The Inaugural ceremony was graced by Mr. Prabal Chakraborty, Vice President & Managing Director, Boston Scientific India. The ceremony was also graced by Dr. Vidya Yeravdekar, Pro-Chancellor, SIU and Dr. Rajani Gupte, Vice Chancellor, SIU. Mr. Prabal Chakraborty mentioned that the complexity of healthcare is arising due to multiple stakeholders, multiple information flows, unstable geopolitical environment, and multiple decision-making processes. Dr. Rajiv Yeravdekar, Dean, Faculty of Health & Biological Sciences, SIU justified the concept of SYMHEALTH by a small story of a young boy who tried to search for god and succeeded. Dr. Rajani Gupte talked about the inter-departmental connections and platform where students get to inculcate skills like teamwork and hard work. Dr. Vidya Yeravdekar explained the need to have communication skills along with other pre-requisite skills in health sciences. Dr. S. B. Mujumdar, Founder and President, Symbiosis; Chancellor, Symbiosis International (Deemed University) emphasized on the need of the hour to have a healthy mind and a healthy body.

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The first session was on Public Health Agenda for India by Dr. Sanjay Zodpey, Vice President, Public Health Foundation of India.

He started his session by stating the 21st-century challenges in healthcare in India and the need to have a healthy population. He did a comparative study of healthcare status in 1947 India and the status at present. He emphasized the poverty status, gender inequality, the situation of sanitation and education in India as compared to the data available globally. He also discussed health landscape indices regarding immunization coverage, sustainable health goals index, related to health and wellbeing, life expectancy, infant mortality rate, etc. He stressed upon the need for government to increase the amount of GDP expenditure in the healthcare sector to have a positive impact on indices like life expectancy and national per capita income. He also talked about the challenges associated with the low expenditure on healthcare, the shortage of clinical and non-clinical staff. He also touched upon the topic of Universal Health Coverage and the point to be focused upon: affordability of healthcare, quality health service and financial protection to the public. He ended the session with the note “Creating ‘Swasth Bharat’ along with ‘Swachh Bharat”.

Mr. Bhaskar Nerurkar, Head, Health Bajaj Allianz ltd started the session with a little humor and introduced his co-panelists. Ms. Gayatri Iyer, Regional Manager, NIC then proceeded with her speech introducing the concept behind RSBY (Rashtriya Swasthya Bima Yojna), Ayushman Bharat and NHPS (National Health Protection Scheme). She also talked about the initial Planning commission and its transformation into NITI Aayog. She concluded her speech by perks and eligibility of the scheme. The session was then proceeded by Mr. Bhaskar where he started by appreciating Symbiosis International University for their educational services by saying that ‘Pune is the home of education and Symbiosis is the kitchen’. He talked about the aspects and the need to have Ayushman Bharat and Pradhan Mantri Jan Aarogya Yojana (PMJAY) from the insurance sector’s perspective.

The session then moved forward to Mr. Arunesh Punetha, Regional Director, Narayana Health who discussed about the anticipated challenges for public and private healthcare providers like the low rate of packages being made available to the clinical staff and the shortage of health workforce. He gave his insights on the Michael Porter’s model of ‘Agenda for Value Transformation’ with patient centricity at the core. He ended the session with a talk about PMJAY and its influence on public health.

Dr. Sanjay Gupte, Medico-Legal Expert began the session by talking about the types of law in healthcare statutory and case laws. He projected the issues by focusing on the interpretation of law changes as per circumstances, unlicensed practitioners, quacks and midwifery. He gave an overview on consent for sterilization, MTP, PCPNDT Act, surrogacy laws passed by loksabha, altruistic surrogacy with the help of many case studies. He spoke about the punishments for the failure to report or to record a case. He gave his inputs on medical negligence and its implications. He majorly focused on euthanasia in India i.e., withdrawal of life supports to patients. He concluded the session by talking about the latest changes in medical acts.

Mr. Rohit Sathe, President, Health Systems, Philips headed the panel discussion and began the session by introducing Philips and their mission and vision. His session was mainly focused on 4 components- accessibility, speed & accuracy, value solutions and innovations.

The session then moved forward to Mr. Vidhi Prasad K V, Head, Wipro GE South Asia. He talked about medical technology. He also touched upon the E-commerce portal for service parts & accessories like Medtronics, Siemens, Philips, etc.

Mr. Surendra Deodhar, VP, Reliance Life Sciences Pvt Ltd took over the session and proceeded to talk about equitable distribution of medicines in India, especially in rural areas, where access to these privileges is a challenge.

