Has Indian Digital Health Industry got what it takes to catch up?
By Arunima Rajan
In a deep-dive investigation, we take a closer look at the gap in India's digital healthcare sector and whether new technology is giving patients more agency in their healthcare.
When *Lakshmi was diagnosed with pre-diabetes, it didn't take her more than a day to consult one of the best endocrinologists in Mumbai using a hospital's app. She also found out soon that her fitness app has a diabetes reversal programme conducted in collaboration with doctors. Within six months, she brought her HBA1C level back to normal.
Now, take the case of *Padma, who stays in Kurichi, a small town in Kerala. Four decades ago, the 76-year-old was diagnosed with diabetes and still doesn't do regular checkups. "The local labs don't collect blood samples from home, and I need to travel at least 14 km to go to the town, do blood tests, and consult a diabetologist. I try to manage my condition with diet and exercise. And consult a doctor once in six months, or if I feel tired," adds the homemaker.
Gautam Khanna is the CEO at P.D. Hinduja Hospital & MRC, Mumbai. “Digitisation of healthcare accelerated considerably during the pandemic and will drive the future. It has impacted significantly in delivering quality health services to patients at home and far away locations by providing solutions like telemedicine and online access to reports etc. Digital transformation of health services will transform the various aspects of healthcare delivery, from primary healthcare to specialised tertiary care and will also help in preventive health.
“It is promising to see that the e-Sanjeevani portal of the government has conducted over 2.2 crores teleconsultations so far. The AB-PMJAY, which was launched in 2018, is a game-changer of healthcare services in our country, and it gives me utmost satisfaction to see that it has issued 17.5 crores Ayushman Cards already. I am happy to note that Union Budget 2021 has focused on mental health with the launch of the National Tele-Mental Health program. Having an open discussion and a platform providing universal access to mental health facilities is a milestone for the country.
“However, we currently need to focus on implementation and ramping up of digital infrastructure to ensure uniform access to all. We must reassess and boost network connections for the underserved communities and areas and Incorporate social and personal context into designing digital health tools. Public sector hospitals in the interiors should provide wi-fi hotspots and public kiosks to enhance patient accessibility. Additionally, health providers and health systems must fill the existing gaps in digital health by partnering with community-based, state organisations to increase access to broadband internet and devices, thereby improving digital literacy and mitigating disparities in telehealth,” adds Khanna.
Anand Narasimhan, MD, Merck Specialities Pvt Ltd, points out that the pandemic has radically transformed the healthcare ecosystem in our country. “Digital innovation undoubtedly holds the promise of reviving rural development. In addition, telemedicine played a significant role during the pandemic. This transition has opened long-term opportunities for basic primary care, especially in rural areas with limited healthcare professionals, which doctors and other medical specialists can now support.
“Virtual health options are closing the gaps in healthcare with a sustainable care delivery model, but the rural areas would benefit the most when the technology gaps are closed. New workflows should be designed at the beginning and not as an afterthought. As a result, the team will have to find a way to force-fit new tools into old workflows. Merck adapted to the new normal and continued to offer recent scientific updates specific to therapy to HCPs with new digital channels. The adopted multichannel approach ensured our employees and HCPs with any disruption on medical education.
“Health tools for the population are in ever-growing demand as we enter the era of preventive and anticipatory medicine. However, equal distribution of digital health tools requires connectivity. Therefore, the Medical Association should adopt an approach to increase internet access by expanding broadband and wireless connectivity in rural areas. Furthermore, to reduce the digital divide in our country, telemedicine and technology leaders should come together and work in synergy to open all the healthcare gates.
“Specialised public sector hospitals can extend their telehealth departments to reach isolated parts of the country to provide cost-effective digital health services to the underprivileged, including digital consultations. In this exponential era where technology must support measurable and value-based care, pharmaceutical companies need to help patients, caregivers, and physicians effectively use digital tools to democratise healthcare and reduce time, cost, and distance between them and consumers. We at Merck have collaborated with healthcare professionals to drive disease awareness and its impact with COVID 19 on various social media channels. These initiatives have supported undisrupted access & continuity to treatment.
“The urgent need to boost digital healthcare is building a robust healthcare infrastructure by equipping it with advanced devices and increasing public health spending. The recent Union Budget announcement to roll out 5G is an excellent step in that respect as a strong internet with 5G connections will further help to boost the telemedicine sector and make health care accessible to people who live in isolated areas, and provide feasible access to medical specialists to connect with patients,” adds Narasimhan.
For the longest time, digital health has been considered the solution for the resource crunch in India's healthcare sector. Unfortunately, the gap in access to digital health in rural and urban areas is a reality. Satish Kannan, CEO of MediBuddy, confirms this.
"International telemedicine initiatives are bringing the world closer, and distance is no longer a barrier in attaining quality healthcare. Despite having so much potential, telemedicine has not attained the 'boom' that it was meant to create. Lack of awareness and acceptance of new technology both by the public and the professionals are holding it back. Governments are now starting to take a keen interest in developing telemedicine practises resulting in a slow but steady rise in its utilisation in public health. Hopefully, telemedicine practices will reach their true potential in a few years," adds Kannan.
