Telemedicine the biggest tech-disruptor to foster accessible healthcare: Oct - Nov Issue 2019

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TELEMEDICINE THE BIGGEST TECH-DISRUPTOR TO FOSTER ACCESSIBLE HEALTHCARE

SPECIAL INTERVIEW ▶▶ Jai Pratap Singh Minister for Medical, Health and Family Welfare Government of Uttar Pradesh

CONFRENCE REPORT ▶▶

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OCT-NOV 2019 | VOLUME 14 | ISSUE 09

TELEMEDICINE: THE 08 BIGGEST TECH-DISRUPTOR TO FOSTER ACCESSIBLE HEALTHCARE

COVER STORY

08 SPECIAL INTERVIEW

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Jai Pratap Singh

Minister for Medical, Health and Family Welfare, Government of Uttar Pradesh

LEADERS’S PERSPECTIVE

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Raghubar Das Chief Minister Jharkhand

TECHNOLOGY PERSPECTIVE 24 Economics of AI, Design Thinking, and Data Science for Smart Healthcare

28 Digital Dispensary—Bolstering Patient Care in Jharkhand

POLICYMAKERS’S PERSPECTIVE

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Dr S Mohankumar Mission Director, UT of Puducherry

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Dr Anup K Yadav Commissioner (Health ) & Mission Director (NHM), Government of Maharashtra

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Ramchandra Chandravanshi Minister for Health, Medical Education & Family Welfare, Government of Jharkhand

CONFERENCE REPORT

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Editorial Telemedicine—Laying Foundation for Accessible Healthcare As a facilitator, technology has played a vital role in every field including healthcare and one can easily feel its importance in day to day life when one fathoms life devoid of computer, laptop, and latest mobile applications for few days. It has made things happen which perceived to be near impossible a decade ago and even a novice can certify the glaring fact that these tools have helped leapfrog delivery of services with improved accuracy and efficiency.

Technology-based applications including telemedicine have not only paved path for enhanced care but also contributed to provide personalised and value-based health services to masses. These modern-day tools hold huge significance as India struggles on healthcare infrastructure including human workforce. Asymmetric distribution of doctors—urban areas have more concentration while rural remote areas are at the mercy of quacks and less qualified physicians, further aggravates the situation and reiterates role of these modern-day technology.

Our latest issue of eHealth is based on the similar theme with cover story ‘Telemedicine: The Biggest Tech-Disruptor to Foster Accessible Healthcare’ encapsulating different aspects on how it bridges geographical barriers in delivering better care, synchronizing medical science and Information technology. The tool helps masses especially those who live in the remotest parts of the country to avail best treatment guidance from expert doctors sitting in renowned hospitals located in metros. Story highlights how telemedicine proves to be a potent tool to bolster primary and secondary healthcare to reduce unprecedented burden on tertiary care delivery system.

The magazine also carries special interview of Jai Pratap Singh, Minister for Medical, Health and Family Welfare, Government of Uttar Pradesh who highlights various initiatives of the Government to boost State’s healthcare delivery mechanism. He delves into various challenges and roadmap to overcome the same.

We have policymaker’s perspective by Dr Anup K Yadav Commissioner (Health) & Mission Director (NHM), Government of Maharashtra; and Dr S Mohankumar, Mission Director, UT of Puducherry. Both of them have elaborated about the Government’s plan to strengthen patient care , leveraging telemedicine as a tool.

The magazine also contains insightful articles on technology perspective, enumerating role of digital technology like artificial intelligence in enabling people at large to avail accessible and affordable care.

The latest issue carries a conference report on the Healthcare Innovation Summit, Chennai comprising outcomes in terms of expert’s inputs to tackle the existing challenges of India’s healthcare delivery mechanism.

With such a bouquet of special features, articles, and interviews, I hope the latest issue of the magazine will evoke an an invaluable feedback of our esteemed readers.

Dr Ravi Gupta Editor-in-Chief eHEALTH Magazine and Founder Publisher & CEO Elets Technomedia Pvt. Ltd. ravi.gupta@elets.in

COVER STORY

Telemedicine: The Biggest Tech-Disruptor to Foster Accessible Healthcare With proliferation of smart tech-devices, telemedicine has emerged as a big boon today bridging hundreds kilometer of geographical barrier which used to pose a big obstacle till last decade. The technology has enabled doctors sitting at big hospital chain in metro cities to provide quality care to patients residing in remotest part of country within no time. Mukul Kumar Mishra of Elets News Network (ENN) highlights different contours of the technology in succinct manner.

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TELEMEDICINE TO CREATE ACCESSIBLE AND AFFORDABLE MODEL OF HEALTHCARE Telemedicine, an emerging technology holds huge importance as India grapples with shortage of doctors.

Dr Inder Maurya, Founder & CEO, Foreign OPD, an online second opinion medical consultation platform which offers one to one consultation with worldrenowned medical experts to patients, says, “Telemedicine or telehealth introduced in the late 1960s has matured over time. The newer form of technologies like remote patient monitoring tools (eg wireless ambulatory, ECG or electrocardiography etc), and digital consultation via video and email have really revolutionised patient care and

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COVER STORY

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ver the last some decades, medical science has grown in leaps & bounds and credit goes to ever-increasing influx of technology which is fast making inroads in every sphere of life.

Thinking of leading the life without computer, laptops and modern-day gadgets seems unfathomable today and even a novice can vouch for the same.

Technologies like Artificial Intelligence, Cloud Computing, Big Data, Virtual Reality, and Telemedicine have the potential to radically revolutionise the entire healthcare industry. These tools have proved crucial to provide enhanced value-based care for consumers and more personalised and customised user experience.

Not only has technology changed patients’ experiences, but it also has had a huge impact on medical processes and the practices of healthcare professionals. These modern-day tools have assisted experts to delivery care even in remotest part of country with same accuracy and urgency.

reduced human effort.”

The unprecedented increase in the number of patients majorly due to non-communicable diseases, huge expectations for personalised care, and serious dearth in the number of caregivers have left the healthcare industry with no other option but to leverage telemedicine and other such digital solutions to enable people to avail better care in terms of quality and cost-efficiency. The efficient and cost-effective solution has played a vital role in facilitating diagnostics, treatment, prevention, research, education and analytics.

Accessibility has been a perennial problem of the Indian healthcare sector. Skewed ratio of doctors proves to be a major issue affecting rural healthcare. In remote parts of India, either doctors are not available in sufficient number or they are not qualified enough to tackle serious health complications. Telemedicine is proving to be best tool to fill these gaps.

“90 percent of healthcare professionals today are available on digital platforms amplifying healthcare services in the remotest part of India, saving lives, and money. It provides great opportunity to connect with doctors globally

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which used to be a great challenge.

It has turned into a boon thanks to telehealth technology,” Maurya further said.

WHAT IS EXACTLY THE TELEMEDICINE? It is a basically a synergy of medical science and Information technology.

It can be defined as the delivery of healthcare services using information and communication technology to exchange or transmit information and records for the reason of treatment, diagnosis, and prevention of diseases and injuries.

Dr Lavanya Aribandi, Chief Medical Officer, ekincare, says: “In telemedicine model of healthcare delivery, a patient located in a remote location, connects with the provider through a chat or audio or video consultation. Medical records can be uploaded in quick manner which in turn helps doctor to provide medical advice.”

“In an age of high speed internet where physical distance is minor barrier to working and interacting, telemedicine is delivering better healthcare support to patients at homes,” believes Ayush Mishra CEO & Co Founder, Tattavan E Clinics, a startup which has

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COVER STORY

established e clinics all across Uttar Pradesh.

The startup has connected healthcare services in nine villages across their existing centers (Bareilly, Kashipur, Saharanpur, Dehradun & Pilibhit). “Non-qualified doctors are practicing with ease and making money by misguiding and giving wrong treatments to poor patients. With the help of Gram Sewa Kendra, we have started our new service initiative in nine villages across all our centers.

Tattvan provides them right advice with qualified doctors at very nominal charges of Rs 90,” Mishra states.

MARKET OPPORTUNITY A recent report from the Business Research Company shows that the global market for telemedicine technology, currently worth $31.8 billion, will reach $77.2 billion by 2022. As per a report by ASSOCHAM, India’s telemedicine market, which has been growing at a CAGR of over 20 percent, holds the potential to cross $ 32 million marks by 2020 from the current figure of $15 million. The implementation of the technology could save India $4 billion to $5 billion every year and

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replace half of in-person outpatient consultations in the country, a report released by McKinsey Global Institute (MGI) has estimated.

How telemedicine proves to be a useful tool • Chronic conditions that require repeated follow-ups • Follow up after surgery

TELEMEDICINE BOLSTERING PATIENT CARE: INCREASES ACCESS TO HEALTHCARE IN RURAL AREAS Through the concept of telemedicine, patients in remote locations can more easily access and obtain any kind of clinical services. Moreover, hospitals in rural regions can be enabled to provide emergency and intensive care services with the aid of specialised professionals in urban locations.

