MUMBAI: Dr. Devi Shetty, internationally renowned cardiac surgeon and chairman and founder of Narayana Health, starts his day much like everyone else. He checks his phone. Not for a dose of morning news or to catch up on a favourite celebrity’s latest. Dr. Shetty is wrapping up his morning intensive care unit (ICU) rounds, checking on hundreds of patients. For six months, Dr. Shetty has been conducting morning and night rounds of the ICU using a smartphone app, Kaizala.
Kaizala, a simple yet ingenious Microsoft app, is the WhatsApp of healthcare. Kaizala has its own messenger and a calling/video-calling facility in collaboration with Skype, but it does much more than a standard instant messaging app.
Patients and doctors, regardless of distance, can seamlessly exchange all kinds of medical data from patient history to test results, while complying with US standards of patient data protection.
From conducting ICU rounds on a WiFi-enabled flight to connecting thousands of patients to doctors, digital healthcare systems are eliminating hours of effort lost in setting up appointments, consultations and check-ups. This comfort offered by digitization is the first step towards transforming India’s healthcare system from a post facto system to a preventive one.
“Doctor-patient interface is required around once a year for chronic diseases, which are the leading cause of India’s health burden," says Dr. Shetty. Take diabetes, for instance: with 70 million diagnosed diabetics, 70 million pre-diabetics and merely 600 diabetologists in India, the supply gap is staggering. “In two to three years, when online diabetes care becomes reality, doctors will be in the pocket of every patient," says Dr. Shetty. “One diabetologist and five to 10 counsellors will be able to look after over 10,000 patients. Chronic diseases can be managed remotely as long as there is online trackability of medical data."
For other diseases, doctor-patient interface is often not required. Access to medical records and simple prescriptions can prevent or treat most mundane illnesses remotely. This will be transformative in countries like India which have an acute shortage of competent doctors.
When Vikram Gupta, founder and managing partner of IvyCap Ventures, visited his friend Dr. Kenneth Ouriel, a vascular surgeon in Cleveland Clinic, Ohio, the doctor invited him to his practice.
“He led me into a room full of, not patients or beds, but computer screens. My bewilderment turned to awe as I watched Dr. Ouriel perform surgery using in-house equipment on a patient 11,400 kilometres away, in Dubai, where robotic arms served as Dr. Ouriel’s arms. And this was in 2004," he recounts. Gupta predicts that telemedicine will restructure healthcare within the next 15 years. “In 10 years, you could go to a hospital, get treated, come out, and then realize that you haven’t met a doctor," he says.
Globally, the healthcare delivery system hasn’t changed significantly in the last 50 years, and providing accessible, affordable healthcare remains a challenge. Manish Singhal, founding partner, Pi Ventures, a venture capital firm specialized in investment in deep-technology startups, suggests a three-tiered system to tackle this challenge.
“The first encompasses all the irreplaceable human elements, including nursing care and the human reassurance aspect," he says. The second tier comprises work like recording and updating data, which will soon be automated. The third is about tackling difficult decisions. “Looking at pathological test results and making diagnoses and deciding courses of action: this is where humans and technology will work together. The human plus technology combination will be unstoppable," says Singhal.
India currently spends a little over 1% of its total GDP (gross domestic product) on healthcare, among the lowest healthcare spends in the world according to National Health Profile 2018 data. This isn’t exclusive to India. Healthcare budgets around the world tend to be grossly inadequate.“Quality healthcare is all about making the right decision at the right time," says Gupta. Even in the US, which has among the highest proportions of highly qualified medical specialists, human error is the third leading cause of death, according to a 2016 John Hopkins study. This is where technology will play another major role: in making healthcare safer. With big data and innovations in machine learning, many within the medical community are optimistic that technology will make healthcare safer.
Cancer remains one of the biggest killers in the world with the number of new cases each year projected to reach 23.6 million by 2030, according to International Agency for Research on Cancer. There is light at the end of the tunnel, says Geetha Manjunath, founder of Niramai, a healthtech startup leveraging an AI-driven solution that detects cancer and abnormalities.
“Breast cancer is the leading cause of cancer death in women. Today, only one in two women with breast cancer has a chance of survival. This is paradoxical given that breast cancer is completely curable," says Dr. Manjunath. Late detection and delayed check-ups are the biggest impediment in the battle against cancer. Early detection can be achieved by employing data-based decision-making. Data-based operations are far more scalable and efficient. “That is what we are working towards," says Dr. Manjunath.
“We are confident that with more specialty hospitals turning to data-driven solutions, the cost of cancer testing and treatment will reduce to about 1/6th of the present cost. Early diagnosis will become reality," she says.
Organizations like Niramai are making rapid strides in accuracy in medical decision-making. The early symptoms of most diseases tend to be similar, which means physicians dispense generic medication to most patients. Generic medication has its merits—it’s cheap and works well against common infections. But India’s dependency on mass-produced, easily available antibiotics is dangerous for public immunity. Prescribing generic medicine for severe ailments is unsafe and ineffective, which is why we need precision medicine that is ideal for a particular patient, based on individual anatomy.
Access to All
Dr. Naresh Trehan, chairman and managing director, Medanta, says ensuring affordability and creating low-cost models will be key to India’s healthcare architecture.
“District hospitals—whether public or private—can charge nominal to reasonable fees to be affordable. The problem of affordability is more difficult to solve when it comes to tertiary care, where you need huge input. The cost of delivery—which, in India, is actually 1/10th of the cost in western countries, for the same quality—is still too high for most Indians," he says. Worldwide, the safety net is provided by insurance so India can build this architecture in the next three to five years.
“The future of healthcare in India is extremely bright. About 1.5 billion people will need healthcare, we have to provide it, learn how to finance it and how to create low-cost models. This is what we need to concentrate on," he says.
Precision medicine, data-based decision-making, artificial intelligence and nanoantibiotics are the trends to watch for in the future.
Experts are confident India can achieve extraordinary headway in reforming healthcare delivery. There’s an example that underpins this optimism: India went from landlines to expensive mobile phones to cheap mobile phones to affordable smartphones in 20 years. The qualified talent pool and resources are available. What India needs to go the last mile is political will. As Dr. Devi Shetty puts it: “It’s like we have the perfect vehicles but no roads on which to drive them. Someone must build the roads."