And The Digital Revolution Begins…

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Digital technologies such as robotics, artificial intelligence, 3D printing, Internet of Things and nanotechnology have great potential to transform healthcare delivery. By Raelene Kambli

Dr X from a leading multi-speciality hospital in Delhi, is busy performing a complex heart surgery, when he realises that the patient is losing a lot of blood and he needs immediate assistance to deliver blood to the patient. He immediately alerts the nurse. The nurse in turn makes a call to arrange required blood. Comes in drone Happy Feet  (fictional name) with the required blood quantity. Dr X immediately supplies the blood to the patient and successfully completes the procedure.

Moral of the story….

This prompt action by drone Happy Feet augmented the entire process of delivering blood to a surgeon when needed. It saved time and provided better outcome.

Does this seem preposterous to you?

Perhaps 10 years ago, it would have seem absurd, but not today.

Recently, Fortis Hospital, Mumbai has announced a collaboration with  IIT-Bombay to employ drones to transport hearts in case of transplants in a bid to save travel time and lives. Dr Anvay Mulay, Head of Cardiac transplant team at Fortis who is in-charge of this project says that utilising drones to transport hearts will accelerate the process of transplants and will save the lives of patients.

In crowded cities like Mumbai, where traffic congestion is a normal sight, using drones to transport medical requirements and save patient lives is  laudable strategy. Moreover, this urges us to reflect on how healthcare in India is advancing and  how  this advancement will impact the business of healthcare?

Digital technologies setting precedent

Today, digital technology is invariably touching every sphere of healthcare diagnosis, delivery, management and research in India. As per Deloitte Touche Tohmatsu India, with increased digital adoption, the $ 100 billion, Indian healthcare market will grow at a CAGR of 23 per cent to $ 280 billion by 2020.

The sector is currently witnessing new levels of mobility and connectivity that are changing healthcare delivery and management in ways never thought before. Right from choosing a doctor, making an appointment to buying medicines, patients are now using Internet to manage their healthcare requirements. Moreover, healthcare systems and medical devices now-a-days are developed using microprocessors, miniature electronic circuits, wired and wireless digital networks and are slowly replacing older generations of mechanical and analog electromechanical devices used in patient diagnosis, monitoring and treatment.

What’s gripping about these technologies is that they have the ability to add more intelligence to medical decisions and research in healthcare.

Mobile applications

201609ehm11Let’s look at the widespread use of mobile applications and Internet of things in healthcare. These technologies have changed the dynamics of healthcare communication and management. Healthcare apps are becoming increasingly useful in maintaining health records, managing diseases and increasing connectivity with doctors and patients. It not only keeps doctors and patients connected but is also making healthcare more convenient, less expensive in some cases and more preventative by nature. They also make the patients more aware of their healthcare needs and provides them with a wider choice. From the business perspective, the real beauty of these apps lies in the creation of a competitive  marketplace for the health and wellness sector. On the other hand, increasing adoption of IOT in healthcare has convinced experts to believe that universal coverage of healthcare in India is not very far to achieve.

Internet of Things

IOT has some how shifted the focus of healthcare delivery from ‘hospital-centric’ to ‘patient-centric’ model. And the good news is that hospitals across the country are all geared-up to explore this field wholeheartedly.

Healthcare robots

201609ehm13Healthcare robots are also setting a precedent in India. Physicians and nurses are superhero saving the lives of patients, but these superheroes also need sidekicks to assist them. Robots play this part. They amplify the surgeon’s potential with superhuman precision and thereby provide better patient outcomes. An example to this is the very famous da Vinci robotic surgical system which is being utilised in various surgical fields. Using this robotic system, surgeons operate through just a few small incisions. The da Vinci system features a magnified 3D high-definition vision system and tiny wristed instruments that bend and rotate far greater than the human wrist. As a result, da Vinci enables surgeons to operate with enhanced vision and precision. Benefits to the patient include smaller incisions that lead to less stress on the body, reduced chances of infection and faster recovery times post-surgery.