IMPROVES OUTCOMES Early diagnosis and treatment often provide improved health outcomes. Moreover, telemedicine offers reduced mortality rates and lesser complications as there is an immediate transmission of health records and data.

REDUCES COST-TO-POCKET EXPENDITURE Since telemedicine is a cost-effective

• Primary care issues with not just the diagnosis as an end, but appropriate referrals and follow up treatment • Preventive advice and promotion of wellness • Rehabilitation programmes • Psychological counseling for issues like stress management and some other conditions • Facilitates transmission of reports securely and without error or loss alternative to hospital stays, they reduce healthcare costs for patients.

Home monitoring programmes are better than high-cost hospital visits and stays. During times of emergencies, high-cost transfers and patient care can be reduced via telemedicine.

FILL INFRASTRUCTURAL GAPS: In India, there is a great shortage for

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COVER STORY

healthcare in rural areas because of irregular distribution of healthcare providers. Telemedicine helps combat the problem by assisting healthcare providers in addressing shortages and giving access to healthcare, irrespective of time and place when needed.

EASY ACCESS TO SPECIALISTS Medical specialists located in urban areas can serve patients at rural regions using telemedicine technologies. Instead of driving to a medical practice, patients can get immediate access to the specialist from anywhere in the world through the concept of telemedicine. That way, telemedicine serves to significantly increase patient satisfaction.

REMOTE MONITORING Telemedicine has a strong role in facilitating collaborative care and continuity model. It creates the possibility of monitoring patient health remotely by collecting and sending medical data through electronic means for immediate interpretation. Such remote access/ monitoring is greatly beneficial for homebound critical/emergency patients where constant monitoring is a must.

STATES LEVERAGING TELEMEDICINE PLATFORM Many States including Jharkhand, Rajasthan, and Uttar Pradesh have been leveraging the tool to leapfrog delivery of patient care.

The Jharkhand Government along with Apollo Telehealth has set up digital dispensaries in different parts of the State so that patients could be connected easily to doctors through video calls. In Rajasthan, the telemedicine centre has been established at the Mahatma Gandhi Hospital (MGH) which enables tele-consultation at 120 centres in various districts, satellite hospitals and community health centres

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CHCs of the state. The Odisha Government is all set to introduce a new tele-medicine policy to expand tele-medicine network to district headquarters hospitals (DHHs) and wellness centres functioning under Medical Colleges and Hospitals. The Uttar Pradesh Government is also leveraging the tool to make a giant leap in rural healthcare. “Patients are being given particular time slot when expert doctors sitting in cities like Delhi or Lucknow appear on the techdriven web screen and guide patients about clinical treatment. Best part of the technology that both patient and doctors don’t physically present at the location but communicate in better manner to exchange information,” said Jai Pratap Singh, Minister for Medical, Health and Family Welfare, Government of Uttar Pradesh.

CHALLENGES As any technology has its pros and cons, so with the telemedicine.

There are many challenges which need to be tackled to leverage its full potential. Like most technology solutions, telemedicine platforms

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usually require training and high-end equipment. Getting required skilled workforce is uphill task for providers working in rural areas.

Other obstacles are linguistic diversity, slow internet speed and intermittent power supply. In India with over 22 officially recognised languages and over 1600 mother tongues, linguistic diversity seems a major barrier in the way of a patient in one region being able to talk to a doctor in another region. In addition, lack of proper guidelines and legislative muscle is hampering expansion of this paradigm. Concerns on the use of data, safety of data transfer, privacy are some of the key issues that need attention from policymakers.

Nonetheless, the tool is proving to be biggest disruptor which has potential to transform delivery of healthcare services, enabling people at large to avail accessible and affordable patient care. A wellplanned robust strategy is needed to ebb all the obstacles, jeopardizing the implementation process.

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LEADER’S PERSPECTIVE

‘Jharkhand Government Taking All Measures to Boost Healthcare System’ A healthy mind resides in a healthy body. There is no shortage of diseases and patients in the country. And the number of such people is on rise due to number of factors. In a bit to improve situation, every possible solution needs to be implemented, said Raghubar Das, Chief Minister of Jharkhand, while delivering speech at the Healthcare Summit held recently in Ranchi.

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rganised by the Department of Health, Medical Education & Family Welfare, Government of Jharkhand along with Elets Technomedia, the conference witnessed congregation of policymakers from across country, international experts, and industry veterans deliberating on various facets of healthcare delivery mechanism.

SWELLING POPULATION TAKES TOLL ON INFRASTRUCTURE The number of sick people is increasing and swelling population is one of the reasons. People should understand the consequences of population explosion which takes toll on existing infrastructure.

Nonetheless, the State Government is taking all possible measures to provide better medical facilities to the people.

I appreciate NITI Aayog’s work in this direction. With smaller family size, health and economic standards become easier to maintain. Public awareness must be spread in this regard. A lot of work has been done in the field of healthcare, since our government took reins.

JHARKHAND STRIVING TO IMPROVE THINGS According to NITI Aayog’s report,

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Jharkhand has performed well on various health parameters. The State got 3rd position which is a proof that the Government is striving to improve things.

The improvements have been witnessed in terms of maternal mortality rate (it was 400 per lakh in 2000, now it has reduced to 165 per lakh), infant mortality rate (it was 72 per 1000 in 2000, now it has been reduced to 29 per 1000), institutional delivery (it was 13.5 percent, now it has reached 87 percent), infant immunisation coverage (it was 9 percent before, now it has reached 87 percent).

Similarly, Jharkhand has obtained 3rd rank in providing OPD services.

These statistics show that the state government is continuously working to make difference in the field of healthcare.

108 AMBULANCE AND BIKE SERVICES Jharkhand’s biggest success story is 108 ambulance services. If any person makes a call on 108, emergency services arrives within 15-20 minutes at their doorstep. This has become most loved service in the state. This service is available across the state.

On an average, 5000 calls are being

Raghubar Das Chief Minister of Jharkhand

received everyday and 8000 patients are treated for various illnesses. The service is popular in tribal areas.

We also have bike ambulances which have been introduced as large parts of the State have a mountainous terrain where ambulances cannot reach. To provide emergency service to the tribal people living in these areas, state government has introduced this service.

ATAL MOHALL CLINICS On the occasion of Atal Bihari Vajpayee’s death anniversary this year, Atal Mohall Clinics have been launched in various districts. Inspired

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by Pandit Deendayal Upadhyay’s dream of Antyodaya, we will have such clinics in all the urban areas of the state soon.

MEDICAL COLLEGES It is little sad that even after 67 years of Independence, we have only three medical colleges in Jharkhand till date. After the arrival of Modi government in Centre, and at the same time, coming of BJP government in the state (doubleengine government), three more medical colleges have been opened.

In addition, there are two more colleges which are on various stages of completion. AIIMS, Deoghar has also been set up.

ASPIRING DISTRICTS Our government’s objective is to make Jharkhand a medical hub. We are working in this direction.

With an aim to establish most aspiring districts across Jharkhand, the state government has made one policy. If someone opens a hospital in a backward area, then 75 percent of the land cost will be covered by the state government; the investor only has to pay 25 percent of the land cost. Similarly, if you open a hospital in block areas then 50 percent of land cost is forgiven and if you open a hospital in urban areas then 25 percent of land cost is forgiven.

We have installed single window system for industry and agriculture so that our investors do not have to knock on 10 doors to get their work done.

AYUSHMAN BHARAT SCHEME Our government launched Mukhyamantri Swasthya Bima Yojana in which 57 lakh families were supposed to be covered. Then came centre’s Aayushman Bharat which covered 28 lakh families in the State. We are resolute to cover 57 lakh families for which we have given Rs 400 crores from the state treasury. Till date, about 49 lakh families have already received the

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JHARKHAND’S BIGGEST SUCCESS STORY IS 108 AMBULANCE SERVICES. IF ANY PERSON MAKES A CALL ON 108, EMERGENCY SERVICES ARRIVES WITHIN 1520 MINUTES AT THEIR DOORSTEP. THIS HAS BECOME MOST LOVED SERVICE IN THE STATE.

golden card.

Jharkhand is the first state to have built a dedicated 30-bed hospital for Aayushman Bharat scheme in Jamshedpur. TATA steel was empanelled in this.

The state government has taken another decision to help the poor people who could not get Aayushman Bharat’s golden card because it required registration fees of Rs 23-25. We have decided to cover the registration fees so that the poor people do not have to face any hesitation in applying for the card. Our PM has a dream that just like rich people go to private hospitals for their treatments, the poor, in the face of any serious illness, should be able get their treatment free-of-cost in private hospitals.

We are promising all possible help to private players to open hospitals which would employment avenues for people.

GOVERNMENT HOSPITALS LACK INFRASTRUCTURE After the economic reforms of 1991, health and education sectors underwent marketisation. When private schools and hospitals came in, the rich people went there because they had the money. And the poor went to government schools and hospitals.

