An IT Dose for India's Healthcare

After 25 years, since computers started influencing the society, the healthcare sector is standing at the threshold of a world of possibilities thrown up by technologies such as virtual reality, cyber surgery, micro-robotic surgery, and 3D image modeling. Perhaps it is a critical time that ICT is used to its full capacity, to take healthcare to more than 800 mn people living in rural and poor India. As per consultancy firm KSA Technopak, approximately 46% of the Indians still need to cover a fair distance to avail basic healthcare. In addition, hospitals, rural health centers, and dispensaries in remote areas remain understaffed for most part of the year, forcing people to go to private practitioners.

Does this scenario leave any doubt at all that healthcare facilities should be taken to every doorstep in India?

Taking healthcare to the masses needs planning, execution, and technological support. The government has to realistically redraw the circumference of its popular citizen-centric health schemes like National Rural Health Mission (NRHM) and inject an appropriate dose of technology to implement them efficiently and transparently. The industry needs to be, if not entirely, slightly magnanimous and look at all the aspects of cost, access, and convenience to augment healthcare services in all parts of the country rather than sticking to large cities and towns alone.

Overstepping Infrastructure and Finance Issues

Most Indians give least preference to health over other necessities. It is only when a disease or ailment hits them that they go to the doctor. According to a PwC CII report 'Addressing the Unfinished Agenda-Universal Healthcare', “While healthcare facilities in the Indian metros are competing with the world's best medical centers, the scenario beyond the urban conglomerate is not encouraging.” 30% of the Indians don't have access to primary healthcare facilities; about 39 mn Indians fall below the poverty line each year because of the healthcare expenses; about 70% of the Indians spend all their income on healthcare and buying drugs; afraid of the expenses, around 30% in rural India don't visit hospitals; and the healthcare needs of 47% of rural India and 31% of urban India are financed by loans or sale of assets.

Also, the healthcare scene is so lopsided that in critical situations the paucity of healthcare staff and improper medical facilities always lead to a higher number of casualties. “The remote areas are untouched by basic healthcare services. The flawed healthcare system loudly talks about the inequities and inefficiencies. The tier-3 cities and rural areas have very limited access to good quality healthcare,” says Dr Bobby John, president, Global Health Advocates India. The poor conditions in these cities and villages make it imperative for the government and the healthcare industry to act on improving the healthcare delivery system.

The country's 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. Out 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, the government has to make sure that the public health system is accessible, affordable, and accountable in remote parts. “To ensure the delivery of services in every corner of the country, it is imperative that we harness information technology to the fullest. To bridge the huge gaps in healthcare system, it is important to figure out how we can use the expertise of one specialist in different areas,” says Arvind Sitaraman, president, inclusive growth, Cisco Systems.

Since the country's reliance on technology has gone higher in other areas, it is the best time to make use of the resources using technology or ICT and address the issues that lie at the base of the pyramid. “Infrastructure is a basic issue, given the length and breadth of the country. But if ICT is given enough preference in the healthcare space, it will certainly usher a new era of change allowing access to maximum number of people,” says Venkatakrishnan R, director, Value Added Corporate Services.

According to a study, the number of beds available per 1,000 people in India is 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 the urban areas. “Adding one extra bed per 1,000 of population in India requires huge investments. 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 an efficient care delivery in the country. We see IT as a huge catalyst in further developing healthcare in India,” says Rothin Bhattacharyya, executive vice president, HCL Infosystems.

IT to Address Multiple Healthcare Issues

To induce more effort into healthcare and make the e-healthcare a reality, it is imperative for the government to work closely with the private sector and technology players in the healthcare space. Telemedicine is one area where the public-private partnerships have cropped up in the last few years, but their reach is still limited. The PwC CII report further outlines that there is no country in the world where healthcare is financed entirely by the government. While it is primarily seen as the responsibility of the government to provide healthcare facilities, private capital and expertise are viewed as ways to induce efficiency and innovation. However the key debate here is the role of private resources in financing and managing healthcare services and achieving the appropriate balance of public to private resources.

