India is a picture of possibilities in matters of technology and its deployment in healthcare. It is perhaps with good reason that if this can be effectively leveraged to attend to the healthcare needs of the 1.4 billion population, India could well be the lodestar for the world in cost-effective, tech-enabled, patient-centric healthcare ecosystem.
This with a lot more detailing on the changing healthcare landscape was the thrust of the address that Sangita Reddy delivered at the FE Care Tech Summit 2022 in Hyderabad on the evening of Monday, July 18th . Organised by Financial Express Online in partnership with Dozee, the focus of the summit was on “embracing technology to enrich patient care.”
The joint managing director at the Apollo Hospitals Group and the youngest daughter of the Apollo Hospitals founder Dr Prathap C Reddy, has been leading several technology initiatives at Apollo, and she was happy that the summit was attempting to put the focus on achievements of the frontline healthcare professionals, particularly those from the nursing fraternity.
Sangita Reddy, who has been till very recent also wearing the hat of the president of the Federation of Indian Chambers of Commerce and Industry (FICCI) painted the changing picture of healthcare in India and the role that technology could play in radically changing the way healthcare of all Indians is approached.
Looking at the Indian healthcare and on the way ahead, she pointed to questions that bother many and the solutions that one could expect. She asked: How do we bridge the gap with 50,000 to 75,000 beds for a population of one billion with critical care specialist shortage across the country, 85 per cent of our top critical care doctors living in the top 15 cities, what do we do with rural areas? Therefore, while at one level, she felt “the problem statement does call for training more doctors, more nurses, upskilling them, get nurse practitioners on board,” a truly transformational step however, she felt lay in solutions that see “the application of AI (artificial intelligence) in clinical decision support juxtaposed with remote care and remote sensing and integrated with mainstream hospital information systems and brought to the bedside through digital devices and internet of medical things.”
This combination framework, she said, if applied in different scenarios will give us the type of responses that we want on how do we bring advanced healthcare within the reach of a billion people.
She was also quick to remind: “Please note, I am talking of an ecosystem and not of a hospital, government or private. We need a system which is focused towards prevention and you design and integrate systems and approach it accordingly.” Giving examples, she said, it could be by way of “putting 5G into ambulances to make sure we do not lose even those critical 20 minutes or half an hour and have the doctor doing telemedicine right into the ambulance. Many solutions will then emerge.”
She felt that like with “our UPI (Unified Payments Interface) and Aadhaar and the entire tech stack of India which is showing a path to the world, we can also have out health stack do the same.”
This is the kind of belief and hope, she said, she had about what could happen over the next five to ten years, “we will see a quantum leap in access to healthcare which is enabled by this combination of health insurance, upskilling and enhancing the number of our professionals while at the very same time applying technology into each and every one of them.”
ASHA worker with a tablet
The range of solutions were possible at every level. For instance, on the technology solutions in primary healthcare, she saw huge possibilities with an ASHA (Accredited Social Health Activist) worker equipped with a tablet. Or from putting a CDSS (Clinical Decision Support System) into primary healthcare connected to telemedicine.
All of it need not be complex technology. For example, the usual gripe about “the primary healthcare centres (PHCs) in the government is that the doctor hardly comes so how do we solve this problem?”
Biometric sensor in the PHCs
To this, she said, “I have three very simple things in my mind: 1, you put a biometric sensor system to monitor attendance. 2, You put a clinical decision support system and the doctor at the centre is able to follow the latest protocols and 3, you put telemedicine there. The 4,5 and 6 thereafter can include lab or the point of care testing, remote ECG so that reports and results are out immediately. And, the 7,8 and 9 subsequently could even include important things like good waiting rooms, clean toilets, a proper EMR and connectivity with the ASHA worker so that the ASHA workers are able to tell what they see in the community versus who visits the primary healthcare centre.”
If you connect the ASHA worker and the mobile van with the primary healthcare centre then you keep track of the health profile of the population at a particular location and ensure more effective monitoring and using technology be in a position to come up with solutions aimed at ailment prevention.
Secondary care & the tele-linked solutions
In secondary healthcare setting, she said, we could talk about tele-ICU, tele-ECG, tele-radiology coupled with telemedicine for second opinions. Similarly, in tertiary care, the range of solution design and concept could all vary. But at the end of it, Sangita Reddy said, “I believe that a common foundation of database standards, security, interoperability and patient-centricity as well as a good UI (user interface) , UX (user experience) interface so that the healthcare worker can see simply and intuitively be able to understand and have interoperability to a stage that you have a personal health record on an individual’s mobile phone. This phone is soon going to go beyond doing the ECG but also get deployed for better monitoring to reduce admissions into the emergency room.”
Risk-prevention & filters on validation
Finally, quaternary care, she felt, will get to combine genomics, risk prediction and stem cell to a point that it may take a full cycle and move from a tertiary care setting to doing quaternary care-type treatments in a primary healthcare setting.
However, Sangita Reddy emphasised the importance of putting filters of scientific practice, validation and certifications before deploying solutions on patients. She said, “we have these available in our country like the ISO certifications for medical devices as a scientific tool or as a drug because if we try and use some of these without the right validation, we may end up doing something radically wrong unless we state upfront to the patient that this is an experiment. These validations are foundational steps towards the future of healthcare as we see it,” she said.
The key point she said was that this system “is the most cost-effective system for the world because a world that is reeling with high healthcare costs with 16 to 18 per cent of the GDP in the US and the NHS in the UK with long waiting list of patients awaiting care, the African subcontinent that is denied of care, it is not just a matter of adding beds but it is a matter of adding health and that ability comes from the series of steps that we need to take and technology is an enabler in those steps.”
Apart from the ecosystem, infrastructure and the frameworks which could be transformational, one area that she emphasized as the crucial aspect was that of risk prediction “because in a country of this size, we always thought we had to do health screening. Even to screen such a large group of people is expensive, time consuming and resource intensive so if we move to risk prediction and the estimation of the at-risk group and then a 100 per cent screening of the at-risk, I think it will transform the smartness in our approach to the population. So, understanding patient cohorts is another very important aspect. What are the clinical conditions that can be safely managed at home because cohorting and staging as well as risk prediction go hand-in-hand with designing of location of care and methodology of care.”
Sangita Reddy also talked of the medical devices to be viewed in an integrated system with emphasis on the importance of signal integration and federated learning models. Active data capture and ensuring data privacy were all aspects that needed to be thought through clearly and efforts made at each step to also educate the patients on the options available.
High-Tech with High-Touch
She also felicitated members from the nursing community for their contribution and pointed to what she called “an unsurpassed moment in history when humanity rises up to serve their brethren in such a manner as during the peak COVID months.” In a world which, she said, was evolving so fast, it was important to retain both the high-tech and the high-touch and quoted her father as saying that the even for the best of physicians and surgeons, “the path from the brain to the hand was best when it travelled through the heart.”