In Jharkhand, we aim to equip government hospitals in such a manner that they match the level of private hospitals. The disparity between rich and poor in availing health and education services has to end.

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SPECIAL INTERVIEW

‘Determined to Develop Accessible & Affordable Healthcare Across UP’ The Uttar Pradesh Government is leaving no stone unturned to foster its healthcare delivery system, enabling people at large to avail best services at their doorsteps.

Despite huge challenge of infrastructure in terms of shortage of doctors and equipment, the State Government envisions to create best exemplary model of patient care, says Jai Pratap Singh, Minister for Medical, Health and Family Welfare, Government of Uttar Pradesh, in conversation with Arpit Gupta and Mukul Kumar Mishra of Elets News Network (ENN).

Q

As the health minister, tell us about various plans and strategies to boost healthcare delivery mechanism in Uttar Pradesh?

Education and healthcare are two important factors which determine economic prosperity of a country.

Around 60 percent of population

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still lives in rural areas in India.

Since initial days when country got independence, policymakers should have prioritised these sectors to develop. But things didn’t happen as it was visualised.

Nonetheless, after seventy years, BJP came to power at the Centre and State. Since then, it has been leaving

no stone unturned to create a healthy and prosperous India. Our objective is to facilitate accessible healthcare to 22 crore people of the State. I am taking stock of the situation at PHCs, CHCs, and District Centres. Services at many of these centres are not up to the mark. Our main focus is to improve infrastructure at these centres,

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SPECIAL INTERVIEW

enabling masses to avail quality and affordable care.

facilities to make them work in remote areas.

Q

Q

What is your prime concern in terms of improving infrastructure so that skilled medical professionals including doctors could facilitate care at primary centres?

There is a standard process of availability of residential buildings for doctors, pharmacists, ward boys, associated with PHCs, CHCs, and district centres. The glaring issue is maintenance of old structures.

We are taking all measures to improve facilities at existing centres in terms of availability of human resource—doctors, nurses, and technicians, required equipments, and maintenance of residents buildings, so that inclusive care could be facilitated to people. In interior areas, residential quarters are not in good shape. The Government’s first priority is to kick-start things at existing centres so that not a single person gets deprived of basic care. Subsequently, we will focus on old residential structures and ensure to get them functional.

Doctors need to provide required

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Can a model district health centre be developed which would be cited an example and attract doctors?

It is practically not feasible due to constraints at different levels. We aim for better functional district health centres and community health centres where basic medical care should be available 24/7. These may not be model ones, but at least stand up to the level of basic standard. At CHCs, now doctors, experts and high-end equipments are available. In addition, telemedicine, and surgery facilities are also being explored at these centres. If people can get primary care at these centre, only serious patients needed to refer to medical colleges and tertiary care hospitals.

Q

What measures need to be taken to improve situation in public hospitals which lack facilities, affecting patient care?

India spends 1.4 percent of GDP on healthcare. It should be ideally three percent to ramp up infrastructure.

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Many of the hospitals have now improved on various parameters.

They are being given good ratings

by National Accreditation Board for Hospitals (NABH) for their overall performance especially in area of clinical outcome. The rating is an indication that people would get best facilities in these hospitals. We are trying to improve things on every front. It’s our moral responsibility to provide better healthcare facilities to people at large. For that, budget needs to be increased and allocated money should be spent in prudent manner. There has been a substantial increase in budgetary allocations in recent years since the government took reins.

Q

Uttar Pradesh was one of the worst performing States in recently released Niti Aayog Health Index report…Isn’t it disturbing as a Health Minister?

The report indicates State’s performances on various health parameters. There are eight aspirational districts across the State. To take stock of the programmes implemented by the

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State Government, the Central government team visits here once in a month. They monitor various points of health indicators minutely. Their ratings indicate progress of various programmes and areas where the State needs to work upon.

To provide holistic care to women and child, there are programmes like Janani Suraksha Yojana (JSY) and Pradhan Mantri Matru Vandana Yojana (PMMVY). Expecting mothers who are registered under the scheme get Rs 6,500, and free medicine, so that they could take good care of their own health and baby’s as well. After the birth of baby, we ensure proper nutrition to child and mother. The Government also makes available free vaccination to child on different interval of time. The State may not have performed well as per the expectations of Niti Aayog.

But we will strive to improve our records in coming years.

Q

How digital tools are being leveraged to improve delivery of care in rural areas?

Through telemedicine, we are leveraging IT technology to bridge communication gaps between patients and doctors. Patients are

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Q TILL DATE UTTAR PRADESH HAD ONLY 13 MEDICAL COLLEGES. IN LAST TWO AND HALF YEARS, A TOTAL OF 15 COLLEGES HAVE BEEN ADDED UP.

being given particular time slot when expert doctors sitting in cities like Delhi or Lucknow appear on the techdriven web screen and guide patients about clinical treatment. Best part of the technology is both patient and doctors don’t physically present at the location but communicate in better manner to exchange information.

Telemedicine is very useful in the light of shortage of expert doctors in remote areas. The technology is already available at some of the CHCs and working to increase the facility.

There is huge a shortage of doctors all across the State.

How is the Government planning to improve the situation?

The Government understands the urgency to improve number of skilled medical professionals to boost patient care. We have made a committee in every district where doctors are invited to work in rural areas directly through walk-in-interview. Many of the expert doctors have joined through the process. The Government is also working on bidding process to recruit skilled professionals. Till date Uttar Pradesh had only 13 medical colleges. In last two and half years, a total of 15 colleges have been added up. Out of these, seven have become functional and rest eight are at various stages. In addition, the Centre has also directed us to establish 14 medical colleges and work is on full swing on that front.

We have started signing a bond with all the undergraduates studying in the Government medical colleges.

As per the bond, they will have to serve for two years in rural areas.

These efforts will bear fruit soon which will ultimately fill gaps of shortage of doctors and other medical professionals in coming years.

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Q

The Government has banned many hospitals on the charge of forgery and irregularity under the Ayushman Scheme. What measures are being undertaken on this front?

Yes, we are taking strong action against such hospitals. Many of such cases have come to the fore. But, when mega schemes like Ayushman Bharat are implemented on such a scale, some cases are bound to be cropped up. Important point is it needs to be tackled with iron hand.

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There are clear guidelines about whole process of treatment. Hospitals must be empanelled to provide treatment facility. Moreover, the coordinator guides the patients how to go about whole processes.

Q

Corruption is one of the biggest issues jeopardising system to facilitate delivery of service to masses. What is your viewpoint?

Corruption can’t be eradicated by any vigilance system or minister or political leaders. It is ingrained within the system and can’t be wiped out. System can rein in but can’t stop it completely. Despite getting good salary and other perks some of the government officials are found to be involved in such practices.

System can teach you a lesson not to resort in such practices through punishment, but ultimately it’s your own conscience that should stop you doing such things.

Q

It has been alleged that BJP government has stopped 108 ambulance emergency services…is it true?

No, 102 and 108 numbers are very much active. A large number of people avail ambulance facilities through these numbers. GVK is our service partner and every month we review the response time. We get feedback from every district about

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WE ARE TAKING ALL MEASURES TO IMPROVE FACILITIES AT EXISTING CENTRES IN TERMS OF AVAILABILITY OF HUMAN RESOURCE— DOCTORS, NURSES, AND TECHNICIANS, REQUIRED EQUIPMENTS, AND MAINTENANCE OF RESIDENTS BUILDINGS, SO THAT INCLUSIVE CARE COULD BE FACILITATED TO PEOPLE.

SPECIAL INTERVIEW

Q

PPP is being perceived as pivotal tool to improve infrastructure under Centre’s Ayushman Bharat initiative. How do you analyse the statement in context of UP? Many of the private hospitals and NABH and Kayakalp accredited government hospitals have been empanelled under Ayushman Bharat scheme. There is a Government’s coordinator in these hospitals who ensures patients get required care under the scheme. People with Ayushman card get Rs 5 lakh treatment facility for 1400 diseases across these hospitals. We have a redressal committee as well which resolves issue pertaining to increased cost of any treatment facility. People are also coming to government facilities to avail quality care now.

response time and investigate if the response time increases or any other sort of issue arises. Service provider faces action if response time increases. We aim to make the service much more efficient in coming days.

Q

You recently took over as Minister in Health Department.

Tell us what all three issues you zeroed in to focus upon on priority.

First is shortage of doctors and the Government is working on plans to improve situation on this front.

Second issue is paramedics staff who wants to be posted as per their choice of districts. These are backbone of care delivery system and play a vital role. Our priority is to convince these staff to move to those places where they are utmost needed. And last but not the least is to improve infrastructure to bolster patient care in remotest corner of the State.

