CTO - Healthcare and Life Sciences Emerging Technologies Division, Dell EMC, USA
India has the second-highest number of hospitals worldwide (excluding private hospitals and clinics as well as nursing homes). However, the country ranks low in terms of life expectancy. The Economic Times1 also noted that India has the highest deaths of children under the age of five and 21 per cent of the world's burden of disease, worsened by poor basic health and sanitation. Yet, government spending on healthcare in India was estimated at 5 per cent of its GDP2 in 2013 and is expected to remain at the level through to 2016, a disproportionate amount compared to its population.
Against this backdrop, the private sector has emerged as a vibrant force in India’s healthcare landscape. The healthcare industry is growing rapidly at a CAGR of 17 per cent3 and is expected to become a US$280 billion industry by 20204. In partnership with the private sector, the government has also committed to healthcare reforms aimed at uplifting the standards of healthcare delivery and to make healthcare available for all.
What needs to be done? A core focus on Translational Medicine both in terms of budget and technologies is critical. For example, the US has allotted almost half (US$60 billion) of its US$121 Billion National Institutes of Health (NIH) budget from 2012-2015to ‘translational’ groups – the Food and Drug Administration (FDA), Centers for Disease Control (CDC) and the Health and Human Services (HHS). I have spoken with several groups about the ‘Aadhar’ program in India and its healthcare vision. Our (Dell EMC) Centers of Excellence (CoE) in Bengaluru and Pune are contributing in a small way toward Aadhar. This is a great start, but we need to focus more on the macro-economic and macro-disease issues within India: Stress, Pollution, Diet, Water and Sanitation.
One opportunity is to link initiatives such as Digital India to help elevate the healthcare system. This points to a ‘mash-up’ between digitisation in healthcare, smart cities and an ecological approach toward water and sanitation. India is in a position to leap-frog past other emerging economies due to its stability as compared to the other BRIC countries.
Across the world, the key challenges facing the healthcare industries include an ageing population; rising incidence of lifestyle-related non-communicable diseases such as diabetes and heart diseases; as well as a growing pool of digitally-empowered patients.
Technology can be the answer to these challenges. However, many healthcare organisations are not refreshing their IT investment fast enough and adopting new solutions with respect to data collection (Electronic Medical Records), data transfer (protocols), privacy and security.
I believe that most important innovations will come in the ‘protocol’ layer for healthcare. Healthcare organisations will need to be able to pool data from any structured or unstructured source into an organised data lake, and use this to keep refining the treatment options for patients.The use of data lakes, over a period of time, can also help institutions uncover trends that can help improve knowledge on patient care, drug options and treatment. For institutions, such insight can also mean new business models and new incentive models at large scale.
Another key area is security. In the US, it is well known that there is a more than 96 per cent probability that any hospital’s data will be breached. The healthcare industry is the least prepared to recover after a breach.In fact, in the recent Global Data Protection Index commissioned by Dell EMC, only 24 per cent of public healthcare providers in Asia are very confident of fully recovering systems and data to meet business service level agreements in the event of a data loss incident.
Predictive Analytics and the Internet of Things (IoT) will shape the future of many industries, including healthcare. However, before these new technologies can truly deliver value to patients such as increasing survivability and life expectancy or providing predictive and prescriptive indicator for diseases, healthcare organisations must first get their data strategy right.
This includes recording of data, saving raw data and keeping it safe and secure and leveraging it for greater patient insights. Dell EMC’s Emerging Technologies Division (ETD) provides the base technologies that build Data Lakes (multi-protocol, scalable data containers that store these raw data and provide analytics engines to work on these raw data) that will guide that change in the healthcare systems. Data Lakes eliminate data silos within the healthcare ecosystem and incorporate technologies such a cloud, big data, mobile and social to empower healthcare organisations to leverage real-time data at the point-of-care.
Healthcare modernisation is being driven by a number of trends including rising healthcare costs, an ageing population and the growing incidence of chronic conditions that will require long-term care (such as diabetes and heart diseases).
The future of healthcare will rest upon three pillars: a digital approach, data intelligence and a patient-centric culture. IT will be at the centre of this transformation, helping to cut costs, drive productivity gains and uncover new economies of scales for greater efficiency and better patient care. Beyond that, IT can also disrupt today’s systems and fundamentally change healthcare delivery through personalised medicine and connected care.
Healthcare represents a significant percentage of the overall Digital Universe, and is growing at 48 per cent per year. As organisations adopt more electronic medical records and incorporate the deluge of new data from genomics, pathology and medical internet of things, care providers will need to transform their IT infrastructure.Analytics will become the driving force in the future of healthcare and traditional silos must be replaced with new approaches to enable valuable insight from that will help improve the quality and efficiency of care. Vendor Neutral Archives and Data Lakes are the foundation on the journey to precision medicine.
Most healthcare providers have made IT investments to establish the foundation for collaborative care —the digitisation and sharing of healthcare data across caregivers involved in a patient care episode. They’ve deployed transactional systems including EMRs, operational, revenue cycle management, and financial systems. Yet, the vast majority of the growing amounts of medical data is coming from unstructured and semi-structured data found in PACS and medical imaging, clinical research, doctors’ notes, pathology reports, and more. Healthcare providers today will require solutions that analyse data from many sources across the continuum of care and provide actionable insights to meet the clinical and business demands of the ever-changing healthcare industry.