The session was concluded by a small Q-A session between the speakers and the audience.

Dr. Simmardeep Singh Gill, COO CK Birla Group Kolkata, began his session by touching upon the very concept of strategic leadership. He talked about the increment in competition and other factors with the help of forecasted charts based on reported data. He also described the challenges associated with the business models. These include: low public spending and high out of pocket spending, talent shortage and high attrition, fragmented industry and lack of standardization. He spoke about the widening trust deficit between the patient and the provider. He stressed about the high asset business model which has put a lot of strain in the financial metrics like sinking valuation, margin pressure an payout of insurance players. Micro insurance was given key importance. He concluded by sharing with us the growth story of CMRI which majorly focused on procurement optimization, patient experience, clinician engagement and manpower optimization.

The post tea break proceedings of day one of SYMHEALTH 2019 began with two parallel sessions. The first session was chaired by Dr. Satpathy, Director, School of Public Health, KIIT Deemed University. He talked in detail about the conceptual meaning of Universal Health Coverage (UHC). He emphasized on the need to have quality medicine, quality treatment, skilled workforce and the public should not face any difficulties while accessing them. He also stated the importance of having Primary Health Centres (PHCs), their efficiency and effectiveness in providing health to all. He stated that 80% of the Health needs can be taken care at PHCs. Further, he addressed the myths regarding Universal Health Coverage. He then proceeded to describe some key facts about UHC and its association with the World Health Organization (WHO). He concluded the session by talking about NRHM and Health Service Providers.

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The second parallel session on Pharmacovigilance & Clinical Data Management was conducted by Dr. Raman Gangakhedkar, Head, Epidemiology & Communicable Diseases, ICMR. He started his session with elaborating on why is pharmacovigilance required. He stated that the aim of pharmacovigilance is to detect unknown AEs at earliest and ensure patient safety. He did a comparative analysis of clinical trials and use after approval.

This analysis was done on the basis of the number of participants, the total duration of observation, vulnerable population, pharmacogenetics, concomitant medicines, and dose and duration. He spoke in detail about the increasing scope of pharmacovigilance. He spoke about the key stakeholders in pharmacovigilance. He spoke in detail about Nevirapine and post-exposure prophylaxis. He further emphasized the importance of the Periodic Safety Update Report (PSUR). Inputs regarding the mandatory data fields in reporting were provided. Role of Indian pharmacopeia commission topic was touched upon by sir. Sir primarily spoke about the importance of the Bradford Hill criteria. He further gave an overview of the national AEH surveillance and emphasized on the ICSR processor. Lastly, sir spoke about IC025 and disproportionate reporting. Sir concluded by saying that pharmacovigilance is an important activity for safety and that good data quality and its completeness is critical in signal detection.

Mr. Lalit Mistry, Director of Healthcare, KPMG began his session by talking about the emerging health trends in India and speaking about the future of consulting in healthcare. He talked about the potential impact on the healthcare industry by the emerging medical technology innovations, treatment innovations, proactive wellness, and digital health. He discussed the drivers of healthcare; the drivers being technology improvements, market forces, costs, regulatory reform, and consumerism. Mr. Mistry then proceeded to talk about the major broad buckets of consultancy sector including project management, management consulting, HR consulting, etc. He stated the fact that healthcare consulting market in India is fragmented and underdeveloped mainly in operations, clinical and strategy consulting. He then concluded the session by giving a brief overview about the career path prospect in healthcare consulting and the skills required like number crunching, report writing, communication skills and the ability to travel in short periods of time and domain knowledge. The session was proceeded by a Q-A session between the speaker and the audience.

The day concluded with sessions on Emerging roles & Opportunities for Healthcare management professionals by Dr. Dinesh Pashankar, Associate Professor, Yale University, USA. He spoke about the equitable distribution of medical equipment’s devices & pharma products. The Department of Pharmaceuticals of India is working towards the initiative to source at least 50% of these domestically so as to reduce procurement and heavy import charges and also make these easily available.

The day concluded with session by Dr. Col. Ajay Gangoli, Group Medical Director, Apollo Health & Lifestyle Ltd. He talked about the Multiple Dimensions of Communication in Health Care Industry. He stated that the purpose of disseminating health information is to influence personal health choices by improving health literacy.

Day 2: Saturday, April 20, 2019

Day 2 of SYMHEALTH 2019 opened up with paper presentations by delegates. There were 4 candidates who presented on various topics.

