Today, the primary healthcare infrastructure covers less than 20% of the country’s primary healthcare needs. To address this issue and help patients in the rural and remote areas, in 2012 Hewlett Packard Enterprise (HPE) launched the eHealth Center (eHC) initiative which is simple, easy to deploy and rapidly scalable solution that leverages technology to create patient-centric healthcare systems at affordable costs. The solutions include a shipping container which is low cost and easy to deploy in the remotest of villages and carry medical instruments like a small laboratory, ECG, spirometer, digital thermometer and other basic medical equipments. To understand more about this, Dataquest spoke to Lux Rao, Chief Technologist, Technology Services, HPE India.

How can technology enhance the key values of healthcare sector?

Lux Rao

Healthcare is among those sectors that can be enhanced through technology. However, domain specialization is an important aspect of this sector. Healthcare professionals need to be highly skilled individuals who also need to possess high levels of domain knowledge. So the question here is how can technology play a role in enhancing the value of healthcare?

Traditionally, a doctor – patient interaction includes the doctor conducting a physical examination of the patient and going through the individual’s past medical records. Furthermore, the doctor will check the patient’s vital signs such as blood pressure and temperature. Basis of all these inputs he/she will give his/her opinion. So here, we are dependent on three important elements – the physical examination of the patient, his/her past medical records, and inputs through diagnostic apparatuses or devices. While such a doctor – patient interaction model will continue, it is important to leverage technology to further enhance this interaction.

What is the role HPE is playing in the healthcare sector? Please elaborate about HPE eHealth Centers.
Primary healthcare is the first line of defence for doctors attending to patients of a large population or community. It addresses almost 38% of the cases, hence we felt that the largest impact could be made here at the bottom of the pyramid. This is how we came up with HPE eHealth Centers, which addresses the needs of primary healthcare.

To enhance the doctor patient interaction through technology at eHCs, it was important to put a few fundamentals in place. Firstly, we created an electronic medical record (EMR) for patients, which capture any transaction, appointment or consultation made by them with a doctor. The EMR is created at time of registration along with an ID that is associated with the patient for all future transactions.

The EMR and a common central repository are hosted on the cloud, which can be accessed by multiple stakeholders irrespective of their location. Cloud is a great way of delivering and ingesting information. In this case it also helps in continuity of care by enabling access to the patients’ medical records irrespective of which eHCs they visit for treatment.

How have technology pieces such as M2M and cloud emerged enablers in the your eHCs? What steps did you take to deal with issues such as connectivity?
Moreover, the eHCs feature M2M technologies, where devices communicate directly to an application, thereby limiting manual interaction. This way data from various tools like ECG are captured and uploaded to patient’s records on real time basis thereby eliminating any input errors. As this patient related information is available on the cloud, doctors located in cities can access these records as they are examining patients who may be located in the remote parts of the country.

In rural parts of the country, bandwidth is an issue; which is why tele-medicine did not take off as expected. So it was important for us to optimize technology to ensure a seamless interaction experience between the doctor and patients. Also it was necessary to recreate the whole experience of healthcare as close to real as possible using technology as an enabler. As a result, eHCs which are basically shipping containers have all required medical devices, examination rooms, and computers ingest the information into the system. It also features buffering technologies in case there was no bandwidth at a given point of time.

How did the idea of transforming a shipping container into an eHC strike? And why?
The idea of the shipping container came about because we wanted to ensure that it can be rapidly deployed. The typical structure for a medical centre would actually take anything between 8 months to one year to setup. In case of shipping containers, we can deploy the whole eHC within 4-6 weeks. These are semi-permanent structures and not mobile health centres. We wanted to bring a sense of permanency since mobile eHCs are good for conducting camps; but when you are taken ill, you need to have a centre where you can go to.

eHCs are deployed in remote areas, complemented by on ground paramedics who manage all eHC related activities including registration and examination of patients under the instructions of the doctors. The doctor is usually located at a studio at a different location and they cater to the centres which are an exact replica of an Out Patient Department (OPD). A typical OPD in a hospital has particular time slots for consultations by a certain set of doctors. At eHCs we do it a bit different, where a particular set of doctors will offer consulting to patient from different eHCs at pre-defined time-slots and this model has worked well for us. The added advantage is that if there is any emergency in any of the centres, these doctors are available immediately.

What makes eHCs by HPE a compelling healthcare solution for country like India?
Another unique feature of eHCs is that consulting specialist doctors is a seamless experience. For instance, if a primary care doctor or general physician who is checking the patient feels the need to consult a specialist, he can do so on the same frame. He can ping or call the specialist located elsewhere to join the conversation. The specialist doctor can come into the conversation, review the patient and his/her records and then offer his/her opinion digitally. For example, a patient located in a remote village in Haryana can visit one of the eHCs and consult a general physician based out of Delhi and if needed may connect with a specialist located in Bangalore.

All these features make eHCs a very compelling healthcare solution. The eHCs can also help in addressing issues related to the medical device’s proof of life, which is one of the biggest problems when such these solutions are deployed in remote areas. In case of eHCs there is a proof of life signal that is synced to these devices that will automatically relay back information related to the devices status. On a daily basis, we are able to identify if certain devices are down or not being used. This impacts utility and effectiveness of all these medical devices in a big way. For instance, if at a particular eHC the pyrometer has not been used for a long time, we will know there is a problem there. Then we make sure we reach out and replace the device immediately. All this happens in matter of a few days or hours. Earlier, we could not think of that level of effectiveness in remote rural areas when compared to what we see in a city hospital. So basically, it’s a roll call of all concerned technologies that we have incorporated in this solution ranging from cloud, mobility, analytics, security as we are dealing with private data, IoT, Machine2Machine technology etc. All this has been placed in a structured framework of how primary healthcare needs to be administered.

Is the end-to-end deployment of eHCs done by HPE or were other partners also involved?
An eHC is an integrated solution, which is led by Hewlett Packard Enterprise (HPE). A large part of the technology deployed is from HPE excluding the medical devices. The eHC platform can accommodate multiple players; for instance the highly skilled medicine domain is provided by hospitals such as the Narayana Hospital in Bangalore, Tata Main Hospital etc. Currently there are 55 eHealth centres across, and 100 plus mobile centres across the country. Recently, we reached a milestone of 3 lakh patient consultations.