Artificial Intelligence (AI)

201609ehm15Artificial Intelligence is another technology that has found immense scope. It is becoming a vital tool in healthcare data mining. IBM’s Watson computer, named after IBM’s first CEO, Thomas Watson, is a diagnostic AI machine built to understand the natural language that is presented in raw data without relying on a pre-organised database to pull information. This is extremely helpful for keeping track of all the different symptoms and potential causes and diseases for any given patient. It can pull information from context and learning algorithms to make connections that would otherwise take years to discover. Additionally, experts are intrigued by Watson’s capabilities in concocting new drugs that take interactions and side effects into account. This can enable healthcare providers to design treatment plans to meet the needs of the patient.

On the same lines,  Atomwise, an big data analyical and super computing firm has successfully developed a virtual search where safe and existing medicines could be redesigned to treat deadly viruses that damage physical, psychological and economy legacies. The idea behind this was to fight back against these viruses months or years faster, than the usual time and Atomwise’s virtual system was effective in the endeavour to search in an appropriate treatment for Ebola virus.

This is just a tip of the iceberg; we do not yet have complete comprehension of what form this digital wave will take. Still, the industry representatives seem upbeat about this trend. They cite more examples to tell us how these new age technologies are reforming healthcare delivery and their business models in India.

Industry testimonies

201609ehm14Says, Dr Narayan Pendse, Associate Vice President, Medical Operation & Systems Group (MSOG), Fortis Healthcare, “Off-premises real-time monitoring of ICU patients in remote areas with limited local clinical talent pool by means of an e-ICU is a simple but great example of what technology is capable of. Surgical applications of robotics are now well developed and have improved quality of surgery by allowing visualisation and access to body parts historically considered poorly accessible. 3D printing is improving minimal access procedures by adding the missing dimension of depth for accurate localisation of disease and intervention area”.

“Advancement in technology makes the perfect case for the IoT in providing connected care solutions. This calls for an open IoT ecosystem for clinical and remote medical devices that can bring together patient monitoring data into a single data management and analytics platform. With the patient information available at finger tips and possibility of monitoring multiple patients concurrently through remote patient monitoring, medical professionals and doctors can improve their efficiency and thus bring down the overall healthcare costs. Due to its live monitoring feature, the overall patient engagement can be improved especially for those who are suffering from chronic diseases,” informs Sudip Singh – Senior VP and Global Head of Engineering Services, Infosys.  He further explains how Infosys is building a connected healthcare ecosystem by utilising IOT. “The Infosys Connected Care Testbed, is an open and developing ecosystem of edge devices, communication protocols, cloud-based platforms and applications, with a focus on cost – effective IoT technologies for healthcare providers. It creates multiple opportunities for healthcare providers to improve hospital and clinical patient health outcomes as well as enable remote patient monitoring to reduce health relapse rates after a patient returns home meeting the regulatory requirements. The engineering services team at Infosys has also developed a comprehensive 3-D human heart model using CT-scan imaging. The model captures biomechanics of the heart in the most realistic manner, helping medical equipment manufacturers and regulatory agencies to optimise design, enhance quality and shorten time-to-market for their products, leading to improved and affordable healthcare to all. Plus, Infosys has also partnered with GE Digital to deliver industrial IoT solutions with advanced implementations in manufacturing, aviation, transportation and healthcare industries. These IoT solutions, based on GE’s Predix platform and Infosys’ Aikido services, will help enterprises simplify, automate and transform their business,” he updates.

201609ehm12Speaking about the research advances in nanotechnology A Nandini, VP Delivery, GlobalLogic says, “Delivery and controlled release of therapeutics, membranes for cleaning blood, miniaturised probes for recognising disease are few of the most researched branches under nanotechnology. Research  on reconstruction  of the brain through super-computer-based models and simulations to prevent neurodegenerative diseases, such as Alzheimer’s and Parkinson’s, and treat acquired brain injury and mental health including depression and bi-polar disorder are also underway”.