The second session of the day was an engaging talk on Corporate Social Responsibility in Healthcare by Dr. Sitarama Budaraju, Consultant, Healthcare Projects, Tata Trust. He introduced top 10 healthcare CSR projects in India in 2018. He spoke about the current health status. He touched upon the supply side constraints namely Human resource for health infrastructure, Health financing, Pharmaceutical, and supply chain and Technology. He emphasized the training of peripheral health workers in soft skills. He ended his session by focusing on the importance of documentation support.

Dr. Anirudha Malpani, Director & Founder, Malpani Ventures discussed the common beliefs among the people that doctors are dinosaurs i.e. they work in older ways than embracing any new technology. He said these days’ people practice eminence-based medicine, not evidence-based medicines. He stated that self-diagnosis and self-prescription are very common among the people and wrongful. He further spoke about different innovations such as Heart buds – using the smartphone as the stethoscope, smartphone-based ECG monitor, peek – smartphone-based eye testing kit, etc. He said that the doctors see the patients daily, doctors know the patients then why should they wait for the engineers to do the innovation. He concluded the session by saying that patients should receive information therapy from doctors. He also appreciated word of mouth marketing approach. His whole session was focused on “Patient as Partner approach” and how communication is the key. The session was full of jocular remarks that made the session very interesting.

The session was anchored by Col. Ajay Gangoli, Group Medical Director, Apollo Health & Lifestyle. He introduced the other speakers. Col. Gangoli gave introductory of the topic than Ms. Nishi Saini took over.

Ms. Nishi Saini, Head- North, Clove Dental Clinics started the session with Clove dental clinics’ inception. She spoke about clove dental history and its vision and mission. She showed a various graph showing clinics and dentist. She explained how to manage the services at such a big scale smoothly. She spoke about talent management under which she focused on intelligent recruitment. She concluded by showing various aspects where Clove serves the need of the society. She concluded by showing various aspects where Clove serves the need of the society.

Mr. George Chemban, Business Head, Suburban Diagnostics started his session with an introduction about his company Suburban Diagnostic which was started by Dr. and Ms. Sanjay Arora. He stated that doctor-patient relationships are transactional in nature. He focused on the essentials for creating a chain of business units by specifying the business strategy and alignment of goals, standardization for customer experience, standardization of people and processes and standardization of technology.

Mr. Anand Mote, COO, Aster Hospital started his lecture by speaking about why healthcare chains are required. He replicated the lecture by third man’s view of setting a healthcare system. He spoke about the changing landscapes in healthcare chains where he spoke about the global players who are entering the Indian market, availability of capital and importance of well-informed customers. He gave a brief about types of healthcare facilities. He also gave a basic template for setting up and managing a chain of healthcare facilities. He ended the session by explaining how the brand is created and perceived in the healthcare system.

The valedictory ceremony on May 20, 2019, was graced by Surg. Vice Admiral Ravi Kalra, NM,VSM, Director and Commandant, Armed Forces Medical College, Pune; Dr. Sanjeev Kumar, IAS Divisional Commissioner, Nagpur, Dr. Rajani Gupte, Vice Chancellor, SIU & Dr. Rajiv Yeravdekar, Dean, Faculty of Health & Biological Sciences (FoHBS).

Around 1000 to 1200 healthcare professionals, from across the country comprising of professionals from diverse verticals of the healthcare sector including domains of Hospital & Healthcare Management, Medico-Legal Systems, Medical Insurance, Clinical Research, Healthcare IT professionals, General practitioners, Specialists & Doctors from Allied Health Sciences, Policymakers & Administrators, Representatives of the Pharma sector, Representatives of Civil Society Organizations and Representatives of private and public Healthcare sector organizations participated in this event.