At present, the major constraint is the financial viability of e-healthcare initiatives. This is despite several isolated initiatives from various organizations and hospitals for implementation of projects. For instance, the Indian Space and Research Organization (ISRO) has today 32 telemedicine locations in India and is injecting huge amounts of investments to help the Indian healthcare to graduate to the next level. To address this issue, collaboration in order to pool resources is required between different hospitals. For example, hospitals in a city can share a common telepathology or teleradiology service. This can happen between government and private hospitals so as to reduce the initial project costs.

“Telemedicine can be extremely beneficial for the people living in isolated communities and remote regions and help to reduce the cost of healthcare and increase efficiency through better management of chronic diseases, shared health professional staffing, and reduced travel time,” suggests Bhattacharyya.

While public-private partnerships take shape in the healthcare space, realizing the strength of technologies that can play a catalytic role in healthcare becomes far more important from the government's standpoint. Mobile penetration is no hidden truth. Steps to deliver healthcare over this platform are often discussed in forums, but do not see any concrete difference at the grassroot level. “It is wrong to believe that poor, illiterate people cannot use it. The telecom success story is in front of us. The stakeholders only have to deliver healthcare in a simple form,” believes Venkatakrishnan.

The purpose of any technology is to deliver service and not become a headache. Hence the purpose of making use of IT will deteriorate if complexities are not reduced for common use. It is where the private technology players have a big role to play and transform the healthcare scene. “Even the illiterate should be able to use a tool being used to offer healthcare services in remote areas. Once successfully materialized, there will be substantial decline in cases,” says Sitaraman of Cisco.

When there is a talk about ICT, it is critical to measure the reach of current broadband penetration and explore further connectivity options to bring at least 265,000 gram panchayats in the loop in India. “The internet pundits have always felt that the development and delivery of medicine will be one area where this medium is likely to have immense benefit to mankind,” suggests Dr Sunil Shroff, president, Medical Computer Society India in his blog (www.medindia.net).

Doctors-cum-Engineers?

While IT enables the healthcare providers to reach out to people in remote areas, it is also important to keep the doctors and healthcare workers ready for the tech platform. Often the mindset of the doctors and healthcare practitioners comes in the way of creating an IT-savvy healthcare workforce. Many resist to be at the phone for offering tele-health services through their health-assistants at remote areas. Their argument that they do not want to be tele-callers is also a concern. “It might be an issue. But if training is offered while in the course or in such a way that adopting technology does not become a headache, it will no longer be an issue,” remarks Dr John of Gobal Health Advocates.

In addition, the introduction of core IT programs into the MBBS curriculum is also cited as the need of the hour to train doctors for taking on the future medical equipments, which will be IT-integrated. Medical experts stress on the need of introducing health informatics into the course. Health informatics combine the fields of medicine, information science, and information technology to formulate various systems for generating, validating, securing, and integrating health-related data. “It will help providers, researchers, and patients to reap the benefits of cutting-edge methods, principles, and rules to alter the way healthcare is currently delivered,” says Bhattacharyya.

While public-private partnerships take shape in the healthcare space, realizing the strength of technologies that can play a catalytic role in healthcare becomes far more important from the governments standpoint. Mobile penetration is no hidden truth. Steps to deliver healthcare over this platform are often discussed in forums, but do not see any concrete difference at the grassroot level. It is wrong to believe that poor, illiterate people cannot use it. The telecom success story is in front of us. The stakeholders only have to deliver healthcare in a simple form, believes Venkatakrishnan.

The purpose of any technology is to deliver service and not become a headache. Hence the purpose of making use of IT will deteriorate if complexities are not reduced for common use. It is where the private technology players have a big role to play and transform the healthcare scene. Even the illiterate should be able to use a tool being used to offer healthcare services in remote areas. Once successfully materialized, there will be substantial decline in cases, says Sitaraman of Cisco.

When there is a talk about ICT, it is critical to measure the reach of current broadband penetration and explore further connectivity options to bring at least 265,000 gram panchayats in the loop in India. The internet pundits have always felt that the development and delivery of medicine will be one area where this medium is likely to have immense benefit to mankind, suggests Dr Sunil Shroff, president, Medical Computer Society India in his blog (www.medindia.net).