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17

LEADER’S PERSPECTIVE

‘Jharkhand Taking Giant Leap to Bolster Patient Care’

T

he Jharkhand Government is determined to improve delivery of healthcare services across State especially in rural areas. We are taking measures to ensure quality care to every strata of society, Ramachandra Chandravanshi, Minister for Health, Medical Education & Family Welfare, Government of Jharkhand, said while delivering speech at the Healthcare Summit Jharkhand held in Ranchi recently.

Organised by the Department of Health, Medical Education & Family Welfare, Government of Jharkhand along with Elets Technomedia, the healthcare summit witnessed confluence of key policymakers, international experts and industry leaders deliberating different aspects of healthcare including challenges and how technology could keep them at bay.

AYUSHMAN BHARAT AND STATE’S PLAN TO SCALE UP EXECUTION Last year Prime Minister Narendra Modi had launched Ayushman Bharat

from the soil of Jharkhand. In a bid to scale up implementation of the gamechanger scheme, we will be distributing golden cards to 57 lakh families of the State soon. We were given a target to distribute golden cards to 25 lakh families by the Centre last year. A total of 32 lakh families have been added up to the scheme under the visionary leadership of Chief Minister Raghubar Das. A total of 2 crore 19 lakh patients availed treatment facilities at both private and government hospitals under the scheme till date. There are 429 private hospitals and 219 government hospitals which have been empanelled under the scheme.

The State Government has spent an amount of Rs 215 crore to facilitate care under the scheme. We are also working to set up health and wellness centres in rural areas. Best part is not only initiatives are being announced but the Government also ensures its execution.

MOHALLA CLINICS AND BIKE AMBULANCE TO BOLSTER CARE The State Government is also working

Ramchandra Chandravanshi Minister for Health, Medical Education & Family Welfare, Government of Jharkhand

on plan to set up Mohalla clinics where doctors will sit for two hours, providing treatment facilities to patients. In addition, plans are afoot to start bike ambulance and 100 telemedicine centres soon.

To encourage private providers, we have decided to provide a series of concessions. Those 300-bed hospitals having 20 acre land would be provided a fund of Rs 30 crore, free road facility upto five kilometers and electricity.

PRIMARY HEALTHCARE We have started imparting training to 200 community health workers in naxal hit-Palamu district. With 20 days training, they are now being equipped in terms of knowledge to facilitate basic care in villages. Soon, we will be recruiting these workers for whole state to bolster primary care delivery system.

In addition, the government is also working to open more medical colleges to train medical graduates. I invite all state private agencies to join our mission to improve healthcare infrastructure in Jharkhand.

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OCT-NOV 2019

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POLICYMAKER’S PERSPECTIVE

Implementation of Telemedicine in UT of Puducherry

T

he Government of Puducherry has taken a slew of measures pertaining to telemedicine, enabling masses to avail accessible and affordable healthcare services across the UT especially in rural areas. Here are brief details about two initiatives Health Kiosk and e-Sanjeevani: HEALTH KIOSK The Department of Health and Family welfare services, Government of Puducherry has signed a Memorendum of Understanding (MoU) with NGO named GCARE Diabetes Council in the 1st week of June, 2019. As per the agreement, NGO will install the health kiosk machine at all the identified Ayushman Bharat -Health and Wellness Centre.

As per the guidelines of the Ayushman Bharat - Health and Wellness Centre initiative, it is mandatory to establish telemedicine services at all the health facilities. In addition, a hub for telemedicine has to be functional at every district.

The G Care Diabetes Council provides the Health Kiosk Machine

where 13 parameters including laboratory investigations will be kept in all Primary Health Centres and identified sub-centres, wherever space is available for 120 sq feet. The investigations are done free of cost.

The NGO has installed the kiosk machine at different centres including PHC Kosapalayam, Nettapakkam and Lawspet of Puducherry and Sub-Centre Kanakalapetta, Dhariyaladhippa &Savitri Nagar of Yanam region. At these centres, telemedicine services have been implemented to provide quality care to people at large.

E-SANJEEVANI: e-Sanjeevani software is a web-based comprehensive telemedicine solution.

A total of 121 Health & Wellness Centres (HWC) have been approved in UT of Puducherry.

Out of that 40 of them are level II (HWC-PHC) facilities and 81 Level III (HWC-SC) under Telemedicine service network of AB-HWC. A total of 40 level II (HWC-PHC) facilities have been equipped with Desktop Computer and internet

Dr S Mohankumar Mission Director, UT of Puducherry

connectivity, while remaining 81 Level III’s Desktop Computer procurement, and 121 Audio Visual equipment are under progress.

As per the instructions of the Ministry of Health & Family Welfare (MoHFW), JIPMER has been identified as the tele-education provider to Puducherry under National Medical College Network.

JIPMER has designated as hub to the telemedicine network for UT of Puducherry, hence the proposal for the establishment of hub in JIPMER has been initiated.

The last mile connectivity to the HWC (SC) and engagement of specialists on daily remuneration basis at the hub level have been proposed in the supplementary PIP of 2019-20 FY. The consultation of specialists under district hospital level has been discussed with MoHFW and it has been suggested that, the pilot progress of implementation of telemedicine can be done by the hubs identified under NMCN. Currently, due to non-availability of the Audio – Visual equipment (USB Web Camera, Headphone & Mike), the tele-consultation, e-prescription, offline & online facilities and other features rather than the live video interaction of e-Sanjeevani portal, is going to be utilised.

The pilot project of telemedicine service will be implemented in co-ordination with JIPMER after discussion.

The writer is Dr S Mohankumar, Mission Director, UT of Puducherry.

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POLICYMAKER’S PERSPECTIVE

Maharashtra: Telemedicine Facilitating Better Patient Care in Rural Areas

T

elemedicine is a rapidly developing application of clinical medicine where medical information is transferred via telephone, the internet or other networks for the purpose of consulting, and sometimes remote medical procedures or examinations.

Objectives of this programme include providing expert consultation to patients in remote areas, video conferencing facility for online consultation, and to facilitate medical education facilities for Medical and Para Medical staff.

There are a total of 62 patient nodes in Maharashtra, which are providing telemedicine facilities. Out of these 62, 23 nodes are in district hospitals while 39 are in sub -district/rural hospitals. A total of six speciality nodes are situated in medical colleges where a team of experts provide opinion pertaining to treatment. Telemedicine control node is also available at Sir J.J. Hospital, Mumbai.

In 2014-15, telemedicine facility extended to 5 high focus/tribal districts in rural hospitals including sub-district hospital, Manchar (District –Pune), rural hospital, Chikaldhara (district – Amravati), rural hospital, Sangamnar (District – Ahmednagar), sub-district hospital, Gokhunda (district – Nanded), and district hospital, Nanded (district – Nanded).

Speciality nodes situated at medical colleges provide treatment opinion

How telemedicine projects took roots across Maharashtra- A timeline • 7 Sept. 2006 - Pilot Project in collaboration with ISRO started in Maharashtra, Specialist Center KEM Hospital, Mumbai with five remote centers (District Hospital Latur, Beed, Nandurbar, Sindhudurg and sub district hospital Karad).

• 2007-2008 - Telemedicine expanded to additional, 20 districts, 2 sub-districts and 4 medical colleges • Feb. 2011- Telemedicine network shifted from ISRO bandwidth to BSNL/MTNL broadband.

• 2011-2012- Telemedicine network expanded to 30 sub-district/ rural hospitals.

• 2014-2015 – Telemedicine facility extended to 5 high focus/tribal districts in SDH/Rural Hospitals - Manchar (Pune), Sangamner (A’Nagar),Chikhaldara (Amravati) ,Gokunda (Nanded), DH Nanded.

22

OCT-NOV 2019

to the patients who are referred from patients nodes situated at district and sub district hospitals.

These speciality nodes are K.E.M. Hospital Mumbai; Sir J.J. Hospital Mumbai, Government Medical College Nagpur, B.J. Medical College, Pune, Government Medical College, Aurangabad, Nanavati Hospital, Mumbai, Lokmanya Tilak Municipal General Hospital, Paediatric Centre of Excellence (PCoE), and Sion Hospital Mumbai (Funded by UNICEF & MSACS).

The telemedicine has facilitated online consultation through video conferencing. A total of 2, 12, 207 referred patient are being provided experts’ opinions at district / sub district / rural hospital through telemedicine centre. Multi-CME conducted till date (on 697 topics) for doctors & para- medical staff at district / sub district/rural hospitals through telemedicine centre.

The writer is Dr Anup K Yadav, Commissioner (Health ) & Mission Director (NHM), Government of Maharashtra

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TECHNOLOGY PERSPECTIVE

Economics of AI, Design Thinking, and Data Science for Smart Healthcare

H

ealth systems are multifaceted and continually changing across a variety of contexts and health service levels. For example one of the critical challenges of the resource deficient public health infrastructures worldwide is the spread of the communicable diseases.

As seen during the outbreaks of the fatal communicable diseases like Severe Acute Respiratory Syndrome (SARS) in 2003, H1N1 in 2009, the Zika virus in 2016, Ebola and Middle East respiratory syndrome (MERS) in 2014, and the Nipah virus in 2018, infectious diseases can spread rapidly within the countries as well as across the national borders.

