AI revolution in the field of healthcare

A doctor being counterquestioned by the patient armed with newly acquired knowledge regarding his symptoms through numerous online websites is already a frequent occurrence nowadays. Add to that the apps, which monitor your vital parameters at all times and the scope for further improvements; wherein, the test results can be fed to your app and the diagnosis indicated by the app would usually be pretty accurate. When Artificial Intelligence, Robotics and Big Data analysis is added to this, it just keeps getting bigger and better. Like most of the conventional industry, the healthcare industry is going to see a big disruption soon. Should the doctors be alarmed, may be yes, may be no; should they be excited Yes!

The advances made in the field suggest that AI should be embraced with open arms in the healthcare sector as it would augment the medical practitioners in not only penetrating these services to larger percentage of society, but also utilizing the time more effectively on each patient and arrive at a more accurate diagnosis. The data collected and learnings inferenced can further improve the medical as well as training processes.

The changes in disease profiles in our country and increase in chronic diseases demand (increase in diseases due to pollution is yet to show its real size) that state and central governments collaborate with researchers and healthcare giants to implement suitable programs that improve healthcare and AI can be a force multiplier in this regard. The effect of AI on major problems being encountered in India in healthcare sector will be discussed one by one:

1. Neglect of Rural Population. India faces acute lack of healthcare facilities in rural areas in terms of both quality and quantity. As per information in open domain, the rural population which comprises 75% of total populace have access to only 31.5% hospitals and 16% beds. Only 37% of people were able to access IP facilities within a 5 km distance, and 68% were able to access out-patient facilities due to limitation in number of doctors and lack of infrastructure. Unwillingness of skilled healthcare officials to work in rural areas only compounds the issue. Minimum tenures of officials have been made compulsory in some states; however, the same is grossly inadequate. According to the rural health statistics of the Government of India (2015), about 10.4% of the sanctioned posts of auxiliary nurse midwives are vacant, which rises to 40.7% of the posts of male health workers. 27% of doctor posts at PHCs were vacant, which is more than a quarter of the sanctioned posts. AI based solutions can use this limited infrastructure and manpower much more effectively. The present and predictive analysis of number of patients is one such tool through which the District Administration can keep a tab on actual situation on ground and can even predict the outbreak of an epidemic. The smart use of paramedicals may also be employed. Use of lightweight equipment for measuring ECG, blood pressure, heart rate, auscultation, oxygen saturation and the temperature of a patient which can transmit data wirelessly anywhere is already a reality and is already making big impact through low cost solutions to rural healthcare. ‘A3RMT’ is one such startup which assisted in treatment of more than 56,000 patients in 450 locations in India and saved more than 2,000 lives through emergency intervention.

2. Only Cure Based. Though the old saying preaches that ‘Prevention is better than Cure’, the present trend in India remains cure based. Though the government’s thrust on health with awareness of Yoga and general health is in the right direction, it’s too little too late. With continuous monitoring of health parameters on individuals using AI, the march towards preventive healthcare can become a reality. Also, self medication is very much prevalent in India. To equip personnel to verify the veracity of such remedies, a startup  Myupchar’ has been created. Other such apps can help the users to avoid wrong or non-effective diagnosis, thereby not losing precious time which may prove crucial in certain critical ailments. Also, awareness about health can also be increased by using various tools and apps. Fitness bands have also increased the overall awareness.

3. Low Budget on Healthcare. The present allocation of about 1% of GDP to healthcare budget is way below what is needed. Though the government plans to increase this to 2.5% by 2025, it is still way below the required mark of 5 to 6%. The entry of AI into healthcare also means that the Government healthcare schemes would have much larger coverage with the same budget. The lower and effective medical help would mean lowering of costs of medical insurance thereby making it more affordable. At present 76% of Indians do not have any health insurance. This in turn should bring in more people to buy medical insurance and providing healthcare protection to larger sections of society. This would increase the overall load on the healthcare infrastructure of the country and thus cheaper medical education to churn out more doctors and nurses with effective use of AI and robotics would become a necessity. As the numbers increase the costs should slide down further.