Dr Nagarjun Mishra, Chief Officer – Business & Strategy & Co-founder, Purple Health expounds on the research and developments in the field of robotic technology. He goes on to say, “Nowadays, many new engineering technologies aim to create a series of practical and effective microrobots. We should move into the future by creating some pragmatic working devices that will help us to cure some of the deadly ailments as well as advance our capabilities directly. A need of the hour is a concerted effort  to develop the working model of a microrobot in the near future,  thereby easing into the advancement of the use of nanotechnology. In some ways, the future is already here. India has about 30 health facilities performing high-end robotic surgeries including urology, gynaecology, paediatric, general surgery and bariatric (weight-loss) surgeries. The greatest impact has been in cancer surgery. It is now possible to remove tumours from almost any organ in the abdomen or chest with great precision and accuracy while saving normal and healthy tissues. Robotic surgery is preferred over traditional laparoscopic techniques because robots operate in 360-degree mode and have better precision and reach leading to better outcomes.”

Jyotsna Pattabiraman, CEO, Grow Fit, shares some out-of-the-box global concepts where technology is utilised to enhance health management.  Being enthused with the idea of applying a bio-hackers mentality to achieve health goals, Pattabiraman spells out how this concept functions and says that this concept can be applied in India too. “Rather than following conventional wisdom, biohackers use experimental trial-and-error methods to gain new capabilities. The holy grail for biohackers is to achieve something called the quantified self, where they can achieve an outcome using an algorithm of some kind.

For example –

  • Hacking sleep by using binaural sounds (e.g. brain.fm) to induce sleep and relaxation
  • Hacking nutrition by using products like Soylent, an engineered product consisting of mixtures of nutrients
  • Hacking athletic achievements by following a specific combination of events, for example, using interval training to ramp up to marathon

Pattabiraman also talks about an increasing curiosity to explore the potential of the concept of  transhumanism or directed evolution. “This means transcending the limitations of our human bodies through a combination of genetic engineering and device implantation. For example, some people have implanted a glucometer, even though they are not diabetic so that they can measure the impact of nutrition on their blood sugar continuously.

Rich Lee, a biohacker, implanted a device that allows him the power of echolocation through magnets implanted in parts of his ears. This allows him to listen to music without earbuds, for example.  Another commercially product, Circadia, is a lightweight implant that measures several metabolic indicators such as the composition of your sweat and transmits them via bluetooth. While these experiments are doubtless bold, they do indicate what is happening at the intersection of biology and technology.”

True to a certain extent that these experiments will push imagination to new horizons. But how far can these experiments succeed if applied in India? And if so, what impact can it have on the industry and largely on the economy?

As a matter of fact, India is yet not ready for experiments like these. But, for technologies such as robotics, AI, IOT, nanotechnology, 3D printing there is immense scope and offcourse the industry is all gung ho to explore them further.(look for more industry voices sharing their views on digital revolution in Indian healthcare Pg no: 24) However, here the question is all about kind of impact these technological advancements can have on the industry.

The impact: Bouquets and brickbats

At the time when India is slowly progressing towards becoming a digital economy, investing in digital technological innovation and building the infrastructure for the same seems to be an obvious choice for healthcare players. Reasons being that leveraging digital technologies will help business leaders in healthcare discover new profitable, scalable and sustainable ways to help their business grow.

On a larger picture, moving towards a digital future will create a healthy healthcare system in India. Explaining this further, Dr Pendse, says, “Simple interventions like better public health record keeping and surveillance by use of Electronic Health Records (EHR) can improve disease prevention programmes (like vaccination, screening for chronic diseases like diabetes, etc.) and help reduce the economic burden of disease by keeping the workforce healthy. Cost saved on employing manpower and maintaining inefficient infrastructure can be spent on improving accessibility to good quality healthcare”.

Chipping in, Mukul Asher, professorial fellow of the Lee Kuan Yew School of Public Policy says, “The technology will increase transparency and accountability, allow development of a robust database which has been lacking so far and has been effectively hampering implementation of health policies and assessment of the outcomes. In terms of the labour market and the economic impact, what is increasingly happening is that we are witnessing very slow movement of formalisation of employer-employee relationship. In European countries, they started the formalisation of this relationship, but they didn’t have the opportunity of leveraging the current day technology, to increase the coverage over a period of time and bring more informal workers into the formal system. Today, across most of the low and middle income countries, including India, we continue to have a larger informal labour workforce and contracted system of working is still in trend. Technology will allow us to have healthcare products and service delivery mechanisms that are portable – not tied to the employer and can be taken all over the country. The fact that India is using the Aadhar card, digital technology and developing new schemes where citizens become members and can access healthcare anywhere in the country, is going to be very helpful in income growth, improving quality and affordability of healthcare.”