Artificial intelligence (AI) has been making its way into the healthcare sector, presenting a variety of possibilities in disease diagnosis, treatment, and prevention. The adoption of artificial intelligence in the healthcare sector is growing substantially. One of the other major problems plaguing India’s premier public hospitals is overcrowding. It takes months for even those with terminal diseases like cancer to get started with their treatment.

The presence of AI would allow individuals to easily access and secure patient’s medical data, then understand and timely analyse their illnesses.

Successful implementation of AI can provide major relief to these issues.

AI IN HEALTHCARE The most critical, vital and fundamental part for initialising Artificial Intelligence for the CEO of a

24

OCT-NOV 2019

Diana Yohannan

Pratyush Mathur

AI and Big data Analyst, Technology Enthusiast

Technology and Business Analytics enthusiast, Narsee Monjee Institute of Management Studies

company is to start thinking as a data scientist.

This activity in itself is contradictory to the thought process of a doctor or a medical professional, therefore it is the primary requirement to employ an analytical data expert who is the blend of a mathematician, a computer scientist and a trend-spotter who has the curiosity to explore the problem that needs to be solved so as to make the organisation AI-enabled.

The basic requirement to successfully implement AI for a smarter healthcare is the availability of adequate digitised data.

The primary objective in the health sector is the successful diagnosis of the ailment in which AI can play a significant role. For the analytics of the symptoms, the primary data is the medical record that the patients present in the first level of data documentation.

For a developing and an aspiring country like India where we like to heighten our reach to the world, simultaneously inwardly looking

into the challenges of Indian medical system, it is very important and critical that the medical records of the patients are digitised.

Towards this the baby steps have been taken by the MeitY – Ministry of Electronics and Information Technology. However, MeitY is facing serious challenges in its efforts to adopt an Electronic Health Records (EHR) system—a digital database of every Indian’s medical record that can be accessed by all doctors and hospitals.

The major challenges to cope up with include the infrastructure creation, standards and interoperability, research and development as well as the legal and policy framework which forms the foundation for mandating it for governance.

And lack of these fundamental infrastructures would make it nearly impossible for a developing nation to establish AI in its true sense. There is a need to start a debate on the aspects of the department of involvement of AI in various health segments. It need

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THE ECONOMICS OF AI IN HEALTHCARE AI is tightly linked with a very strong health sector business analytics which in turn has strong linkage’s with the big data generation and big data analytics in the sector. It is strongly suggested based on our evaluation that this realisation need to be market driven for health sector to flourish, as it has been seen in most of the government participations, after a quantum of load the services are not able to cope up with the load. AI eventually will settle down in providing healthcare to all financial segments of Indian

citizens as it will optimise the cost of evaluated medical tests, cut expensive surgery’s and will eventually balance out the demand and supply chain.

This technology will act as a catalyst for optimisation of process which otherwise would have taken many years to achieve. Implementation of AI will also lead to economic advantage in overall hospital care, clinical research, drug development and even in the insurance cause economic benefits. AI applications are revolutionising how the health sector works to reduce spending and improve patient outcomes. Health sector is the only sector where all 34 disruptive technology’s needs to be synchronised to achieve the eventual goal. Few of these technologies meet the governmental legal and policy framework whereas most of them are self-sustaining in the business environment.

HEALTH SEGMENT AI DATA MONETISATION VALUE CHAIN The AI has started taking the centre stage due to benefits being visible in the public sectors, its positive effect on the population and the advances that would visibly reduce the data privacy issues in the medical electronic records. Still, the mind-melding requires political and governmental support.

The AI data monetisation would

become a vast business opportunity.

It will form a critical pillar towards the structured AI in the medical field. If we take the history as the guiding principal, the monetisation of medical big data can safely assume free medical scanning capabilities available to the patients just to have generated databases. It is expected that this industry towards which the seeds have just been sown, will form a vibrant system in another 2-3 years. Those days are now near when any government hospitals would have counters that will provide your complete health records, which will form the fodder for AI diagnostics machinery.

In 5-6 years, AI may assist doctors by providing assured diagnosis to patients. In 7 -8 years we will have alexia like devices which will assist and advice based on the health and photo inputs about the impending disease which may affect its users. The ecosystem need for AI driven e-health is vast and complex due to the trust element inside it, between the doctors and the patients. The three key areas of investment for AI in healthcare would include: • Digitisation: Utilisation of AI to reduce the cost and time and hence increase the efficiency • Engagement: Improvement of patients/consumers interaction with healthcare providers, systems and services.

• Diagnostics: Development of efficient tools/products/services for timely and accurate diagnoses and health advices.

TECHNOLOGY PERSPECTIVE

not necessarily mean that all segments require the same level of AI infusion as the certain critical ones need.

The field of predictive analytics holds increasing promise for helping clinicians diagnose and treat patients.

Machine-learning models can be trained to find patterns in patient data to aid in sepsis care, design safer chemotherapy procedures, and predict a patient’s risk of having cancer.

The accuracy of decision making is vital in the health as it builds the patient doctor trust which forms the foundation cornerstone for any segment in health sector to flourish.

There is a need to cautiously examine that the infusion of AI in the segment shouldn’t downwardly change this agreement.

DIGITAL TRANSFORMATION AND AI ADVANTAGES There is an increasing need for healthcare establishments to implement solutions that effectively improvise treatment outcomes, manage rising costs and navigate through the demands confronting the sprawling healthcare system.

Some of the potential applications

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25

TECHNOLOGY PERSPECTIVE

 DRUG RESEARCH AND DEVELOPMENT

and advantages of AI in health sector include:-

 DIGITAL CONSULTATION Many a times due to situations like calamities, overcrowding, or difficult geography the access to a physician becomes nearly impossible. At these conditions an applications can give a primary medical consultation based on the personal medical history and common medical information. The users can feed their symptoms into the application, the algorithm then using the speech recognition can compare against a database of illnesses to give the primary consultation.

 MANAGEMENT OF MEDICAL RECORDS The first step for effective implementation of AI in healthcare is compiling and analysing information (like medical records and other past history). Data management would be the most widely used application of artificial intelligence and digital automation as it would reduce the time consumed in the mundane works.

Robots/machines would accumulate, store, and trace data to provide faster as well as more reliable access.

 FAST & ACCURATE DIAGNOSTICS As AI systems would have the capability to learn from previous cases

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OCT-NOV 2019

and store knowledge, also access stored knowledge from anywhere around the globe. It would play a very significant role in diagnostics.

It is scientifically proven that artificial neural networks can diagnose some other diseases includes eye problems, malignant melanoma etc in fast & accurate manner.

In the medical field, Cancer is one of the major challenges in which early detection plays an important role. AI has the potential to diagnose diseases and illnesses through deep learning. For example, many medical facilities are shifting to Digital Breast Tomosynthesis (DBT) technology solutions as preferred method for screening and diagnostic mammography in order to detect and diagnose women with early-stage breast cancer.

 PERFORMING REPETITIVE TASKS Analysing lab reports, X-Rays, CT scans, data entry, and other routine tasks can all be done faster and more accurately without any biases by the trained machines. Cardiology and radiology are two disciplines where the amount of data to analyse can be vast, time consuming and also time critical.

Proficient utilisation of AI would facilitate doctors to spare more of their time in the patient interactions/ treatments.

Development of pharmaceuticals through clinical trials can take more than a decade and cost billions of dollars. And if the whole process of research and development is assisted by an AI system it can make the process faster and cheaper. For example, during the Ebola virus spread, an AI programme was used to scan existing medicines that could be redesigned to fight the disease. The programme was able to identify two medications that could reduce Ebola infectivity in one day.

 GENETIC MEDICATION Genetics and genomics look for mutations and links to disease from the information in DNA. If a database of family genetic history of any hereditary disease is created and digitised accordingly, then using the appropriate AI algorithm, early diagnosis and appropriate treatments of ailments like cancer, physiological and vascular diseases can be done.

 HEALTHCARE SYSTEM ANALYSIS The growth of computational power has led to a substantial increase in the amount and granularity of stored digital medical and healthcare data.

The ability of AI to quickly analyse huge volumes of this data and create meaningful and actionable insights will have weighty effects on how healthcare is delivered and received.

AI can be utilised to scrutinise the data to highlight mistakes in treatments, workflow inefficiencies, billing errors, hospital administration, and unnecessary patient hospitalisations and hence increasing the efficiency of the healthcare system analysis. It can also, help doctors to work more reasonable hours by optimising shift scheduling with data and measuring physician satisfaction to further improve the system.

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ď ˝ REDUCE HUMAN ERRORS AI may be most effective at reducing human error. Humans after analysing the routine scenario many times get biased and results to an error at the diagnosis phase. Even due to any emotional trauma or stress on the doctor’s side might be a reason for the error in the diagnosis and the treatment. AI could be the best assistant as it would monitor the whole procedure and greatly decrease stressful situations.