4. Shortage of Healthcare Officials. A 2011 study estimated that India has roughly 20 health workers per 10,000 population, with allopathic doctors comprising 31% of the workforce, nurses and midwives 30%, pharmacists 11%, AYUSH practitioners 9%, and others 9%. The resource and knowledge sharing in between healthcare organisations can become online and instant depending on present usage of the resources. If the resource can be more effectively (or profitably) utilised by another organisation through virtual allocation by AI, the overall working efficiency would be higher. This is especially important in a country like ours where the infrastructure and number of healthcare specialists are far lesser than the need. Simple example of the same is sharing of ambulances.

5. Lack of Medical Research. The international pharmaceutical companies have for long neglected research in medicines for tropical diseases due to low profitability and the Indian companies have been limited in success in this area due to prohibitive costs of R&D. With the latest amendment in the rules for CSR by the government, the money can now be utilised for R&D and this would mean that the pharmaceutical giants would be pumping in large amounts of money into research in India. This would mean significant increase in the clinical trials in the country. The AI tools can make the clinical trials more effective and result oriented and would be able to indicate the side effects on the subject much earlier than otherwise.

6. Alternative forms of Medicine.  AI tools can be utilised to monitor the results of medical practices like Allopathy, Ayurveda, Unani and Homeopathy. The data on successful diagnosis through these could be compared for various diseases and most effective form of medicine for each type of disease can be computed for further analysis.

7. High Cost of Healthcare. The high cost of healthcare is prohibitive for majority of Indian population and thus proper healthcare facilities remain out of their reach. The factors listed above will bring down the overall costs of healthcare.

8. Awareness. A study in urban Haryana found that only 11.3% of the adolescent girls studied knew correctly about key reproductive health issues. Since the same is a difficult topic to cover for parents as well as teachers, AI based training modules can be used to teach certain sensitive issues.

9. Accountability. With better data logging and AI based approach, the responsibility can be determined for various actions. Last year, a dengue patient was billed around Rs.16 lakh by Fortis Hospital, Gurugram for 15 days treatment in its ICU despite the death of the patient. Inspite of having the best of the doctors and latest technology, cases of medical negligence are reported frequently. In another case, an alive baby was declared dead by Max Hospital, Shalimar. With better use of AI tools, accountability in such cases can be fixed. However, for this, complete legal framework will have to be prepared to ensure that only those are punished who are proven guilty of intentional malpractice beyond doubt. Also, the data once stored should be protected to ensure that no tampering can be done even at back end. The privacy of data also needs to be taken into account.

10. Home Care. Avenues of patients being treated at home also need to be explored. This would ease the load on limited hospital infrastructure and reduce the chances of secondary infection to the patient. This also eases the life of attendants of patients, usually the close relatives. Start-ups like ‘PORTEA’ are working in this field and providing such avenues with mush lesser costs.

The doctors should also be excited as by intelligent use of AI, the major problems faced by them in India could be eased in a limited manner:

1. Understaffing. The doctors are overworked and often complain of fatigue. The problem is compounded due to poor infrastructure and support facilities. A human is after all a human and human fatigue of doctors in hospitals can be brought down with the use of AI tools effectively. The number of specialist doctors and nursing staff on duty can be brought down with AI machines acting as assistants to the duty staff. The AI machine with complete history of each patient and earlier diagnosis by the specialist can be of great help to the duty staff. This would also mean that time spent on each patient by the doctor reduces significantly thus giving doctors and staff to utilise this time effectively in upskilling themselves. The monitoring of patients with critical illness and assistance provided to them can be greatly enhanced. The use of AI tools in hospital administration would bring up the overall efficiency and hence reduce time spent on avoidable tasks.

2. Troublesome Patient and Relatives. With better sampling of data in case of each patient and data being available for analysis in future, the number of cases of malpractices would significantly come down. This would vastly improve the trust factor between the doctor and the patient, which would eventually bring down the cases in which the relatives manhandle the doctor and damage the hospital property. ‘Credihealth’ is one of the medical support startup that gives guidance to the patient regarding finding the right doctor to guiding them in admission to discharge process based on disease to be treated and even give cost estimates for every process. The policy and rules would have to be amended accordingly to cover the legal aspects of medical cases with the availability of AI and big data. All this would also require a
framework where the data is protected and reproduced as required without any chances of tampering at back end.

3. Expectations of Instant Relief. Use of AI tools could help convince the patients better regarding the diagnosis administered and time to recover. A predictive graph of such ailments and dosage would greatly dispense fears amongst patients and their relatives.

