Indian Healthscape 2011: Leveraging IT to Heal the Masses

While healthcare experts see Indian healthcare as a recession-proof sector, the reality is that medical facilities have barely reached the masses. When people are seen queuing for healthcare facilities in cities, the fate of 700 mn Indians residing in rural and sub-urban parts without doubt remains uncertain. As per consultancy firm KSA Technopak, approximately 46% of Indians still need to cover a fair distance to avail basic healthcare. Understaffed and underfinanced public hospitals continue to haunt the rural landscape. People are forced to visit private medical practitioners even today. Does this scenario leave any space for thoughts that hang around taking healthcare facilities to every doorstep in India? Taking healthcare to the masses needs planning, execution, and technological support. The government has to enable its National Rural Health Mission (NRHM) by injecting the appropriate dose of technology. Similarly the industry needs to look at all aspects of cost, access and convenience, and augment services in all parts rather than sticking to large cities and towns. We need to look at ways of bridging gap that persists in our healthcare system, says Pankaj Vaish, president, healthcare IT, Religare Technologies.

Lopsided Healthscape

The countrys healthcare scene is full of disparities, where number of doctors and number of hospitals are at its abysmal levels compared to foreign counterparts. The picture becomes further grim when we view the healthcare condition in rural areas. The countrys rural health centers are critically short of trained medical personnel. The NRHM report suggests that 22,669 primary healthcare centers are in a sorry state of affairs. Of them, 8% centers do not have a doctor while nearly 39% are running without a lab technician and about 17.7% without a pharmacist. This is when every primary health center is supposed to have one medical officer supported by a paramedical staff. Under the NRHM, government has to make sure the public health system is accessible, affordable and accountable in remote parts. We certainly need enablers that make it possible for the poor to avail healthcare services, suggests Kaveri Gill, who has been a consultant with Planning Commission of India for healthcare related project.

Although healthcare services have gone up over a period of time, these are not able to keep pace with the demand that the growing population has posed. India faces the challenge of availing healthcare facilities to a larger chunk of population with fewer doctors and hospitals, says Vaish. According to a study, the number of beds available per 1,000 people in India was only 1.27, which is less than half the global average of 2.6. There are 369,351 government beds in urban areas and a mere 143,069 beds in rural areas where the larger chunk lives. Similarly there are only 6 doctors per 10,000 people. Moreover the rural doctors to population ratio is lower by 6 times as compared to urban areas. Thus there exists a huge urban-rural divide in terms of healthcare services. To add 1 extra bed per 1,000 of population in India we require a huge investment. Out of this, a good portion will come to IT as it is now accepted by one and all that IT is a must for efficient care delivery in the country, says Rothin Bhattacharyya, executive vice president, HCL Infosystems.

Anomalies that persist in building healthcare infrastructure have hindered the delivery of services to the rural mass. And this is something, experts believe, that cannot be addressed overnight. We must not believe that there is going to be an overnight shift. Healthcare infrastructure is pretty low and needs to be built up steadily. At the same time, we need to devise ways that enable us to do more with less given the challenge that we have less doctors, less hospitals, and less beds, says Girish Kumar, practice head, healthcare and life sciences, HP India.

An Untapped Market

Disparities prevalent in the Indian healthcare also call for the untapped business opportunities for IT companies, among others. Many see IT as a great enabler for $40 bn healthcare industry which is expected to grow to $79 bn by 2012 and $280 bn by 2020. The average CAGR for the next 10 years, therefore, has been estimated at 21%, which projects a picture of the unexplored areas.

In areas such as telemedicine and delivering IT solutions for hospitals and healthcare institutions, there lies a huge business opportunity. The Indian healthcare spend is less than half the global average in percentage terms when compared on a percent of GDP basis. Healthcare reserves innumerable business opportunities for everyone. What remains to be seen is how we tap these opportunities. Indias spend on healthcare is significantly low compared to other countries which has to be increased. While US spends 15.3% of its GDP on healthcare, India stands way behind with merely 1%, says Vishal Gupta, VP/GM for CISCO services & healthcare business unit.

Despite low healthcare spend India has maintained its growth in healthcare services. Healthcare scenario in India is undergoing rapid changes and still in a growth phase. In coming years, we feel that the healthcare industry will invest on technology to address the growing need of this competitive market, adds Bhattacharyya.

Public Private Partnership

Taking healthcare to the remotest areas and to the people who need it most, India needs a collaborative approach. There are some projects in which both government and private players have worked together. But the collaboration is way behind than where it should be. Though there are projects which have attracted the private players, the partnership must go further. An initiative like Aadhar wherein all citizens have a unique identifier also holds great promise for healthcare IT. It would help streamline, increase the efficiency of our government schemes like the NRHM. The government and the industry can only take healthcare to the untouched mass, says Rajeev Agarwal, GM, healthcare informatics, Philips India.

Vaish of Religare also insists on the need of approaching rural and sub-urban areas with equal emphasis. He says, Private sector is limited to metro cities and is focusing majorly on a middle and high class. Working along with the government, it has to expand its reach into remote areas. The industry needs to come out with solutions that can be offered at affordable prices and at the nearest point to people. While IT companies are ready to offer solutions, governments and hospitals need to take decisions as to how they can leverage it further.

At the same time, upgrading and replacing the obsolete systems is a critical issue which can be addressed through the public private partnership. Outdated and outmoded healthcare systems are still prevalent in India, especially in rural areas. This poses a severe challenge to governments to ensure access to reliable healthcare for the masses. Therefore, improving access to healthcare should be a priority for India, adds Gupta of CISCO.