GOING FORWARD Humans are complex bio-chemical devices due to our complex evolution from a single cellular organism to a human machine over a billion years, the complexity is unimaginable. A complex AI with advance computing power will also take at least one generation to understand complete molecular level of this bio-chemical machine. The AI has started taking baby steps by understanding the interdependence of various artworks of famous artists. These types of algorithms will also form the eventual symphony in understanding the human bio-chemical device.

The policy making bodies need to understand, the effort towards these researches in the present context will have negligible benefits but will eventually make an exponential effect on eradication of diseases at genetical and molecular level with maximum economic benefits.

From hospital care to clinical research, drug development and insurance, AI applications would revolutionise how the health sector works to reduce spending and improve patient outcomes. These benefits will accrue incrementally, from automated operations, precision surgery, and preventive intervention.

Healthcare providers need to have confidence over the algorithms to use them, and that often means they want to see clinical validation of it. Many will continue to be skeptical about

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adopting AI tools until a large body of proof verifies their outcomes.

There is reluctance on the patient side, too: Around one-fourth of the consumers surveyed by one of the leading IT multinational said that they would not use AI-powered health services and cited concerns about the technology as their reasoning, from not understanding enough about how AI works to worrying that the technology might not understand them.

To overcome the fears and concerns associated with AI, it’s imperative that providers work to implement these new, innovative technologies effectively by first carefully considering and researching the right solution. Then, providers should invest time considering and understanding how their system is capturing and collecting data in order to analyse it and check for errors.

With artificial intelligence, the patient can get doctor assistance without visiting hospitals/ clinics which results in cost-cutting. AI assistants provide online care & assist patients to add their data more frequently via online medical records etc. The ability of AI to sift through large amounts of data can help hospital administrators optimise performance and improve the use of existing resources as well as saving cost and time.

The algorithms are able to ingest years of electronic health record data and apply data science and AI to learn how best to manage expensive constrained resources infusion chairs, operating rooms, imaging equipment, inpatient beds and more to improve patient access, decrease wait times and reduce healthcare delivery costs.

Physicians and healthcare organisations are facing big challenges nowadays. Physician breakdown is increasing and the repercussions are expensive. Rather than replacing human clinical judgement, artificial intelligence will augment the clinical intelligence to scale that we may not imagine today and economically benefiting the patients as well as the health sector which is the prime requirement of a developing country like India.

Disclaimer: The views and opinions expressed in this article are those of the authors and do not reflect the official policy or position of any agency of the government.

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TECHNOLOGY PERSPECTIVE 28

Digital Dispensary— Bolstering Patient Care in Jharkhand

We have enough doctors in urban areas but remote rural areas lack the same.

People have to travel far just to get basic primary care which they can get near their homes. We are striving to improve things on this front with support from the State Government, said Anurag Vohra, Chief Technology Officer, Apollo TeleHealth Services while delivering speech at the Healthcare Summit Jharkhand held in Ranchi recently.

DIGITAL DISPENSARIES Apollo is working on a telemedicine plan to create accessible and affordable model of care to masses.

We have started about hundred digital dispensaries across Jharkhand to facilitate telemedicine service with doctors sitting in Apollo Hyderabad.

In last six months, we have operationalised over 100 centres in rural areas. Unique patient count is close to 68,000 with 36% repeat usage.

This can be monitored anytime through dashboard. People can track real-time about how the services are being availed.

The software even tracks the attendance of people, the equipment and the medical prescriptions written.

This is the benefit that digital tools bring to you.

with some startups have come up with this innovative device which can collect haemoglobin in a non-invasive way. It takes a photo of your eye and then tells your haemoglobin value accurately.

Similarly we have a fetal heart rate monitor and multi-vital monitor. This works like a digital stethoscope. It has a 12 lead ECG with digital thermometer.

Vitals can be recorded in the software. The data can be easily accesses by doctors attending patients from Hyderabad through video calls. They guide patients as per the requirement-how to go about treatment plan.

In addition, we have an extra digitizer. In case patient comes with their physical X-ray reports, those can be uploaded and viewed. On that basis doctors provide their suggestions.

KEY COMPONENTS OF OUR SERVICE DELIVERY MECHANISM We have required infrastructures including skilled manpower, homegrown EMR software, urine electrolyte analyzer, and a non-invasive haemoglobin measurement machine.

People often do not want to have invasive blood tests. They are found to be averse to give their blood or get pricked and hence their screening does not happen. To do away this, we along

CASE STUDY This is a simple story of a person suffering from a severe skin infection for over six months. Despite many visits to doctors, the disease was not getting diagnosed. Someone suggested him to come to our distal dispensary.

We have dermatologists who guide patient through video chat. Disease was diagnosed and cured without much hassles. This is how we are making a credible difference in delivery of

OCT-NOV 2019

Anurag Vohra Chief Technology Officer Apollo TeleHealth Services

services to common man. Through video consultations, doctors including paediatrics, gynaecologists and NCD experts provide best care at these centres.

ROBUST TRAINING PROGRAMMES We have also set up not just broadband but Internet local loop, that’s a full leased line of Internet, to ensure smooth connectivity between these centres and our Centre in Hyderabad.

Apollo invests a lot in training of ANMs and the nurses. With full videobased learning management system we conduct exams to check their level of

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understanding. We can also check their learning ability as well. 60 percent of our beneficiaries are female who are unable to go far to get treatment. They can get those treatments close to their home. We have 33 percent referrals in dermatology.

Currently we have 10 consultations per day per Centre. Overall, we are doing more than 1,000 tele-consults per day. We also take feedback directly from our beneficiaries. We have surveyed 82 percent of the beneficiaries who have availed benefits and our score is pretty good.

TELE EMERGENCY PROGRAMME IN HIMACHAL We are also running Tele emergency programme at a height of 14,000 feet in Himachal Pradesh. We have three centres each in Lahaul and Spiti valley.

We have stabilised more than 1,100 emergency patients over the last four years. Nurses are trained for six weeks in Apollo emergency department and then they are placed where they can stabilise patients.

URBAN PRIMARY HEALTH CENTRES We are running about 180 centres with staff of six people--one doctor, two ANMs, one lab technician and one IT person. It’s a four-room set up, fully paperless clinic. We do close to 40 lab investigations.

TELE-OPHTHALMOLOGY CENTRES We are also running 115 tele-

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ophthalmology centres. Just in the month of August, we have seen 88,000 patients, close to 10,000 specialist tele-consultations. On a typical day, we do 12,000 OP and 1200 to 1500 specialist video consultations.

We do a lot of analytics in terms of what kind of diseases are happening, which district is getting affected the most and how many communicable disease cases are cropping up.

LEVERAGING AI AND MACHINE LEARNING We are using machine learning and AI in multiple projects. AI is also being leveraged to augment the training part. In addition, we are using IoT devices in the UPHC to even control the temperature. The machine tells when the AC should be switched on and off. All these things can be controlled from our base in Hyderabad.

Apollo and Microsoft have joined hands to leverage AI for cardiac risk prediction. We are investing in ML in ‘Ask Apollo’ which is our B2C platform. As an end consumer, you can download the ‘Ask Apollo’ app and book a virtual consultation with any Apollo specialist.

Leveraging health analytics, we have reduced load on the district hospitals in Andhra Pradesh as more people are coming to primary health centres.

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NEWS HIGHLIGHTS

Latest from Healthcare World Only one allopathic govt doctor for 10,926 people in India: Report

India has only one allopathic government doctor for every 10,926 people in India against WHO’s recommended doctorpopulation ratio of 1:1000, a Government report states.

The National Health Profile, 2019 compiled by the Central Bureau of Health Intelligence (CBHI) states that though the situation has improved but still lots needs to be done to ramp up the number to serve people with accessible and affordable care.

As per the report, the number of registered allopathic doctors possessing recognised medical qualifications (under the MCI Act) and registered with state medical councils for 2017 and 2018 was 43,581 and 41,371, respectively.

“At present, an average population served by a government allopathic doctor is 10,926,” the report said. The report, however, highlighted that there has been a marked improvement in the number of dentists and registered AYUSH doctors.

MGM Hospital in MP gets first sliver certificate under PMJAY The Quality Council of India (QCI) has bestowed Mohanlal Gupta Memorial (MGM) Hospital and Research Centre in Madhya Pradesh with silver category certificate for quality healthcare under the Ayushman Bharat- Pradhan Mantri Jan Arogya Yojana (AB-PMJAY).

The hospital is the first such healthcare provider which has been awarded under the category by QCI. The development comes days after when three hospitals were awarded ‘Gold certificate’ for their performance on quality criteria.

MGM hospital is one of the empanelled healthcare institutions among 18,097 hospitals on board with ABPMJAY.

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India’s life expectancy rises; NCDs major concern: National Health Profile 2019 Life expectancy of Indians has gone up from 49.7 years in 1970-75 to 68.7 years in 2012-16, as per National Health Profile 2019 released recently by the Union Minister of Health and Family Welfare Harsh Vardhan.

