DIGITAL TRANSFORMATION

HEALTHCARE IN DISRUPTIVE TIMES

Usha Manjunath, Director, IIHMR Institute of Health Management Research

The integration of IT in healthcare has opened doors for various innovations in the technological frontier. India unlike countries like UK or US has a lot of pitfalls in the healthcare sector and technology is very crucial to address the growing menace. This article explores how the digital transformation in healthcare is shaping the Indian healthcare system.

India’s healthcare market is one of the fastest growing, witnessing an overwhelming growth of nearly 25 per cent in the recent years and rightly so. The market value of Health Information Technology is pegged at USillion and expected to grow one and half times by 2020. The disruption in the sector is driven by technology innovations including IT, biomedical research, healthcare delivery models, population health, financing of healthcare, people and provider knowledge and expectations in addition to the epidemiological spectrum.

The Stage for Transformation is Already Set:

India which has been taking notable steps towards digital proliferation in different sectors has also seen affirmative growth in the healthcare industry. Though not swift, a steady growth has been witnessed. Now with the availability of well-equipped medical devices and telemedicine, the phase of digitisation in healthcare has taken a new dimension. Subsidising to this factor, the ‘Universal Health Coverage’ themed policy of the union budget has been a great boost. In fact, a sole factor cannot be termed as the pioneer to digitisation of healthcare. Several factors have contributed for the digital transformation in healthcare which has been saving millions of lives every day.

Technology, digital literacy, and internet penetration in India is becoming more pervasive and very impressive

We have more than 460 million internet users in 2017, and by 2021, the number is expected to reach 635.8 million users which indicates that digital healthcare is increasingly becoming feasible. Digital connectivity growth of about 15 per cent in 2014 is expected to grow to 80 per cent access in 2034, with rural internet users increasing by 58 per cent annually. Smart phone users with 299.24 million going up to 340 million by the end of 2018 would soon surpass the number of users in the US. Nearly 1 billion subscribers for mobile phones are reported from the country’s telecom regulator and soon they will all become smart phone users. With 2G/3G/4G technology and broadband internet, the healthcare users will look for multiple channel experience from provider companies.

Startups and entrepreneurship

India’s Global Innovation Index is improving, and it is ranked 3rd among the middle-income countries. Despite the protracted profit interval, approximately 300 start-ups entered healthcare information market in 2015. The technological developments in healthcare applications have transformed the lives of people. Health apps have been instrumental in performing various functions like oversee personal vitals to making the treatment easier, real time data capture, telemedicine, point of care devices and trackers. These developments attracted huge funds in 2010-15 for healthcare sectors like Medical Health apps, appointment booking, wearables, telemedicine, data analytics, practice management, wellness and clinical decision systems in that order. In fact, telemedicine industry has been witnessing exponential growth and is expected to be worth US2 million by 2020. Furthermore, even artificial intelligence; augmented reality and virtual reality are changing the landscape of healthcare industry.

Digital India

It is not only that private healthcare is investing in technologies but the Government’s e-health initiatives in line with ‘Digital India’ campaign are giving a fillip to the sector’s growth. Domestic market growth will give a boost to healthcare domain, medical devices, digital applications, and Health IT. Top pharma companies have had 63 per cent unique apps in 2014 compared to 2013. Digital India, Skill India and Start-up India campaigns are bearing fruits and will pitch India for a better ‘Digital Healthcare’.

Reducing rural and urban divide

The technological innovations are modifying the healthcare industry and will loosen the rigid division of urban and rural gradually. Urban areas have much sophisticated healthcare infrastructure while rural areas are lacking basic amenities and access to it, despite having major population residing there. Technology can definitely play a great role in bridging this gap. The use of mobile phones for medical consultations by using videos, image and conference has been a great help to people residing in rural area; who have to strive to seek medical care. Telecare, better patient engagement, health education and public health innovations are already underway.

Health financing

Investments and healthcare funding will be the most critical area that needs attention. Major transformation in Universal Health Coverage must be technology enhanced for transparency, governance, and access to high quality care for all. Healthcare is now at the centre of Central and State budgets: India cannot afford to miss the opportunity for demographic dividend. Commitments in increasing public spending in National Health Policy 2017 to nearly 2.5 per cent of GDP cannot be back tracked. In the private sector, IBEF has highlighted the critical investments in India: Max Healthcare (US$48 million in Cancer care hospital), Practo Technologies (raised USU million), Gamma Group (investing USD9.68 million in health infrastructure and education sectors). This is an indication of growth in the sector and gives a big boost to technology based care, technology adoptions and transformations.

Transformation is Underway:

The dynamic digital transformation that is being spoken of is not something in vogue. In fact, India has always been a steady adopter of technology in healthcare. Today, when integration of IT in healthcare or telemedicine is a proves this reality.

Patient care and safety

Dr. Nandakumar Jairam, CEO, Columbia Asia, in CAHO Tech 2017 reiterated that transformation is evident: Stethoscope in 1970s has given way to today’s healthcare as ‘frontier science’. IVF and fetal medicine and many others are already a reality. Technology and automation in diagnostics and laboratory services are already being adopted in the Indian scenario. From better Turn Around Time (TAT), improved accuracy and report delivery to patients, the transformations are evident. Medanta – The Medicity has implemented innovations in lab automation successfully. Majority of the emergency physicians, hospital lab head and internists agree that TAT of lab results enhances trust and sense of well-being and enhances patient safety.