SYMHEALTH 2019 | 19 – 20 April 2019

A mountain of unstructured data

One area where AI would do heaps of help to physicians and medical practitioners is to deal with the insurmountable amount of clinical unstructured data. Nearly 80% of the clinical information is “unstructured” and in a format incomprehensible to health information systems. Thus, getting useful information from these so-called unstructured databases becomes a labor-intensive task. To top that, clinical data is doubling every three years; which leaves the healthcare system with a massive volume of unsorted heterogeneous patient information which may hold answers to several health challenges, but strictly speaking, is of little use in its current form. This challenge in healthcare of too much data, too little insight can be alleviated by employing Natural Language Processing (NLP), a form of AI which identifies key information from spoken or written human input, such as physical examination records, handwritten lab notes, discharge summaries etc. The promise of NLP lies in its ability to turn this big data into smart data. It can be applied to mine big blocks of clinical data and convert that into organized curated easy-for-retrieval information, which can make documentation of clinical information more manageable. In 2014, IBM’s Watson collaborated with Epic Systems and Carilion Clinic to analyze massive 21 million records in just six weeks and pulled important information about risk factors and other features from examination notes written by physicians and clinical laboratory results into organized EHR templates, and further used predictive modeling to identify patients at risk to congestive heart failure with an assuring 85% accuracy rate. Similar efforts of using NLP to tackle cancer and genomics datasets are in process. NLP algorithms thus can be employed with much effectiveness to unlock healthcare’s big data crisis to extract clinically relevant information and make it available for doctors to make smart decisions about their patients.

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Can Artificial Intelligence replace a doctor?

Another facet of healthcare where artificial intelligence can find use is analyzing structured data namely genetic data, imaging data from X-ray scans, CT scans, MRIs, etc. and electrophysiological data obtained from electrography of the heart, brain, and other body parts. Machine learning plays a major role owing to its ability to ‘learn’ and make predictions from data without explicit programming. Of the many machine learning algorithms, two such algorithms have been used extensively in both research and healthcare, namely Support Vector Machine (SVM) and Neural Networks (NN), both use supervised learning models. SVM, in particular, has been useful in tasks involving classification and for novelty detection. For example, a 2012 study used SVM to identify imaging biomarkers of neurological and psychiatric disease. SVM has been used as prediction models for diabetic and prediabetic patients. In 2010, a research group from Korea applied SVM to make predictions about heart failure patients and their adherence rate to their medication. Two researchers from Australia used SVM for the diagnosis of cerebral palsy gait with an accuracy rate of 96.8%.

Neural Networks, on the other hand, form another major chunk of AI algorithm in healthcare. NN algorithms are vaguely based on biological neural networks, in which a collection of interconnected nodes processes the data like how neurons communicate in a human brain. The potential of NN has been multiplied manifold, thanks to the advent of Deep Learning which is an evolved form of NN, it uses multiple hidden layers that can be used to process complex multidimensional data like a human brain. A huge portion of NN algorithms is used for diagnostic imaging. Early last year, a study published in Nature used CNN, a type of deep learning NN algorithm to identify skin cancer from clinical images. The algorithm which was trained on 29,450 clinical images, was highly specific and sensitive to detection and was on par with the performance of an expert dermatologist with over 90% accuracy. A 2016 study used a variant of deep learning NN to identify interstitial lung disease using CT scan images with 85.5% accuracy. Google’s artificial intelligence team employed deep learning algorithms to study pictures of the back of the eye, for the detection of diabetic retinopathy, a blinding disorder in diabetic patients. Their results showed above 90% accuracy in both sensitivity and specificity of detection, which is at par with a skilled ophthalmologist.

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Some areas where artificial intelligence surpasses humans is in looking for patterns in data and in making predictions about that data. Processing thousands of images and looking for a subtle discernible pattern within huge volumes of data is a tough task for humans, but that’s what Shinjini Kundu, a physician at the University of Pittsburgh Medical Center has been doing. Her AI algorithms examine images like MRI scans for subtle differences which may not be perceptible to the human eye, and she has employed this to study osteoarthritis and to predict its development way before it’s diagnosis with a whopping 86.2% accuracy. Similar algorithms can be used to see nuanced differences in electrocardiograms, CT scan images and even in oncology to look for invisible patterns of disease onset and progression. As artificial intelligence algorithms get better after each iteration, routine lab tests like X-rays, CT scans, MRI scans, ECG etc. would fall into the domain of artificial intelligence for more quick and reliable results.

Investment in AI-centered healthcare

Beyond research laboratories and hospitals, the emergence of AI has caused exponential growth in policies regarding AI and investment in AI around the world. AI-based startups have seen rampant growth. Startup Health, an incubator in the US recently reported that there were 7,600 healthcare start-ups around the world working on digital health innovation, a major portion of which involves AI based innovation. An Accenture report published in late 2017 states, “Growth in the AI health market is expected to reach $6.6 billion by 2021 – that’s a compound annual growth rate of 40%”. Another report by CIS India published this year states that AI could add a whopping $957 billion to the Indian economy by 2035. Even state governments are pushing for growth in AI-based sectors. The government of India aims to increase healthcare spending to 2.5% of the Gross Domestic Product (GDP) by the end of its 12th five-year plan, and to 3% by 2022. Such high rates of adoption are due to several AI start-ups and involvement of major players like Microsoft and IBM.