For the same period, life expectancy for females is 70.2 years and 67.4 years for males.

In area of non-communicable diseases, the survey notes that out of 6.51 crore patients who attended NCD clinics, 4.75 per cent people are diagnosed with diabetes, 6.19 per cent are diagnosed with hypertension, 0.30 per cent are diagnosed with cardiovascular diseases, 0.10 per cent are diagnosed with stroke and 0.26 per cent are diagnosed with common cancers.

Soon, all medical devices to come under Drugs and Cosmetics Act for quality check With an objective to bring all medical devices under one regulatory framework so that all imported as well as locally made medical devices meet certain quality standards, the Government has come up with a proposal.

As per the proposed draft notification, all medical equipment being used on human beings or animals will fall into the category of “drugs” and will be regulated under the Drugs and Cosmetics Act. The manufacture, import and sale of all medical devices will need to be certified by the Central Drugs Standard Control Organisation (CDSCO) after the proposal gets officially notified.

“In pursuance of sub-clause (iv) of clause (b) of section 3 of the Drugs and Cosmetics Act, 1940, the Central Government, after consultation with the Drugs Technical Advisory Board, hereby specifies the following devices intended for use in human beings or animals as drugs with effect from the 1st day of December, 2019,” the draft notification read.

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Centre okays six new medical college for Tamil Nadu; sanctions Rs 1,950 cr The Centre in-principal has given nod to six new medical colleges which will be established in different parts of Tamil Nadu in due course of time. With the new set of colleges, tally of total number of government-owned Medical colleges in the State would move to 30.

The Centre has sanctioned an amount of Rs 1,950 crore for medical colleges while the State’s share would be 780 crore for the medical colleges which would be set up in districts including Tiruppur, the Nilgiris, Ramanathapuram, Namakkal, Dindigul and Virudhunagar. All these colleges would be attached to existing hospitals in these districts, as per a report.

“It is a historic occasion where the Centre has granted approval in one go for six medical colleges in Tamil Nadu. I extend

my thanks on behalf of the people of the State,” Edappadi K. Palaniswami, Chief Minister, Tamil Nadu, was quoted as saying.

As per the report, expenses for these colleges would be borne by both the Centre and the State with former sharing 60 percent cost and State the remaining one

Facebook forays into personal digital healthcare with ‘preventive health’ tool Social networking giant Facebook has ventured into personal digital healthcare as it has unveiled a “Preventive Health” tool that connects people to health resources and sends checkup reminders.

Launched first in the US, the tool is designed to help Facebook users in many ways including guiding them to find affordable places to receive care, set reminders to schedule tests and mark when tests are completed, a IANS report said.

“Our initial focus is on the top two leading causes of death in the US: heart disease and cancer, (according to CDC) as well as the flu, a seasonal illness that affects millions each year,” Freddy Abnousi, Facebook’s Head of Healthcare Research

said in a blog post on Monday.

The resources available in the tool are provided by the American Cancer Society, the American College of Cardiology, the American Heart Association and the Centers for Disease Control and Prevention.

IIT Kharagpur to roll out MBBS course with 50 students from 2021 The superspecialty hospital of IIT Kharagpur, Dr B C Roy Institute of Medical Science & Research, will soon rollout MBBS course for the academic year 2021-22.

As per reports, the OPD services in the 400-bed super specialty hospital will start by the end of the year. Initially a total of 50 students would get admission in the college which will be increased in subsequent phases.

The number of seats will be extended to 100 with the scaling up of the hospital to 750-bed in phase II, as per the plan. The

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institute will also introduce Postgraduate degrees in medical sciences eventually.

A statement from IIT Kharagpur said the course curriculum will be as per the Medical Council of India (MCI) guidelines.

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CORPORATE UPDATE

Corporate Acquisitions/Appointments NATHEALTH, Roche Diagnostics India ink pact for quality diagnostics In a bid to improve access to quality diagnostics to masses, Healthcare industry’s apex body NATHEALTH has signed a memorandum of understanding with Roche Diagnostics India.

“We have joined hands with Roche Diagnostic India to provide momentum to our efforts to push policy making that ensures greater access to medical technology and building awareness on the role advanced screening and diagnostic solutions play in reducing the disease burden of the system and the common man,” NATHEALTH President

Sudarshan Ballal was quoted as saying.

The healthcare federation looks forward to working closely with Roche Diagnostics India in building awareness on innovations in cancer diagnosis and treatments, he added.

Cipla acquires anti-infective product Elores from Venus Remedies

Pharma major Cipla has acquired a novel and patented anti-infective product, Elores, from Venus Remedies Ltd (VRL) for the Indian market.

The acquisition is aimed at further

strengthening the firm’s presence in branded Indian critical care space, and as a part of its agenda to contribute to the fight against anti-microbial resistance (AMR), Cipla said in a regulatory filing.

The company, however, did not disclose the value of the deal.

Elores is a novel combination of Ceftriaxone (a third-generation betalactam cephalosporin), Sulbactam (a beta-lactamase inhibitor) and Disodium EDTA, an antibiotic resistance breaker (ARB), indicated for the treatment of life threatening infections caused by gramnegative bacteria, it said.

Fujifilm partners Max Healthcare for early detection of breast cancer Max Super Speciality Hospital, Saket a leading hospital chain in North India has signed pact with Fujifilm India, a leader in the development and application of imaging and information innovations.

In view of shortage of radiologists and limited experts in the area of breast cancer diagnostics, two giants have decided to join hands to train doctors in early detection of cancer.

Fujifilm will be sponsoring an advanced fellowship in Breast imaging with Max Healthcare Hospital under the guidance of Dr Bharat Aggarwal, Director – Radiology Services, Max Super Speciality Hospital, Saket and Dr Harit Chaturvedi, Chairman – Max

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OCT-NOV 2019

Institute of Cancer Care.

The doctors will be trained in Breast Mammography, Breast MR, and Breast Ultrasound techniques for six months through the Max-Fujifilm Collaboration fellowship program.

The program will train two select Radiologists per year towards early detection of Breast Cancer.

Wellness brand Pee Safe raises Rs 30 crore in series A funding Pee Safe, a leading hygiene and wellness brand, has secured a fund of worth Rs 30 crore in Series A funding round led by Alkemi Growth Capital, a health and wellness focused fund.

Vikas Bagaria, Founder, Pee Safe, said, “We are delighted to raise this capital from Alkemi Growth Capital.

Alkemi brings a global understanding of this space. We are aligned on one common goal – Make Pee Safe a household brand that is synonymous with quality. What started as a journey with one product inspired by my own personal experience, is now a basket of many products inspired by the personal experiences of several thousands of our loyal customer base.”

Continental Hospitals appoints Dr Rahul Medakkar as new CEO Dr Rahul Medakkar has been appointed Chief Executive Officer by Hyderabad-based Continental Hospitals.

Medakkar, who has proven track records working with renowned hospital chains in past including Manipal Hospitals, Apollo Hospitals, B Braun Medicals and CARE Hospitals, will supersede Faisal Siddiqui.

He has more than 15 years of experience in various domains of healthcare management including hospital operations, quality assurance and accreditations, market research, consulting and strategy.

He is persuader of integrated healthcare delivery model which can consistently customized to societal needs for health and wellness.

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SPECIAL REPORT

Anton Chernov, Deputy Consul General, Consulate of the Russian Federation in Chennai, Repubic of India, inaugurating the Healthcare Innovation Summit, Chennai, in the presence of Dr VS Raghunathan, Deputy Director General, NIC Chennai (Second from right); Jayant Nadiger(second from left), Trade & Investment Commissioner, Flanders Investment & Trade, Government of Flanders, Belgium; and Vijay Annand(extreme left), Regional Sales Manager, Advanced Sterlization Product (ASP) – Johnson & Johnson

Exploring Best Practices for Sustainable Healthcare Delivery Model In view of rising demand of personalised healthcare services from people at large with accessibility, affordability, and cost-efficiency being considered major determinants influencing delivery of patient care, the Healthcare Innovation Summit held recently in Chennai.

The event was organised as part of the endeavour to discuss all contours of healthcare delivery mechanism—existing practices, Government initiatives, opportunities for stakeholders, challenges on various fronts, and possible way out. Organised by Elets Technomedia, the healthcare summit witnessed spectrum of healthcare luminaries including key policymakers, international experts, industry leaders, and hospital decision makers.

They deliberated upon how to leverage modern-day technologies and innovative practices to reach out to people living on the last-mile and various obstacles on this front.

Inaugurated by Anton Chernov, Deputy Consul General, Consulate of the Russian Federation in Chennai, Republic of India in presence of Dr VS Raghunathan, Deputy Director General, NIC Chennai; Jayant Nadiger, Trade & Investment Commissioner, Flanders Investment & Trade, Government of Flanders, Belgium; and Vijay Annand, Regional Sales Manager, Advanced Sterlization Product (ASP) – Johnson & Johnson, the conference witnessed one of the finest congregations of experts of the healthcare world.