Healthcare as we know it will disappear in less than 25 years, especially in Primary Medical Care. To quote a famous futurist, Systems Biologist and Seattle native, Dr. Leroy Hood (whom I have had the privilege of working with) on the “4 Ps” that will aid modern medicine for the physician: Predictive, Preventive, Personalised and Participatory. All of these are IT-based.
Healthcare providers have been confronted with a growing wave of destructive, malicious attacks from a new breed of cybercriminals who target clinical and financial data for its high value. These cyber threats are also getting more sophisticated and damaging. Attacks such as fraud, identify theft, and ransomware can leave healthcare organisationscompleted locked out of their systems. The healthcare organisations of today need to take extraordinary measures to protect their most vital patient, financial, and operational data.
Two-thirds of healthcare respondents in the HIMSS Cybersecurity Survey reported a significant security incident in the recent past with 64 per cent noting an incident had been conducted by an external actor such as an online scam artist or hacker, or through social engineering. In addition, the 2016 Sixth Annual Benchmark Study on Privacy and Security of Healthcare Data by the Ponemon Institute estimated the average cost of data breaches for healthcare organisations over the last two years at more than US$2.2 million per breach with criminal attacks as the leading cause. With this current landscape in mind, healthcare IT leaders have ranked security and data protection as a top organisational priority.
With stringent requirements from HIPAA, HITECH, and the EU Data Protection Directives, healthcare providers need solutions that minimise risk; detect, investigate and respond to advanced threats; confirm and manage identities; and ultimately, prevent identity theft, fraud, and cybercrime. And, to combat growing cyber threats and preserve the integrity of the health IT infrastructure, Chief Information Officers (CIOs) and Chief Information Security Officers (CISOs) must take a comprehensive approach to security and establish plans to address as many scenarios as possible. This is what we called the layered data protection approach. Equally important is the need to put in place a recovery plan, in the aftermath of any security incident.
Anything related to telemedicine. The Indian population is more than two-third rural. Yes, there is a large middle class in the burgeoning large cities – however, it is the rural populations with affordable care that will benefit the most.
Telemedicine will be the largest transformative change for healthcare, especially in places that lack access (which are typically the communities that need health services the most).
I don’t think IT has changed the macro health landscape of India much, to date. India needs to invest in IT infrastructure specifically for healthcare in a national imaging database, a national registry for diseases, a CDC-like approach toward real-time reporting and self-reliance in all of the above. India needs to take a sovereign approach toward research and translating research into clinical use with large changes in current trends for disease. I have visited Indian Institute of Science (IISc), National Centre for Biological Sciences (NCBS) and National Tuberculosis Institute in Bengaluru, AIIMS staff in Delhi conducting Genomics research along with various Indian Council of Medical Research (ICMR) institutes, Indian Institutes of Technologies (IITs), Pharma companies as well as Healthcare organisations. India is catching up in the ‘h-index’ of major academic journals in clinical and biotechnology research. The real question is translation.
We need better protocols. We need web services and object-based protocols. We need EMR systems with better Clinical Decision Support. Not just in India, everywhere.
The market opportunities are enormous. India has a very healthy Healthcare start-up economy now; it is just waking up to its potential.Medical devices represent the ‘front-end’ of what technology advancements can deliver to healthcare.This is also where the healthcare world will benefit most from unstructured data, a piece that has been missing in healthcare analytics. In tandem with this rise, healthcare organisation will also need to look at integrating these devices to the core IT infrastructure, the connectivity to support data collection from these devices to a data lake as well as the storage, management, protection and archiving of these data.
Let me close,as I had opened with my current Seattle roots, by quoting Dr. Roger Perlmutter, Executive Vice President Merck and President at Merck Research Laboratories, also a Seattle native, talking about the human body: “Since we don’t know how the machine works, we don’t know what to do when it breaks.” Most medicine has been empirical, observational and grows with our knowledge (and stutter steps along the way).
Let us not forget that at the end of all of this technology there is the patient and their families. This is best paraphrased with Sir (Dr.) William Osler’s comment “The good physician treats the disease; the great physician treats the patient who has the disease.” IT is an enabler and a helper, a wonderful one at that. Let us put it to good use.
Sanjay Joshi is the CTO of Healthcare and Life Sciences, Emerging Technologies Division at Dell EMC. Based in Seattle, Sanjay's 28+ year career has spanned the entire gamut of life-sciences and healthcare from clinical and biotechnology research to healthcare informatics to medical devices. His current focus is a systems view of Genomics and Proteomics for infrastructures and informatics. Recent experience has included Electronic Medical Records; Proteomics and Flow Cytometry; FDA and HIPAA validations; Lab Information Management Systems (LIMS); Translational Genomics research and Imaging. Sanjay holds a patent in multi-dimensional flow cytometry analytics. He began his career developing and building X-Ray machines.