Doctors-cum-Engineers?

While IT enables the healthcare providers to reach out to people in remote areas, it is also important to keep the doctors and healthcare workers ready for the tech platform. Often the mindset of the doctors and healthcare practitioners comes in the way of creating an IT-savvy healthcare workforce. Many resist to be at the phone for offering tele-health services through their health-assistants at remote areas. Their argument that they do not want to be tele-callers is also a concern. It might be an issue. But if training is offered while in the course or in such a way that adopting technology does not become a headache, it will no longer be an issue, remarks Dr John of Gobal Health Advocates.

In addition, the introduction of core IT programs into the MBBS curriculum is also cited as the need of the hour to train doctors for taking on the future medical equipments, which will be IT-integrated. Medical experts stress on the need of introducing health informatics into the course. Health informatics combine the fields of medicine, information science, and information technology to formulate various systems for generating, validating, securing, and integrating health-related data. It will help providers, researchers, and patients to reap the benefits of cutting-edge methods, principles, and rules to alter the way healthcare is currently delivered, says Bhattacharyya.

The IT solution providers have to look at ways or solutions which are simple to operate. Ultimately doctors are doctors. And dont expect them to be software or IT engineers. My belief is that IT solutions have to be simple to use. It will induce more interest from the medical community into this and allow them to offer their services remotely or without having to go to remote, rural location, argues Dr John.

Linking UID, RSBY, and NPR

When it comes to taking healthcare services to the grassroot level, utilizing the network and support system of various e-governance programs can help solve the riddle. Almost every doctor agrees that if the history of a patient is available, it becomes easier to treat him/her. The government national initiatives such as Unique Identification (UID), Rashtriya Swasthya Bima Yojna (RSBY), and National Population Register (NPR) are linked together to create a national citizen medical record database, it will help reduce the healthcare problems. In my view, UID, RSBY, and NPR data can play immense role in addressing several health-related issues. The government must try to create a uniform health register for citizens through their data, suggest Dr John.

Medical records are critical in treating a patient. While the government tries to offer financial help through RSBY, data collection through such schemes can be used to address health-related issues, suggests Rana Mehta, executive director, healthcare advisory, PricewaterhouseCoopers.

Dataquests 3-step Approach

The country has a huge population to cure. The government has the responsibility for framing the basic standard guidelines to make use of IT in healthcare. The ICT ministry has come out with its recommendations by pushing some basic standards.

Dataquest presents a 3-step approach. The government needs to assess the applicability and take the necessary sub-steps to ensure that the challenges are effectively addressed.

Here are the 3 gaps and solutions that can be built leveraging ICT:

# Enhance the Reach of Healthcare:
Mandated broadband connectivity for 265,000 village panchayats across the country through which remote access to healthcare could be made possible.
Linkage of various e-government schemes such as UID, RSBY, NPR, and NHRM, etc, to create a National Citizen Health Record (NCHR).
Use of mobile to offer healthcare services.
Monitoring system with a few parameters to measure the impact and implementation.

# Enhance Effectiveness of Telemedicine:
Use of Hospital Information Systems (HIS) to optimize hospital resources and provide best possible healthcare remotely.
Pooling together resources by various hospitals within a city for creating either a common telepathology or teleradiology service, etc. The model will reduce the initial project cost.
Private-public partnerships to create, support, and operate (if required) ICT based healthcare systems.
Decline in the cost of telemedicine hardware (through tax reduction) to make it more financially viable for healthcare providers.

# Make Healthcare a Reality:
24/7 healthcare advice and treatment in remote villages through a common mobile platform.
To seamlessly fuse cutting-edge technology with touch-and-feel services thereby providing, preventing, diagnosting, palliating, and promoting healthcare.
Technology will play a major role in bringing quality in healthcare, be it better nursing communication systems or patient monitoring devices. IT will provide for storing all medical records of a particular patient and will also enable quick access to such records.