Given the skewed ratio of doctors to patients in India, AI-based healthcare techniques would provide much-needed help in providing healthcare amenities to the masses. Globally, US government have made heavy investments in two of its AI-centered healthcare initiatives, with $1 billion proposed budget to its Cancer Moonshot Program and another $215 million in its Precision Medicine Initiative.

Ethics and issues with AI in healthcare

As rapidly as AI has been embraced by the medical and healthcare community, its benefits cannot be actualized without understanding its ethical pitfalls. But there are several concerns when applying these algorithms at a large scale to make real clinical decisions. Algorithms, albeit self-learning is products designed by human and may reflect their biases in the results they produce. These algorithms may reflect the biases of its designer or biases caused by the dataset on which the algorithm was trained. For example, algorithms developed by private sector entities can be biased to ensure outcomes of their interest or healthcare institutes may use AI systems selectively based on say, insurance plan or economic status of that patient or any other parameter.

Even though Deep Learning algorithms can perform sophisticated predictions on imaging data, they are essentially not fed by an explicit code of information but are self-taught systems and even though the prediction score it gives, for example, whether the lesion is malignant or benign are surprisingly accurate when corroborated with the diagnostic report by a doctor, there’s no way to determine how exactly it came to that conclusion, thus rendering AI systems as a black box; with little clarity on how it works. Recently though there have been several predictions to understand how deep learning works, the information bottleneck theory being a prominent one, but the debate is far from settled.

The issues mentioned above are all pertaining to the AI system and its functioning, but there are vital concerns about AI’s effect on people involved in care. Several studies have shown that patients prefer AI chatbots and virtual nurses over humans when learning about their diagnosis as they can proceed to learn at their own pace without the embarrassment of not keeping up with the doctor’s speed. Patients are also more open to conversation with a computer than a human being, part of the reason being the diminished shame and fear associated with being vulnerable. But Allison Pugh, a Professor of Sociology at the University of Virginia and a writer for the New Yorker, thinks that virtual nurses and AI bots offer nothing more than the thinnest veil of care. She writes, “[…] automating or using AI to deliver care would be the same as relying on a “cloth monkey”—a reference to a cruel experiment, carried out in 1959, in which infant monkeys were given a choice between two surrogate mothers, one made from welded wire, the other from terry cloth. (The infants preferred the cloth mother, even when only the wire mother gave them milk.) AI-driven care was a sorry version of the real thing.”

As demonstrated by several research groups, deep learning algorithms have achieved human-level accuracy and then some more. It can look for patterns which are invisible to the human eye. Thus, sooner or later, displacing and relegating doctors from their positions, at least in certain areas of healthcare. This can lead to massive burnouts in doctors as their roles shift drastically and may even lead to a gradual attrition of their skills. But there’s more to care than just interpreting blood reports and imaging data of a patient, it has much more to do about understanding the needs of patients, their mental state, etc. The secret of healthcare is not in reading out objective reports, but in the assurance and the warmth, a doctor’s cadence can provide. “Caring is expressed in listening, in the time-honored ritual of the skilled bedside exam – reading the body – in touching and looking at where it hurts and ultimately in localizing the disease for patients not on a screen, not on an image, not on a biopsy report, but on their bodies.”, writes Abraham Verghese, an author and a physician at Stanford.

Employing AI to most healthcare activities might also have a negative effect on how knowledge is generated. Most medical knowledge generated in the past has been curiosity driven. AI systems can tell us whether the lesion is a benign mole or a tumor, but it can’t provide answers to why the tumor has a corrugated surface or white patches etc.

Artificial intelligence is going to be pervasive across the spectrum of healthcare. From routine lab tests to offering a clinical decision, AI algorithms will play a major role in the future of healthcare. As deep learning algorithms get stronger and as the workings of the black box are revealed, AI technology will make further strides in healthcare. But advancements in AI-based healthcare doesn’t mean the downfall of human doctors. Healthcare is a highly emotional and human-centric field and the “human touch” will always play a pivotal role in the delivery of healthcare. Humans, even highly skilled doctors are fallible beings with inherent limitations and artificial intelligence will not sideline these practitioners but augment their abilities, in making an objectively better yet humane decision.

About the author

Pratik Pawar is a science writer based in Mumbai. He has a Master’s degree in Biotechnology and currently works as a freelancer writing science-centric pieces with a focus on neuroscience.

Pictures credit: InnoHEALTH Magazine