Leveraging Technology to Create Sustainable Digital Healthcare Infrastructure
Shailja Dixit is the Chief Medical Officer of Scientific Commercialization. She is also an active member & fellow of Health Innovation & Technology Lab, NYC.
Author shares a personal experience, which motivated her to contribute towards the development of a digitally centralized healthcare infrastructure – something handy especially during emergencies.
All stories don’t have a happy ending:
It’s 2:00 a.m. in the morning. I am in post-op care, watching my dad in a five-star Metro hospital.
The unfolding of the past day’s events is crystal clear in my mind: what was supposed to be a simple, regular follow-up for my dad’s gastric problems, literally turned into a ‘ticking time bomb’, and both our lives were turned upside down. Thankfully, with the help of ultramodern technology, the discovered malignancy was diagnosed and he was immediately operated on.
Now, he has developed low-grade fever, and no one really knows the reason for it.
After my annoying persistence, the highly competent specialist agreed to perform a culture and lo, behold! My dad also had a multidrug resistance bacterial infection. Several members of the bewildered medical staff could only remark, “We have never heard of this bacterium”.
Driven partly by my scientific curiosity, and partly by my admittedly obsessive compulsive nature, I started my own little investigation. I went to the lab and hematology department, and to my surprise, found out that there were a significant number of such cases being registered but NOT reported. On top of this, several times in the past few years, my dad had been prescribed antibiotics, which had to be administered via I.V.
The lack of proper infrastructure and adherence to standards was quite apparent to me. This was a system where data was not used effectively, neither to drive appropriate responses, nor to inspire insights, which is one of the greatest disservices that can be done to patients as well as the medical community.
At my insistence, Dad’s antibiotics were changed and our story ultimately had a happy ending but not all stories have this kind of happy ending.
Since this episode, I have realized that, if this kind of thing could happen to my father, it could just as easily happen to others who have insufficient access to proper medical care. Many are probably inhibited by the taboo in our society against challenging anyone in the medical community, and as a result, probably many others are simply dying every day!
Indian economy is in a phase of growth:
India is the 3rd largest exporter of medicines in the world. Indian Medical Tourism Industry is worth $1 billion, and yet the healthcare system for the Indian population faces serious challenges in almost all facets:
• Healthcare delivery
• Resource constraints
• Proper access
• Quality of healthcare delivery
• Lack of information for physicians and patients, and at times, information asymmetry
A good start has been made by creating a universal identification (the Adhaar Card), a bank account for every person in the country, and the availability of ubiquitous (if not dependable) mobile infrastructure in the country.
A Perfect Storm: Challenges and Opportunities
India is at an ideal developmental stage where technology usage is fairly high, in terms of percentage of mobile users and Internet penetration. Many of the demands for high-tech solutions can be met by utilizing a combination of mobile/web apps, faster and dependable internet (standard or wireless), and by investing in healthcare IT infrastructure like Health Exchanges, Personal Medical Record, and Health Data Banks. Cumulatively, these provide strong hope of improving the health of India’s 1.3 billion people.
Connected Health: Quality care for all – anytime, anywhere!
Unfortunately, many people fall in the hands of “quacks” in rural India and even in the metro areas beyond, so there can be stark differences in the quality of healthcare available in all locations, largely due to the lack of skilled medical resources.
We need to build such an infrastructure that it reaches the remotest corners of India by leveraging technology; to ensure that at least basic care is made available to all. We need to utilize telemedicine technology, and leverage simple web/mobile
web/mobile applications, which provide decision support for conducting diagnostics and managing simple conditions. This would help to overcome the immense shortage of trained medical staff, and would also ensure that everyone in the system is working at the “top of their license”. Hence, we need to ensure an optimum use of the resources. The technology and applications are available, but what is lacking is the political will to deploy them, and to establish a proper oversight to make the whole system workable.
The second most important aspect is ensuring a basic level of healthcare information called an “emergency medical record”, which should be made available to every citizen via a unique identifier. Every year, many patients die in emergencies, the most surprising of which are road accidents. Emergency information can be included right with the “Adhar Card” number.Information can be accessed by a medical unique identifier or a physical smart card. The barebones information includes demographics, health care coverage, life-threatening conditions, patient medicines, blood group types, and information on chronic conditions. The information should be easily accessible across hospital systems and state lines, so that it can provide the backbone of a “National Health information Exchange”. Such information would not only be extremely useful during emergencies for individuals, but would also be essential for planning purposes by the government organizations. Once the backbone of healthcare information exchange has been established, it can be used for creating a surveillance system to monitor any outbreak, and a number of other value-added services.
Challenges: Rome was not built in a day
Of course, creating an emergency medical card is a daunting task in a country with a population of 1.3 billion people. There are multiple challenges to be met before we even worry about the technical aspects of the challenge. There are huge behavioral challenges, for instance, in motivating people to voluntarily provide information about their health care, and to keep it up to date. Apart from that, there are other challenges like security and data privacy that still need to be resolved.
But the good news is that a start has already been made, by providing health insurance to all citizens below the poverty line. The insurance provider can digitize this basic information and make it available to individuals and providers with proper authorization.
Collaborative Innovation: “all hands on deck”
When distributive changes and fast paced growth need to happen, the government needs to take an “all hands on deck” approach, and act as a catalyst to such reforms. Governmental organizations must build the foundation of public healthcare IT infrastructure, and incentivize the private sector as well, so that solutions to these healthcare challenges can jointly be found.
A Public Private Partnership (PPP) can be started as a pilot project to digitize the health information of a small sector of population, e.g. weavers, or an entire state like Delhi, to learn from the process and repeat it elsewhere. Health being a state subject, similar pilots in a PPP model could be started in progressive, cash rich states, with the private sector executing the project and the government providing the oversight. The key is to have a sustainable business model funded by the government, and all lessons learned from such programs could then lay the foundation for a future policy and a long-term governance. The private sector should be incentivized to create profitable and sustainable value-added services to ensure a long-term sustainable business model (ref: image below).
To sum up, I dream of a day when every Indian citizen has the bare minimum information about their health which can be used in an emergency, when quality medical care is available at even the remotest areas of India, when a nearby real time surveillance system can warn us of any major outbreaks, and when sophisticated analytics can drive insights and allow more informed decision making.
At that time, we will have many more stories with happy endings, because we will have accurate information in the hands of the appropriate personnel, and we will have a universal exchange of healthcare information, properly leveraged by medical facilities, and supported by robust governmental policies in a sustainable business model!