Rommel Tickoo is either glued to his laptop or the mobile, monitoring patients. In the last year, he has kind of earned a ‘doctorate’ in virtual consultations. “I was on average doing 1000 virtual consultations in April this year, when the pandemic was at its peak. Sometimes I slept for just 2-3 hours. It was both exhausting and exhilarating. There were times when I was overtaken by fatigue and frankly I could not attend to some of my own family members,” says Tickoo, director, internal medicine, Max Hospital. Tickoo’s virtual consultations have a global canvas—from the U.S. to the U.K. to other Asian countries. “The pandemic has taught us the importance of being knitted together via a tech-based robust platform.”

Digital technologies have become an essential component of a sustainable health system. As the world gets ready to brave a new wave of the pandemic, hospitals and health systems across India are redesigning their architecture to be more tech-centric. The process of technological innovation in private hospitals, which kickstarted two years ago, has become more intense, dwarfing the traditional face to face consultations. Robotics, cloud computing, 5G telecommunications, artificial intelligence (AI), digital infrastructure have become vital for addressing the challenges. Data analytics is being widely used to locate the hot spots and even predict the new risk areas.

India’s biggest hospital chains are now relying heavily on electronic health services since the early stage of the pandemic. Welcome to the world of teleconsulting, teleradiology, telepathology and tele-prescription.

According to a Review in Nature Medicine, digital technologies cannot operate in isolation and need to be integrated into the existing public healthcare systems. For example, South Korea and Singapore successfully introduced contact-tracing apps to support large teams of manual contact tracers as one of many measures, including strict isolation of cases and quarantine.

Virtual vibrancy

The emergence of the digital health market is expected to increase the potential of big data and analytics and transform the consumer healthcare market.

The e-Health market is set to boom due to the rise in internet penetration and digital transformation. India is home to more than 133 funded e-health startups and the companies witnessed a spike in demand during the lockdown. According to ‘India’s e-health market opportunity Report 2021’, the market is projected to hit $10.6 billion in revenue by 2025, up from $2.5 billion in 2020. Telemedicine will be the greatest contributor in the e-health market and is expected to reach $5.4 by 2025—a 25% share in the country’s overall healthcare market. India’s telemedicine guidelines were issued as recently as March 2020.

The report says that e-pharmacy, though in a nascent stage, is expected to reach $4.2 billion by 2025. The larger health tech market in India is likely to reach $21.3 billion by 2025 acquiring 3.2% of the global health tech market pie.

“The pandemic has brought in many changes for our hospitals. At an operating level, there has been a greater acceptance of digital routes. At a design level, the last 18 months taught us not to hardwire hospitals and to recognize the importance of flexibility of infrastructure and at a more basic level, it has underscored the need for efficiency so as to minimise the effect of economic shocks,” says Dilip Jose, CEO, Manipal Hospitals.

Ashutosh Raghuvanshi, MD & CEO, Fortis Healthcare, maintains that telemedicine and remote monitoring have been the most important takeaway from the pandemic.

“It is not just about medical deliveries. Covid-19 has also cemented synergy between the government, healthcare providers and the industry. This is no longer a public vs private narrative but how India as a country can leverage its capacity through greater partnerships.”

Acknowledging the importance of having a vibrant digital architecture, Raghuvanshi says, “Many Fortis hospitals were able to function as full or hybrid Covid-19 facilities by scaling up manpower and modifying the existing spaces. We have also increased our bed capacities and oxygen supplies.”

Remote reference

Experts maintain that the pandemic has brought in several advantages of remote consulting for the patients. There are, however, different opinions on its use.

“Remote monitoring as the primary option has its own constraints. Most people still prefer in-person consultations. However, as the system matures, enhancements with an overlay of AI and analytics can increase the efficiency of remote systems,” feels Jose.

Ashutosh agrees. “Remote monitoring comes with limitations. It is largely to manage existing consultations or mild cases which do not require hospitalisation. We have invested in robotic surgery and AI as robotics-assisted technology.”

Enumerating the macro-level changes that have seeped into the health services, Ashok Patel, Founder and CEO Max Ventilator says: "Besides a reinvigoration of digital services, there has been a greater degree of partnership between the private players.” Patel, however, does not deny that digitalisation has its own set of problems” Founded in 1995 in Vadodara, Gujarat, Max Ventilator has been a leading indigenous ventilator technology company that has designed, manufactured and marketed a wide range of ICU, anaesthesia and home care ventilators.

Stressing on the greater role of remote services Patel says, “New age technologies like robotics can help but am not sure whether a lifesaving device such as ventilator should be left totally in the hands of AI systems.”

Home Hospital

The pandemic has brought in a new change—the build-up of a micro-hospital at home.

According to a Mckinsey report, tech-enabled home medication administration allows patients to shift receiving some infusible and injectable drugs from the clinic to the home. This shift can happen by leveraging remote monitoring to help manage patients and monitor symptoms, providing self-service tools for patient education (for example, training for self-administration), and providing telehealth oversight of staff.

Sandeep Budhiraja, group medical director, Max Healthcare, maintains that the wider strategies for manpower, processes and infrastructure were redesigned. “The advisories for various states kept changing and we had to keep ourselves abreast. Our first challenge was to convert a hospital into a full-fledged isolated ward. There were other initial hiccups like handling the oxygen supply. I would, say, that at this stage, we are definitely much better prepared for a third wave, if that happens.”

Budhiraja maintains that IT has played a pivotal role in remote consultations. “There is a kind of micro-hospital set up at home where the devices with the patients transmit data for live monitoring. I strongly feel that remote consultation will continue to be a part of our life even after the pandemic ends.”

The technology he said had essentially three standpoints—improve the clinical outcomes, improve the patient’s tracking of services and enhance the business productivity.

Vishal Lathwal, head of the Max@Home business, says that the business volume of home care of his hospital had grown 5 to 10 times since the pandemic started. “Home care was like the 12th man in cricket for healthcare delivery. The pandemic brought to the fore the importance of this service. We started this Max@Home five years ago, and have continuously added new products and services ever since the pandemic started especially focusing on the remote management of patients.”

Besides an extensive training programme, Lathwal mentioned that they had been actively managing the health of their own staff to check community transmission.

Telemedicine transmission

The biggest challenge in India when it comes to the adoption of telehealth services is its broken health system and the tech illiteracy in the rural population,” says Vikram Thaploo, CEO, Apollo TeleHealth.

Another big concern, Thaploo says is that some major problems cannot be detected over video conferences. “New training programs are needed for an accurate assessment of patients.”

Sugandh Ahluwalia, chief of strategy, Indian Spinal Injuries Centre, says “India's private healthcare industry has made a considerable contribution, accounting for roughly 60% of inpatient care. After the pandemic, there has been a surge in demand for online consultations and telemedicine services”

Admitting that the pandemic had put even the most advanced health care systems to the test Aashish Chaudhry, managing director, Aakash Healthcare says, “We have made significant investments in quarantine and treatment infrastructure besides stepping up the remote monitoring. While we are using Artificial Intelligence and robotics for the knee replacement surgeries we also plan to expand these for additional surgeries next year."

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