4. High Medicinal Costs and Charges by Hospitals. Doctors have often complained that whilst patients bear huge medicinal costs, the consultation costs in India remain very low. With the use of AI tools, the exact dosage for patients can be worked out, which will bring down the medicinal costs borne by the patients. Further weaning off of a patient from medicines could be predicted. Also, as the working of hospitals and organisations could be automated with use of AI, the total operating costs of hospitals could be significantly lowered. This would reduce the total cost burden on a patient and thus higher consultation costs of doctors could be facilitated. The option of choosing between a non-emergency plan and emergency plan of medical cover is also being provided through smart solutions. ‘Afforplan’ is a startup that gives plans where one could plan, save and pay for non-emergency planned procedures like pregnancy.

5. Non-compliance by Patients. In instances where the patients do not comply to the instructions of doctors, the blame still comes to the doctor. With better recording of parameters and use of AI tools, the monitoring of patients can improve significantly, thereby reducing the blame on doctors.

6. Prohibitively High Training Costs. The training costs for doctors especially for specialisation are prohibitively high. Presently average cost of completing MBBS from a private college is approximately 25 Lakh and for MD it is almost three times or more. These training costs can be brought down significantly with the use of AI-based training and college administration tools. The automotive and other industries have already started moving towards AI-based training making it more personalized and focussed.

The net throughput to every student in such cases is also higher resulting in better skill of every trainee. Reduction in training costs should also be utilised to educate the young trainees to the financial aspects of the healthcare (both the public and the private sectors) in low-income countries result in gaps between providers’ knowledge and the care provided, this is known as “knowdo gaps” and is a serious concern in delivery of proper healthcare services. Start-ups like ‘Timble Tech’ are working in the field of training using AI tools, the same company is presently also working with AIIMS on mapping the symptoms and response to certain kinds of diseases. a delivery system so as to bring in behavioral change towards cost-consciousness in the implementation of governmental schemes. Also, low knowledge by the providers

7. Poor Working Conditions. Majority of the government infrastructure, especially rural lack good infrastructure, proper management, dedicated staff and many other things which are required to provide reasonable and appropriate healthcare. The AI based tools can help this on multiple accounts. The tools can help in better reporting and monitoring of the issues. Also, the staff responsible for administration can be better trained with special emphasis on implications of poor hygiene and infrastructure and finally in better accountability. In 2017, 300 infants were reported to have died in Baba Raghav Das Medical College, Gorakhpur due to shortage of oxygen supply, indicating poor management. There is little evidence to indicate that the lessons learnt have been implemented or rather lessons have even been learnt.

The fear of AI taking away all the jobs should be dispensed with as the machines cannot think, not yet. All they can do is learn from previous results. Thus, large sample size is a pre-requisite for better estimate of probability and hence better inferences by AI operated machines; however, the results differ with different algorithm used on the same data sample. This difference in results based on different algorithms is called the algorithm bias. This issue is compounded by the problem that the healthcare data gathered through various tools may be inaccurate and the same is mostly not counterchecked. The AI operated machine once fed with such skewed interpretations can create havoc if left unsupervised. Thus, for a long time to come, these biases would ensure that the final decision making remains out of the control of machines. The healthcare industry thus needs to upskill themselves to be able to utilise the AI tools more effectively. Even with the use of AI, more health officials are required to be able to provide adequate medical coverage to the citizens of this country. The legal framework to cover aspects of AI based health coverage and training thus form the most important tasks ahead.

The decision making on use of AI in healthcare sector should be based on penetration of quality healthcare facilities rather than profitability. As the affluence in the populace increases, the profits would eventually rise too. Though AI is not a ‘one solution to all problems’ remedy, it can facilitate improving the conditions in the healthcare sector significantly. Each AI based solution will have to be built carefully and incrementally to ensure low investment. The study of functioning of each organisation could reveal the areas where the AI based tools should be employed the first; however, it is felt the hospital administration and training are the areas where its demand is going to be highest. Integrating of every individual’s data from smart watches/ fitness bands could come in next followed by intelligent resource sharing amongst various organisations.

Further advancements could be decided on the Return on Investments on the ones quoted above. There are numerous start-ups in India working in the field of AI being incubated under the ‘Make in India’ program and should be able to partly meet demands of healthcare sector to move towards AI. The Government and the healthcare sector need to factor the opportunity costs of loosing global business by not moving towards AI at the right time. The medical tourism in India is a significant contributor of revenue in this sector. Improved facilities and care could significantly increase the medical tourism in the coming years.