Manipal Hospitals, being the first hospital chain to adopt robotics for surgery and operations, deployed IBM’s AI cognitive computing platform ‘WATSON’ for treatment of cancer patients. AIIMS, New Delhi has a state of the art ‘robotic surgery unit’. Hospitals like NH and others have already successfully implemented innovations in ICU monitoring using high tech and many interfaces. Technologies for ‘data visualisation’ and hence improving accuracies in diagnostics and treatment options is of high value. Hospitals like Amrita Institute of Medical Sciences are using 3-D Printing for facilitating difficult cardiac care decisions.

Applications of telecare in ophthalmology, radiology and cardiac care consultations have already been proven to be very effective in improving access and reducing costs. Applications of point of care devices, wearables, IT and digital education/empowerment in geriatric/chronic care and home healthcare are making inroads at a faster pace.

Training and skilling of providers

Simulation-based medical and nursing education from use of lifelike manikins to present synthetic models to hi-fi simulation suites have enabled dissemination of knowledge, skills, and attitudes. It is common for e-learning platforms and certification to eliminate cost and geographic challenges in skilling. SMAC - (Social, Mobile, Analytics and Cloud) based technologies have given newer opportunities for learning and teaching. A case in point is the successful implementation Simulation in Training of ‘Healthcare Workers’ in Father Muller Hospitals, Mangalore and others. Digital education in not only empowering providers but also patients.

Health informatics and data management

The integration of IT in healthcare has revolutionised the process of medical treatments, management of data, electronic prescription, scheduling appointments, pathology lab management, case analysis etc. In fact, there is no doubt that other function of hospitals like HR, administration and marketing will receive a good boost with its applications in information system of hospital management and enterprise resources planning software. The public-private partnerships are all set to get a hold to leverage the CSR and power of technology. The programmes, which are CSR-based in technology have been very successful in appealing to companies who are big players in the market. However, the growing integration of IT in healthcare has not made everything easy for the organisations. Now the biggest task lies in front of them is to find a meticulous way to build capacity by acquainting the right skill sets among zealous health and hospital management professionals. Outpatient, in-patient, emergency/ambulance, ICUs, critical care, home healthcare services etc. will be impacted positively by cloud computing for data access and management, Electronic Medical/Health Records and mobile and the internet of things. Electronic Personal Health Records (EPHR) at population level will transform data management. Right now, patients using private labs can download reports and soon that could become common in public health too. Big data from health will make Public Health data for evidence-based applications of various health programmes. For e.g. Programmes for ‘TB Free’ India and ‘Stop TB Strategy’ needs many digital applications for programme implementation and monitoring.

Emergency and ambulance services

This is one area in which technology and IT applications has already transformed emergency and ambulance services since its large-scale innovations by EMRI in 2005. 108 Ambulance Services have very positively impacted maternal care in India. Technology and process standardisations have been highly possible in a short span of time.

Research and innovations

Technological advancements in bio-medical research, drug delivery, clinical research, evidence-based medicine and medical device innovations (low cost, m-health, e-health, app-based etc.) have all entered the vocabulary of research and innovations in healthcare in India.

Personalised medicine in the age of robotics and impersonalisation is the reality (!). Embedding of sensors (vs wearables like band-aids) like ‘nanosensors’ in blood stream could detect cancer, an impending heart attack or a forthcoming autoimmune attack with improved precision and early. Continuum of care, ‘womb to tomb’ dissection, decoding and defining granularity at the molecular level for DNA sequencing will all be possible.

Cochlear implants for hearing loss and a trachea transplant are already here. Concept of Cyborgs ‘fusion of artificial and biological parts’ in humans is science fiction. Futuristic possibilities could be a ‘sensors’ to transfer thoughts and call (& talk) via body area networks (or brain area networks)!

From the dawn of civilisation until 2003, the world had accumulated I billion gigabytes, now the data richness is generated in multiple zettabytes (each zettabyte=1 trillion gigabytes each year)! Healthcare providers must leverage BIG DATA for making ‘health-and-wellness’ for population a reality. Life science, Technology and Medical Industry must come together with governments for transformations to be harnessed. Many social, moral, ethical, and existential dilemmas must be tackled with sensitivities in this exciting odyssey.

Equally important for India is a ‘Healthy India’, health as a right for every citizen. We already saw ‘Humanoid Sophia’ meet the press, we could have ‘Humanoid Doctors’ in remote areas! The ‘Dr. McCoy from Star Trek’ moment for healthcare with robotic arms that perform surgery to nanorobots delivering drugs through the bloodstream is already here!

--Issue 40--

Author Bio

Usha Manjunath

Usha Manjunath, a Healthcare Management Academician and currently the Director of IIHMR, did her M.Sc. (Speech & Hearing) from AIISH, Mysore and M.Phil (Hospital & Health Systems Management) and PhD in Quality Management from BITS, Pilani, and Rajasthan, India. She has completed a Certification Program in Strategic Leadership and Management in Healthcare in December 2012 by IIHMR, Delhi and Johns Hopkins Bloomberg School of Public Health.