On the occasion, healthcare experts shed light on trending innovative practices across the globe and how that can be leveraged to improve healthcare delivery system in India.

Various enlightening discussion sessions touched upon issues such as: ‘Role of Emerging Technology for Building Smart Hospitals’, ‘Ensuring Affordable Quality Treatment and Meeting Up with Patient Expectations’, and ‘Integrated Healthcare Delivery - M Health, Telemedicine, AI & VR’, were organised at the conference Eminent dignitaries, on this occasion, unveiled a special issue of eHEALTH Magazine, which has been highlighting innovations in healthcare ecosystem for over a decade. Also, industry leaders, diagnostic equipment manufacturers, and healthcare service providers were felicitated with Healthcare Excellence Awards for their extraordinary contribution in healthcare world.

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OCT-NOV 2018

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SPECIAL REPORT

A GLIMPSE OF THE CONCLAVE Inaugural Session

Experts participating in the inaugural session of the HIS, Chennai

Anton Chernov

Jayant Nadiger

Deputy Consul General, Consulate of the Russian Federation in Chennai, Republic of India

Trade & Investment Commissioner, Flanders Investment & Trade, Government of Flanders, Belgium

Sustainable development of society requires excellent and effective health protection system. Main driving force to attain the objective includes science, technology, artificial intelligence, and robotics. Without a healthy population, it is impossible to fulfill humanitarian task and mission. Medical technology can increase average life expectancy by 30 years and mortality from cardio vascular disease by 0.7 percent. Russia and India are working together on various aspects of medical science and development.

Belgium has Europe’s fourth best healthcare system. Healthcare in Belgium and Flanders as a region is funded through Staterun mandatory insurance scheme, with premium automatically deducted from an individuals’ salary. Reimbursement of up to 75 percent of all healthcare costs. Foreign Nationals can choose between the National Health Insurance System and Private health insurance. Brussels Airport is World’s first CEIV pharma certified community. Flanders is a hotspot for the life science and health industries.

Dr VS Raghunathan Deputy Director General NIC Chennai

NIC is providing network backbone to healthcare sector. It is working with every ministries of the Government of India. We deal in healthcare IT and automation solutions. Our products and services include ehospital, a Hospital Management System.

It is a ISO certified end-to-end solution which is being provided in 30 plus major public hospitals across country including AIIMS and RML, Delhi. It covers 322 plus hospitals, and OPD registration of more than 12 crore. It has many features which play a vital role in improving clinical outcome.

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OCT-NOV 2018

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SPECIAL REPORT

Vijay Annand Regional Sales Manager, Advanced Sterlization Product (ASP) – Johnson & Johnson

An infection acquired in hospital by a patient who was admitted for a reason other than that infection. According to WHO, out of every 100 hospitalised patients at any given time, seven in developed and 15 in developing countries acquire at least one HAI (Hospital Acquired Infection). Different type of Infection includes Surgical Site infection, Ventilator Associated Pneumonia (VAP), and Catheter-Associated Urinary Tract infections (CAUTIs). Improper cleaning and sterlisation are important reasons for HAI.

Panel Discussion: Role of Emerging Technology for Building Smart Hospitals

Healthcare luminaries discussing various facets of technology and its role in the delivery of patient care

Chaitanya Shravanth CDO Cloudnine Group of Hospitals

Smartness and automation basically include customer experience, clinical path, and operations. Hospitals can adopt lots of easy-way automation things like online booking, payment and lab reports. Unless prescription is digitally captured, all efforts to move in direction of automation fall flat. We have a latest technology named doxper. Whatever is written on the paper is automatically captured through this technology.

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OCT-NOV 2018

Abdullah Saleem Group CIO Omni Hospitals

Smart Hospitals means it has to deliver care in smart way.

Digitisation of services (EMR) is one of the important aspects of such hospitals. It is based on people, process and technology.

Until or unless the technology enhances patients’ and providers’ experience, a hospital doesn’t qualify to the smartness. If a hospital declares itself a smart one then it must have each and every individual’s data and it should be available to clinicians at point of care to take decision.

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SPECIAL REPORT

Faisal Siddqui

Dr A Subair Khan

CEO Continental Hospitals

Managing Director Orthomed Multispeciality Hospital

Smart hospital concept starts right from planning stage. It is majorly based on technology but it should not replace human element. Healthcare technology is changing rapidly and one of the biggest challenges of the Indian healthcare sector is to cope up with the same. With digitisation and accessibility in terms of mobility of care, patients do have access to lots of care delivery models. Smart hospitals should leverage the technology to ensure flawless service to patients.

With growing expectations of patients, hospitals need to be smart to live up to expectations of patients. Technology-enabled smart hospital concept is going to play a key role in near future.

It is not only limited to technology part, but the way people work and how the technology and processes work in sync, influencing patient care. Overall, the hospital has to function smart way to deliver smart care in terms of quality, accuracy and cost-efficiency.

Vijay Navakodia Head IT RPS Hospital

We have a huge swathe of data, which needs to be deduced to get inference. Internet of thing (IoT) is an important tool which makes thing lot easier. We are leveraging IoT synchronizing different aspects including human cognitive to deduce repetitive works and streamlining processes with SoPs.

Panel Discussion: Ensuring Affordable Quality Treatment and Meeting Up with Patient Expectations

Panelists shedding light on affordability and cost-efficiency during panel discussion

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SPECIAL REPORT

Sameer Mehta

Dr J Hariharan

Vice Chairman Dr. Mehta’s Multispecialty Hospital

Managing Director Vihaa Multispeciality Hospital

Customers’ affordability is the function of what the customer which is target prime audience is able to afford in discretionary income of healthcare needs. A customer who wants a robotic surgery can’t be middle income. If a patient has clarity that he is paying for quality or set of outcomes, then they can choose from packages. Trust is important factor which makes a patient loyal to providers.

Affordability can’t be defined. Every hospital has its own working cost and they deliver services accordingly. Technology helps medical staff to execute things in a better way but it can’t work on its own. We have to leverage it to facilitate things. Human Resources play an important role in delivery of healthcare and they must be trained enough to leverage modern-day technology to bolster care. Hospitals need to devise packages according to need of the customers.

Sonymol K Director of Nursing Continental Hospitals

Maximum of customers today want prioritised and individualised care. Affordability is a myth. In India, only 10 percent people have health insurance. Ayushman Bharat, a game-changer scheme is great initiative of the Government where people can avail facilities in both private and public entity. For quality affordable care, hospitals need to devise best business model. PPP models, telemedicine could be adopted to balance cost and quality

Panel Discussion: Integrated Healthcare Delivery - M Health, Telemedicine, AI & VR

Healthcare decision makers highlighting significance of integrated healthcare delivery during panel discussion

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OCT-NOV 2018

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SPECIAL REPORT

Raj Shekher Janapareddy

Dr T Palaniappan

Director Bloom Hospitals

CEO Medway Hospitals

When millions of data and data points are available, making sense of that is crucial aspect. Data, information, and knowledge are part of a pyramid. At the bottom most thing, there will be data. When it is distilled and put in a particular shape it becomes information. When it is distilled and applied, it becomes knowledge. We are at very nascent stage in terms of data and its authenticity.

Integrated Healthcare is a wide spectrum. We predict the outcome of diabetic patient through AI and ML. India lacks resources on various fronts. A good resource is pretty much difficult to get in healthcare industry. Through modern-days tools, resources are utilised in better manner which ultimately enhance patient care. Telemedicine could be leveraged to provide services in rural areas with doctors sitting in metro cities. It also helps to train junior doctors.

Sriram

Dr K R Balakrishnan

AGM IT SIMS Hospital

Director Fortis Malar Hospital

Today technologies have advanced, enabling people to see records with the click of mouse. Telemedicine is proving to be great tool, bridging physical distance between doctor and patient. AI & ML can’t replace the bond between patient and doctor. Patient feels secure in presence of doctor. Artificial Intelligence could be useful tool in radiology and laboratory.

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Despite the technological advancements, zero-error surgery can’t be possible. We are trying to minimise errors in surgery and technology including virtual reality & 3D are proving to be great boon. In surgery there is no chance to press undo button to correct things. A doctor is judged by the latest records- good or bad. His past laurels don’t make any difference. Rational and scientific-based billing is need of the hour.

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OCT-NOV 2018

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SPECIAL REPORT

Healthcare Excellance Awards

Ayush Mishra, CEO & Co-Founder, Tattvan E Clinics receiving the Healthcare Excellence Award

Healthcare Excellence Award being received on behalf of Continental Hospitals Private Limited

Healthcare Excellence Award being received on behalf of American Oncology Institute

Awardees during photo-ops at the Healthcare Innovation Summit, Chennai

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Dignitaries and Delegates Visiting Stalls at EXPO

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