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Covid-19 has driven massive acceleration in digital transformation across sectors and boosted the adoption of digital services by consumers, besides creating new opportunities for agile startups, Navdeep Manaktala, director and head, startup business, Asia-Pacific and Japan, Amazon Web Services (AWS), said in an interview. Manaktala shared his views on the emergence of healthcare startups and how they helped tackle the pandemic. Edited excerpts:

The pandemic has accelerated the digitization of health-tech startups. What is your take on it?

We see particular demand for better and easier access to healthcare in these times, and, in fact, health-tech is one of the fastest-growing verticals across the Asia-Pacific. In March 2020, the government announced telemedicine guidelines during the nationwide lockdown, and state-owned teleconsultation portal eSanjeevani is setting high records. Regulatory interventions provided an additional impetus to healthcare digitization, and leading health-tech startups reported a three to five times increase in patient traffic within just six months of the onset of the pandemic.

Sectors that led the way were telemedicine, e-pharmacy, and e-diagnostic solutions for at-home sample collections. The covid-led lockdowns forced patients to place their trust in healthcare digitization, and they realized the convenience it offers. The growth is also translating into consolidation and the entry of major players into this space, and you see this play out in acquisition deals, such as Tata Digital’s decision to buy out 1mg, PharmEasy’s acquisition of Medlife, and Reliance Retail Ventures’ acquisition of Netmeds.

Digitization will further increase among healthcare technology providers, including health-tech startups, with the adoption of the National Digital Health Mission (NDHM). Today, patient data is stored in silos across healthcare stakeholders such as hospitals and diagnostic labs. NDHM provides a fabric for healthcare data interoperability, enabling patients to store, access and share standardized digital health records with all stakeholders and receive seamless care and faster insurance claim settlements.

This patient-consent based open digital infrastructure will pave the way for startups to build patient-focused innovations on top of NDHM, such as personalized tips for chronic care management or building machine learning models using anonymized patient data. Our digital healthcare partner, KareXpert, manages over one million electronic patient records for 25 healthcare providers across India through its software-as-a-service (SaaS) platform, and they already have a cloud-native NDHM-ready stack running on AWS. Startups reduced the impact of the covid-19 second wave on India’s healthcare infrastructure with innovative solutions for diagnostics, patient care and vaccination drives.

Preventive care gained importance due to the increasing cost of healthcare. How can startups build on AWS to offer a solution?

As per the World Health Organization, India’s out-of-pocket healthcare expenses from an individual’s personal savings stands at around 62% versus 18% globally. The high cost of healthcare and a change in mindset towards staying fit and monitoring health closely are an impetus to preventive healthcare. Startups are using innovative business models to tap into this mindset change. Online fitness classes are emerging as a big use case due to the pandemic.

Startups leverage AWS here for content delivery, where fitness videos and other content are stored on AWS Edge locations across India and delivered to consumers securely and at high speeds.

For instance, Cult.fit’s live classes spiked 30 times the usual volume within a week of the pandemic-induced lockdown. Within three weeks, the app was re-architected on AWS to support 300,000 concurrent users in a class, using AWS Media services and Amazon CloudFront.

Cult.fit also uses machine learning models trained on Amazon EC2 P3 instances to aid in tracking user movement during exercises, display how accurately users are performing the exercises, and calculate how much energy they are burning.

Can technologies such as remote patient monitoring and telemedicine help solve issues related to inadequate healthcare infrastructure in remote areas?

Startups are driven to solve problems that were never solved before and address challenging structural gaps in day-to-day life. They do this by applying technology to create new access and new business models, and they are not constrained by traditional practices. Remote patient monitoring (RPM) uses sensors to monitor a patient’s vitals remotely and raise the alarm in case of any deterioration.

We have seen Indian startups using RPM to manage chronic conditions such as diabetes and asthma, with connected devices to capture data, and using a personalized mobile app to show progress, set pill reminders, book appointments and generate alarms.During covid, RPM became all the more useful due to an acute shortage of staff and the risk of infection from in-person contact with covid-19 patients. AWS customer Dozee provides remote patient monitoring devices to over 230 hospitals, addressing the shortage of nurses in India.

Using Dozee’s contactless sensor, hospitals can upgrade normal beds into step-down intensive care units (ICUs) in under 5 minutes and enable remote and central monitoring of patients at wards. Dozee streams data from over 5,000 devices monitoring vitals such as heart rate, oxygen saturation and blood pressure to the Amazon Aurora database. This data is monitored for adverse events by customized machine learning models running on AWS. Dozee estimates it has saved over 75,000 nursing hours so far.

Cloudphysician, for example, is redefining critical care with the application of cloud technology to optimize clinical operations in highly demanding, frugal ICU settings in India. They deliver a one-stop critical care solution that augments resource-constrained ICUs across India, where there is a shortage of intensivists or ICU specialists. Till date, Cloudphysician’s intensivist-led clinical teams have treated over 25,000 critically ill patients in 14 states. Government and private sector hospitals choosing Cloudphysician as a preferred partner to treat over 4,000 covid-19 patients represents a potentially game-changing shift in the tele-ICU approach. Cloudphysician-enabled ICUs manage life-and-death situations with both pre-emptive and prescriptive support for healthcare teams. This is made possible by Cloudphysician’s proprietary ICU management solution, RADAR, which allows clinicians to manage hundreds of patients 24x7. RADAR leverages highly reliable and scalable Amazon Web Services and seamlessly connects specialists. It also institutionalizes life-saving protocols every day, from Leh through the Cachar Valley in Assam and from Gujarat to Tamil Nadu.

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