Furthermore, industry people are also of the opinion that these new age technologies will open new avenues for medical practice and research.Pattabiraman  says, I do not see healthcare practitioners becoming under-employed but rather, acquiring new skills in data science and technology. I see them migrating to personal medicine and tackling lofty goals like extending human lifespans, reversing Alzheimers and who knows, bio-adopting humans for life on other planets.

Likewise, Harsha Muroor, Founder and CEO, Teslon Technologies feels that utilising digital technologies can have a larger impact on healthcare cost and accessibility. “Having accessibility to high quality healthcare at the right time can save a life and also save huge expenditures leading to complications. Using technology to educate patients on healthcare can work as preventive means for further hospitalisation and occurrences. Affordable quality healthcare has always been a major challenge. In our point of view technology will help save millions of dollars on healthcare expenditure. The costs of healthcare will drop significantly as the conditions will be diagnosed at a much earlier stage leading to faster recoveries. The accessibility of care will be transformed.”

To this point, many technology providers will agree that digital technologies can bring down healthcare cost. However, in an financial stretched healthcare sector, will digital technologies such as robotics, AI, nanotechnology etc., not be an expensive luxury? And how many people in India can really afford paying for this kind of luxuries?

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Currently, the cost of acquiring and deployment of these technologies are high in India. And these cost burden are incidentally transferred to patients making these services overpriced.  Joy Chakraborty, COO, P D Hinduja Hospital states, “Rising cost of acquisition to the healthcare companies, time taken to adapt to newer technology, over dependency etc., are some of the drawbacks. Moreover, the biggest disadvantage of all is that these technologies are being developed in the West and so importing these to India increases cost.”

For instance, a da Vinci system that costs approximately $ 1.4 million (Rs 7 crores) and annual maintenance costs of $ 100,000 with a lifespan of five years. This high cost of installation and maintenance will certainly raise the cost of surgical procedures conducting using this robot. Also, insurance do not reimburse robot procedures in India. So, in the bargain patients spends the entire healthcare cost out-of-pocket.

Equally, fee charges of online consultation platforms are also excessive when compared to physically visiting a general practitioner (GP). During an investigation on a story on online consultation platforms in healthcare, we spoke to few video conferencing and mobile consultation start-ups who charge a fee of Rs 400-500 per consultation of any kind of ailment. That would mean a patient seeking an online consultation on through these mobile apps could pay around Rs 400 for a cardiac ailment or even a common cold. Now general practitioners would anyway charge a fee of around Rs 200 in a metro city for common cold.  So, the difference in the fee structure of these new age doctor consultation platforms is almost double of what a physician would charge. With such disparity in the fee structures of digitally-enabled healthcare services, how many patients would seek for these services?  This is something that service providers need to retrospect on.  Having said that, if over a period of time cost of deploying these technologies will reduce, we can hope that the cost of services to patients may reduce in future.

Besides this, one more concerning area is the lack of a regulation on data privacy and cyber-security. Data theft in healthcare is not as stolen credit card where the payout is immediate and ends as soon as the card is blocked or account is cancelled. Healthcare cybercrime has a larger, and a long- term impact. It can include a complete digital record of an individual illness, with personal information, medical prescriptions  and insurance claim data. Time and again, experts have brought to the fore this important issue of data security, but very little has been done on this front. Regulation on data security is quite needed.

More concerns are also on the how this digital wave will disrupt the manpower space within healthcare.

Agreeing with this point, Bansal says, “Excessive usage of technology and analytics might create underutilisation of skills of medical practitioners. However, such technologies will also demand different skill sets for instance, data scientists will have to play a bigger role in some areas. The traditional educational system would also undergo a radical change to cater to the changing needs of the new age healthcare segment.

But Dr Pendse thinks otherwise. “Given the fact that India will continue to lag behind on the optimal patient to healthcare worker ratio, I do not see increasing technology application leading to underemployment. On the contrary, such technologies will supplement and complement the current model. New skills and competencies will have to be developed to make use of these advancements which will help create more employment opportunities,” he asserts.

