believe remote technologies will soon become the flag bearer of the healthcare segment. Companies are working to make solutions more seamless and take them to the next level. 5G will offer a plethora of opportunities in the healthcare sector in general and remote healthcare technologies in particular, including the interplay of health sensors, algorithms, and smart devices, for smooth operation of telemedicine. "The ease of use, seamless experience and a holistic approach will propel the next level of usage and adoption," says Agrawal of Avaya.

The current scenario has opened the door to incredible opportunities for these technologies to expand and scale. The next two years are likely to see a lot of action in the space.

(K.T.P. Radhika is a freelance journalist based in Chennai)