The need of the hour is a multi-pronged approach to define a profitable roadmap while keeping the services affordable in the rural areas. Given the size of Indias population and geography, government can deploy video conferencing solutions developed specifically for the healthcare sector. Industry players can help government with affordable and rental solutions, further adds Gupta. He further suggests that the government can deploy vans in rural areas to reach out to the larger mass.

Both sectors have also undertaken initiatives to improve functional efficiencies in the form of accreditations, clinical research, outsourcing of non-core areas, increased penetration of healthcare insurance and third-party payers.

Girish favors the enhanced use of IT in public hospitals and primary health centers in order to reduce time and enhance efficiency. According to him, Government and technology companies can work together for public hospitals. It will reduce the time spent on technicalities and bring transparency. The use of IT in association with private technology partners will enable public hospitals to offer effective services.

Addressing the Supply Side

ICT can help address the issues related to supply side such as non-availability of doctors, paramedics staff and nurses. The major challenge facing the healthcare industry is that we have a paucity of doctors and other paramedic staff. This is largely because of the low number of seats in the medical colleges in the country. IT is a great enabler and lets you to take services at low cost to remote areas, says Bhattacharyya from HCL Infosystems.

Adding to this, KR Shivakumar, lead architect, Philips Innovation Campus, Bengaluru says, Primary challenge is supply of various medical personnel since there are not enough qualified personnel to provide quality care in the short term, this can be addressed by adopting technology aggressively which will allow the same personnel to cover more patients as well as will allow people to get trained faster. The next challenge is catching chronic diseases earlier in the disease cycle leading to better outcomes as well as reduced burden on the healthcare systems.

Tech as Enabler

With the challenge to support an aging and remote population with limited number of clinicians at specialized centers of excellence, technology is the only hope. As Dr Pervez Ahmed, CEO, Max Healthcare puts it, Like the mobile phone and Web 2.0 are 2 leap-frog technologies that have changed the definition of communication, there is also a need of a Doctor Anywhere, that understands the needs of customer. This Doctor Anywhere then can also reach out remote population at a nominal cost. While Dr Ahmed seems right, India needs to look into technologies that make the concept of doctor anywhere possible. At the same time cost as a factor can never be undermined when it comes to taking healthcare to the rural mass. Government and private sector can jointly steer this task as the responsibility lies on both. Even market peers hold the opinion that in order to sustain in the market, private hospitals cannot continue to overlook the poor and rural mass. Deploying innovative IT tools can keep them profitable. The new ICT tools will help control costs while improving health by ushering in an era of wellness, self-monitoring, increased and earlier detection of disease and more effective treatments, believes Kandasamy Sankaran, director, healthcare, CSC India.

In many of the hospitals, communicating digitized patient information is typically done through a system like Telecare. Volumes of patient data are transformed into information for decision-support through HIT (healthcare information technology) applications and systems that are crucial for providing successful telecare services. But the practice has largely been confined to large private hospitals. Small hospitals, that are challenged by issues like need for improved care, slow RoI and high upfront costs, can also start with basic healthcare information systems that will provide digitization of their various departments on clinical and back-end operations including administration, billing, and HR, suggests Sankaran.

Similarly government has to introduce IT at large scale to offer better healthcare services, while at the same time improving living conditions. The application of e-governance in healthcare can monitor and improve the quality of healthcare services, make the system efficient, transparent and cost effective. Two technologiescloud computing and mobile technologyhold sway:

Cloud Computing: In the case of the healthcare industry, cloud would involve the provisioning of healthcare products and services to patients by physicians, clinics, pharmacies, public health organizations, and payers. Providing a range of services across the entire spectrum of care would require the ability to scale application workloads, collaborate and share information and at the same time ensure that patient information is authentic and secured, and available anytime, anywhere.

Cloud computing has a lot of promise and potential. In the healthcare IT space for a country like India, it holds a promise similar to what mobile phones did over fixedline phones, says Agarwal.

In the case of the healthcare industry cloud would provide for the seamless management and access to electronic health records of patients, says Nitin Khanapurkar, executive director, KPMG.

M-health: In India, a lot depends on mobiles which have penetrated in every nook and cranny. M-health or mobile health is a critical tool for rural health delivery. The challenge is to offer healthcare services over the phone. In 80% cases, patients do not need to face the doctors. If we are able to cater to this segment through an interactive medium, it will transform our healthcare system. The government needs to develop a mechanism that drives healthcare delivery over the mobile phone, suggests Vaish.

In addition, the onset of 3G technology holds promise for healthcare services. Telemedicine has seen a trend but has not really taken off to an extent as was envisioned. 3G technology through a proper mechanism can help telemedicine-like initiatives to move further. The penetration of 3G in India will provide the needed backbone to realize this. On another front, the large adoption of mobile phones is India can accelerate mHealth so as to spread awareness, provide reminder services, suggests Shivakumar.

A Long Way to Go

Now, taking healthcare services to the masses is not the lone challenge. There are other challenges posed by lifestyle diseases such as diabetes, obesity, blood pressure and hypertension, etc that need steadfast attention. Thus, the need of the hour is to develop a comprehensive and proper healthcare delivery mechanism that ably reaches the masses including the 65% of Indias population that does not have access to quality healthcare.

According to the World Health Organization, these not-so-privileged people are disfranchised of their right to health with women and children being among the worst sufferers in the 600,000+ villages spread across the country. There is hence, a long way to go. The joint responsibility lies on both the government and the private players. They need to re-look at the sub-urban and rural landscape which has never been favorite of doctors and the industry.

Onkar Sharma

onkars@cybermedia.co.in