Concurring that increasing technological application in healthcare will create new learning areas for healthcare. That bring us to the question on whether this would inflate the cost education and training of such specialised field of healthcare. Well most industry people have not yet contemplated on this aspect as we haven’t reach that stage yet where the need for speacialised education and training is made fundamental.

Balancing risk and rewards

Against this backdrop, the upsurge of digital technologies in healthcare is going to take root. Internet users in the country are forecast to grow to 730 million by 2020 with 75 per cent of growth in new users coming in from rural areas, predicts a joint study conducted by YourStory.com, Nasscom and Akamai. As we look to the future, the digital revolution has the potential to be truly a game changer for patients, especially in areas of disease management, aging, and discovery and development of new medical innovations. All the same, it is important to wisely utilise these digital tools. Finally, healthcare providers who come up with strategies that balance risk and rewards of digital technologies will indeed achieve economic value in the long run.

More industry voice

201609ehm17India is at a very early stage of adopting digital technologies often because even the basic infrastructure or system required for applying these innovations lack across the healthcare eco-system, at large. There are some areas like robotic surgeries that are beginning to see adoption, especially in specialities related to spine, heart or urological procedures. On the other hand, adoption of solutions like big data analytics is still some distance away as India doesn’t yet have integrated EHRs both in private and public healthcare segments. Our innovation focus has to make the benefits of some of these innovations frugal and available to a large majority of the population.

Kaustav Ganguli, Healthcare Lead, Senior Director, Alvarez & Marsal


201609ehm18The concept of connected world and disease surveillance is creating a solid platform for both structured as well as big data analytics, for predictability in drug supply chain, paramedical workforce deployment and availability of preliminary as well as speciality healthcare facilities. A lot of emphasis is also given to the health information exchange and citizen- centric health records standardisation across regions and medical facilities throughout the world. This will change face of the industry in terms of predictability and connected healthcare network, covering both payers as well as providers. Huge investments from governments, states, WHO, corporate etc. are now targeted at this segment which will have multi-fold impact on innovation in technology.

Arpan Bansal, AVP, Newgen Software


201609ehm19Implementation and adoption of latest technology will definitely help mankind in the coming years. Introduction/usage of technology should be taken positively. Accuracy in technology can help cut down a lot of problems, like surgeries resulting in less bleeding and fewer complications, etc. Technology allows clinicians to perform miracles, but is also a seductive and self-perpetuating force that needs careful monitoring by those who use it.

Siva Narreddy, Sr Director, Cigniti Technologies


201609ehm20As a matter of fact, we are amidst the revolution. Products and services like Carenation, Lybrate aim to revolutionise care delivery and also disrupt the healthcare market by opening doors to new models that are drastically different from what the traditional hospitals are used to.

The healthcare research industry will also have a huge impact with the ease of which smaller entities can perform better research and quickly deliver results leading to a highly competitive market.

Harsha Muroor, Founder and CEO, Teslon Technologies


201609ehm22This is a spectacular beginning of a digital care revolution, since we witness a massive technological shift in healthcare, driven by smart phones, security systems, IoT, big data and cloud computing. These technologies are empowering patients to access healthcare easily, understand the choices they have, and have control over their health decisions. These technologies are also unlocking new possibilities for healthcare delivery partners – care providers and payers – in terms of simplified diagnostic tools etc.

Tushar Rangatreya, Founder & CEO, SmartifyHealth


201609ehm21The field is now more than 15 years old. We at present are just seeing the tip of the iceberg. In the foreseeable future, it would be possible to operate on a patient without a single cut on the body, through robotic instruments inserted through the body’s natural orifices. It would be possible to superimpose the most advanced imaging and microscopic technology on to the camera of a robotic system to precisely determine the locations and extent of cancer in the body so as to ensure that it is removed completely each time and every time, by surgery. You could even have a scenario where the entire surgery is performed on a 3D printed model of the offending cancerous organ a day prior to the actual surgery and is later on, fed into a computer-controlled robotic system thereby ensuring an error free surgery on the actual patient. The possibilities are many. However, at present and in the foreseeable future, the human touch and judgement during surgery does not seem to be readily replaceable with a technological equivalent.

Dr Gagan Gautam, Head – Urologic Oncology and Robotic Surgery, Max Institute of Cancer Care, Max Super Speciality Hospital, Saket

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