Composed by Gaurav Sharma

Gaurav Sharma holds M. Tech from IIT Delhi and is a keen observer on the effects of Artificial Intelligence in the field of HR.

The responses have been given by Ankur Gigras, VP, E-commerce of 1mg

What are the objectives and your vision to start this organization?

1mg was launched in 2015 with a vision to make healthcare accessible, understandable and affordable. In the last five years, we’ve fundamentally disrupted healthcare in India and have emerged as clear leaders of the fast evolving digital health ecosystem.

Here is a look at what we have achieved so far:

• ~35% share of category amongst medical apps; 350m monthly page views on 1mg platform
• Integrated Healthcare Platform: “Wiki” for healthcare information & India’s largest ePharmacy, eDiagnostics and eConsultation lines of business
• Strong supply chain across India and a fast growing profitable B2B business line [Pharma distribution & Phlebotomist network]
• Strong ecosystem partnerships with unique integrations with Insurance, Hospitals & Pharmacos to deploy novel models of healthcare delivery to patients across India

Patient centricity forms the core of our values. In the times that we are currently in, a digital healthcare platform is incomplete without online consults or telemedicine. We believe in offering our users a complete treatment cycle: from online consultations to ePharmacy and Lab tests.

What do you think needs to change in the health sector?

In healthcare, the information around our medicines and lab tests is either unavailable or incomprehensible to us, and that is the biggest change the sector needed to go through. Hence, with an aim to democratise healthcare, we decided to create a platform that stood for transparent, authentic and accessible information for all.

Unavailability of doctors due to a low patient to doctor ratio is another issue faced by the healthcare sector, especially in rural areas. With our video, audio and chat consultations, we hope to reduce that gap.

What tools and resources do you propose to bring these shifts in healthcare delivery?

In addition to the transaction & information services, we have built and launched many popular digital health tools such as medicine reminders, digital health locker, emergency profile etc. We also work on several unique models for patient support programs, digital health education programs, insurance solutions etc;

eConsults or telemedicine is another tool that we believe can bring about this shift. With most people practicing social distancing and minimizing contact, online doctor consultations, as per the guidelines issued by the Government of India, seem to be the safest option of seeking expert medical opinion and diagnosis.

Can you share about your business model?

1mg operates on a marketplace model where we have tie ups with licensed pharmacies, accredited diagnostic labs and with registered doctors/medical professionals. 1mg is an information technology platform on a digital and electronic network and acts as a facilitator between a buyer and a seller. The business model of 1mg is tied to the online transactions completed by consumers for Pharmacy and Diagnostics. The partners pay a small commission to us for bringing them orders and as volumes drive up, so will the profitability. As consumer usage increases, we would try and also introduce other monetization models through advertising. However, we are going to keep the offering free for consumers. [ lil’ bit on how econsults operates]

As mentioned earlier, patient centricity has always been our focus. 1mg believes in taking care of the needs of the patients, bringing about transparency and making healthcare accessible to all. We started out as a content platform for all health and medicine related information and later on went on to become an ecommerce platform.

What is the key strategy you adopted for acquisition?

1mg is a leader in the industry, with a ~35% share of category amongst all medical apps in India. So far, we have received over 350m monthly page views on our digital platform. Our app downloads have crossed 33 million till date.

It was possible for us to acquire such a huge user base only after we built enough trust among the people with the authentic information we provided. A major chunk of our customers are those users who came to our platform to consume health content.

What are the factors that influence market innovation and its impact on your organization?

To put it simply, the needs of the customers impact market innovation. For example, in the current times as the world is battling COVID-19, there is an urgent need for authentic and updated information around the same. So, we took it upon us to keep people informed. We experimented with different forms of content like ebooks, mailers, app notifications, website landing pages and more to help people consume as much authentic and medically accurate information as possible.

What are your strategies to deal with your competitor and what makes you different from others?

