President, Apollo Telemedicine Networking Foundation, India.
That healthcare is absolutely essential even for sustenance is well known. Water management, energy management, building automation, transportation –every single item in the formation of a smart city presupposes healthy individuals in the ‘smart community’. Attention to ‘smart healthcare’ in 2015 is therefore not a luxury but an absolute necessity. Contrary to public perception providing ‘smart healthcare’ is eminently feasible, cost effective and just needs a little tweaking of software and hardware used to provide other ‘smart facilities’. The major difference between deploying Smart Healthcare (SHC) and other smart functions is the requirement of a radical transformation in the mindset of the healthcare provider and the receiver. SHC presupposes:
• DIY (Do it yourself)
• POCD (Point of Care Diagnostics)
• Promoting wellness proactively
• Staying Smart the eWay.
While behavioural modification at all levels of the healthcare ecosystem is critical in deploying SHC, it is WiiiFM (What is in it For Me) that needs to be primarily addressed.
1. Promoting health literacy the eWay providing authenticated, validated customised health information to a pre-defined population through smart phones etc. If public WiFi is available this could be exploited
2. Telemedicine enabled pre-hospital management in smart ambulances for emergencies, trauma etc
3. Remote health monitoring at home that reduces hospital bed occupancy by converting a home into a hi care ward using technology
4. Today’s glucometers can be supplemented with similar tests for liver function , kidney function, cardiac function etc. This can be done with just a few drops of blood without any requirement of a paramedic. This will eventually be replaced with non-invasive sensors which through the skin will use surrogate biomarkers to study blood biochemistry. Eventually urinalysis using surrogate biomarkers will even be able to examine brain pathology–just a few examples of ‘smart’ diagnostics
5. Large hospital complexes can have in-house SHC for its residents
6. Large offices can have in-house SHC for employees
7. Family physicians, specialists, super specialists can conduct virtual OPs at offices, malls, or residences
8. Most importantly 24/7 availability of EMR will considerably reduce duplication of investigations. Immediate access to entire past and present medical history to authorised personnel will produce incremental changes in quality of health care delivery
9. Scientific, statistical evaluation of health care outcomes, incidence prevalence, follow up etc. will for the first time be feasible
10. ‘Health’ is an inherent and major component, which must always be taken into account while planning a smart city. Whether it be pollution, the metro or even water or transportation management, inputs of a clinician who is familiar with technology and its implications and most importantly the behavioural response to use / imposition of technology needs to be considered
11. In the past, health has always been an afterthought, retrofitting being the order of the day – we have never ever been future ready – with the imminent construction of smart communities, this is once in a life time opportunity.
The challenges in implementing SHC are more with individuals than with the technology. Considerable behavioural modification is required. Receiving health care is not like buying a pizza online or a commodity on Flipkart. Champions and evangelists should be identified from the Health care community who have a passion and believe in SHC. The product has to be packaged to suit each customer. Care requirements are variable in different places, at different times and for different people. All this needs to be understood. In most m2m implementations and designing, sufficient emphasis is not given to the specific needs. Technology should not search for an application. It should be the reverse. A HCP (healthcare provider) should be involved at every stage not just a m2m expert.
This is even more important in SHC as the user’s health and life are directly involved. Any m2m product must be compared with existing gold standards. Prospective double blinded, randomised, statistically valid clinical trials are necessary; patient feedback is critical. These are expensive and time consuming but absolutely essential. Today most m2m products in healthcare are driven by mega MNCs with an eye on RoI – whether they are useful or necessary is secondary!
This is as essential as with any other ‘smart’ application but we need not get paranoid about this. Much more difficult to ‘sell’ to the end user is the fear of dehumanisation – of the human touch disappearing altogether. We still require a kind doctor who practises TLC (tender loving care) to be at the back end of the m2m technology. This must be viewed as a means to achieving the end not the end in itself .
The stakeholders need to fund a project to establish a base line, to clearly define what constitutes SHC in the Indian context, what is required, what is not required, what is available now, what do we really need, when, where, how, at what cost and so on.
K Ganapathy (Neurosurgery) is a Past President of the Telemedicine Society of India. Former Secretary and Past President of the Neurological Society of India, former Secretary of the Asian Australasian Society of Neurological Surgery, Past President of the Indian Society of Stereotactic & Functional Neurosurgery. Ganapathy is an Adjunct Professor, at the IIT Madras, Tamilnadu Medical University & Anna University, Chennai. Dr. Ganapathy was formerly Honorary Consultant and Advisor in Neurosurgery Armed Forces Medical Services.