Being an integrated healthcare platform, 1mg enjoys leadership position and is driving the digital healthcare innovation in the country. Today, 1mg has become the most preferred integrated healthcare app for consumers/patients, and we clearly stand-out in the competition in terms of

• Relevance and speed of search results for users
• Quality of medical data/content available on our platforms, which is kept up-to-date at all times
• Predictive algorithms and machine learning

We have great respect for our competitors but our qualities and values set us apart from the pack:

• Clarity of vision – Since day one, 1mg has believed in integrated healthcare as the only model of healthcare that works for a consumer. We believed in it even before it was fashionable and for the last 5 years, we have worked very hard to make it happen. Our thought process, our innovation is naturally ahead of time.
• Superlative team – We have one of the best teams in the Indian internet space, with leaders who have built and led large consumer businesses or healthcare divisions. We have also had the good fortune of having worked (or known) each other for a really long period of time. As a result, our team has a very high degree of trust and works in a very agile and collaborative fashion to achieve quick results.
• Clarity in values – Since the very beginning, we have been clear about the values we want to uphold at 1mg:
  • Our value of “done is better than perfect” enables us to rapidly innovate and test real products out in the market
  • Our value of “Be CEO” empower individuals to take charge and do what’s right without an organizational bureaucracy holding them back
  • Our value of “accountability with empathy” ensures meritocracy
  • And our value of “team before individual” enshrines collaboration

We strongly believe that this is our winning formula.

With respect to telemedicines, we are one of the firsts to introduce audio and video consults, as well as COVID-19 specific consults.

What were the challenges you faced in initial days and how are they different today’s scenario, especially during this pandemic and what is your role in that?

Access to healthcare has been a challenge even before the pandemic, and health tech companies have tried everything to knit the gap existing in the healthcare system, be it telemedicine, online doctor consultation, mobile hospitals, etc. But, with the demand surging due to Covid-19 across different parts of the country, health tech companies are witnessing a new behavioural shift in Tier 2 and Tier 3 cities, which is here to stay.

Do you see any major growth opportunity in the post COVID-19 world?

Doctors have now started recognising the need for technology to engage better with their patient base. Hospitals too have become receptive of the change, as most of them are seeing a 40%-50% reduction in footfall. Suddenly they have started to feel the pain that they are not connected with the patient when they are at home. Onboarding doctors on telemedicine platforms has been a major challenge in the sector. Realising which, existing telemedicine companies have even adapted to models like collaborating with hospitals, or local pharmacy chains.

In the post-COVID-19 world, we believe that consumer behaviour would shift towards teleconsultations. The consumer’s fundamental pain point has never been about saving money on healthcare or ignoring it, it’s always about access. Going to a doctor’s clinic, waiting for two hours, and having to leave work early is often seen as an inconvenience. But with telemedicine they can consult the doctor anywhere without having to go through the hassle of visiting a clinic.

Further, the involvement of corporates and insurance companies in digital healthcare is also expected to go up.*

Share a bit more about the culture and values of your company? What is important to you and why?

• Our value of “done is better than perfect” enables us to rapidly innovate and test real products out in the market.
• Our value of “Be CEO” empowers individuals to take charge and do what’s right without an organizational bureaucracy holding them back.
• Our value of “accountability with empathy” ensures meritocracy.
• And our value of “team before individual” enshrines collaboration

We strongly believe that this is our winning formula.

What are your Future plans and any message for our readers?

Since the inception of 1mg we have always believed that technology and data will fundamentally change healthcare delivery. 1mg has already changed the healthcare landscape by making consumer centric integrated healthcare real. Over the years we have invested significantly in product and supply chain and most of the investments will continue or get accelerated. Some areas which will see disproportionate investment will be the ones below:

• AI and Machine Learning – Artificial Intelligence will fundamentally change healthcare and will make it personalized, predictive and preventive. With billions of healthcare data points, 1mg is already working on cutting edge AI models and we will continue to accelerate work in that direction. Our most recent peer review journal publication on teleconsultation is proof of our deep capabilities.
• New healthcare models – It’s clear that at 1mg’s scale, we now have the ability to enable new healthcare models for the ecosystem. These models, such as smart hospitals, outpatient insurance etc. will be the models of the future and will make healthcare accessible and affordable. Accessibility and affordability are 2 core pillars of 1mg’s vision.
• Integrated Care plans – Using the 1mg platform, our goal is to enable truly integrated outpatient care in the country. Such a plan will provide a patient with continuity of care both online and offline and across all their healthcare service needs.

We strongly believe that product and technology are our core strengths at 1mg and ones that have and will continue to help us deliver superlative value to a healthcare consumer.

Interviewed by Disha Soni & Dr Prateek Malhotra