Rural India and Digital Health
Another CXO with a plan to narrow this gap is Shashank Saini. He is the Founder of Medpho, the healthcare technology startup backed by Cygnus Medicare Group. He hails from Rudrapur, located in Uttarakhand.
"India is a vast country, and its healthcare needs are immense. Advanced and specialised healthcare is still a privilege for rural India, which makes up about two-thirds of our population.
Only 13% of the people in rural India have access to a primary health centre, 33% to a sub-centre, and 9.6% to a hospital. But India's public health system is still developing, and the COVID-19 pandemic has exposed the flaws in our existing health system," says the CEO.
Everyone knows that hospital visits are frustrating. Parking is difficult, waiting takes hours, medical records often go missing, and bills are also high. Medpho understood the gaps in the healthcare system and leveraged the technology to facilitate a single call teleconsultation service where a patient can connect with one of the doctors almost immediately, regardless of location. The company aims to offer affordable and accessible healthcare services for Bharat. "So we have collaborated with more than 600+ doctors and 100+ supply partners to serve more than 1 lakh patients and ensure seamless operations and high-quality service to every individual in India's Tier-1, Tier-2, and Tier-3 locations. Our customer base presently includes large corporations and individuals across these locations. We strive to make sure that every one of our clients/patients gets the care they deserve without the added burden of paying the total price. We offer discounted medicines with free delivery, discounted home sample collections, heavy discounts on surgeries, and free doctor consultations," adds Saini.
Is UHC the solution?
If there is one thing that people in both the private and public sectors can agree on, it is that UHC has become highly crucial for India's online and offline healthcare models.
Experts like Hardik Thakker, AVP— Corporate Development, Shalby Multi-specialty Hospitals, highlight that Universal Health Care is adopted by various developed and developing countries, and India also needs to implement it.
"UHC will ensure that everyone has access to healthcare and treatment despite their pay range. The developing country of Mexico prides itself in its Centennial Care 2.0, a system set to implement new and innovative initiatives targeted for filling the gap of healthcare systems and providing better care to their vulnerable population. The government also needs to address the lack of WHO prescribed limit of patient-doctor ratio. Vietnam provides healthcare facilities at central and provincial levels to help the facilities at the district level. Similarly, the franchise model and opening new healthcare facilities in rural and sub-district areas will ease the pressure on Tier 2 and Tier 1 city hospitals. The best way to move forward while the new initiatives take root is to make the most of our available resources while delivering quality healthcare to a significant portion of the population," he explains.
The MFine Model
Digital health space may seem daunting. But India has a lot to offer regarding digital health solutions.
Ajit Narayanan, CTO, MFine, points out that India currently has 600 million smartphone users, and smartphones have a good penetration even in rural areas where other sophisticated infrastructure is absent. "Using smartphones to monitor health vitals supplemented by telemedicine consultations can be a game-changer for India. Moving beyond telemedicine consultations and healthcare services, MFine is working on various next-gen AI technologies which convert the mobile phone into a rich diagnostics and vitals monitoring tool," he adds.
The healthcare startup focuses on delivering an AI-driven, on-demand healthcare service across India. It aims to be one of the largest virtual hospitals in the world with services across primary care, secondary care and chronic care management in collaboration with its trusted partners.
In 2020, MFine expanded its geographical coverage beyond the physical boundaries of the cities to serve people from over 1,000 towns in India and launched several new services such as AI-based self-assessment of various health conditions and long term care programs for chronic conditions.
MFine launched the SpO2 tracker to provide access to tracking SPO2 levels without the need for an additional device. More than 1200 users use the tool daily to track their oxygen saturation level.
In 2021, MFine launched a series of online self-checks that ask users simple questions about their medical and family history, lifestyle habits, and symptoms. "Based on a user's responses, MFine Self-Checks inform users of their impending health risks. Most of these Self-Checks have been created for chronic conditions such as diabetes, hypertension, PCOS, etc. Since these Self-Checks are within the MFine ecosystem, an alerted user can instantly access the right specialist for the next steps," adds Narayanan.
Is Phygital the solution?
Nimith Agrawal, CEO of DoctCo, a healthcare startup, knows from his experience that UHC and hybrid models can play an essential role in rural India. DoctCo is a health-tech startup founded in April 2021 with the mission to make healthcare accessible to patients suffering from chronic diseases in tier 2 and tier 3 cities.
"We are setting up Phygital centres in small towns that provide access within a 15-minute distance to super-specialists. The centre is equipped with a doctor and IoMT device that offer an almost omnipresent consultation between medical specialists and patients that mimics in-person consultations. DoctCo provides end-to-end experience to the patients from OPD to surgical procedures and then follow-ups. The OPD and follow-ups happen within the city limit of the patients, and a patient has to undertake travel to tier 1 cities like Delhi/NCR only for surgeries. DoctCo Saathi provides a seamless experience to the patients travelling for surgeries. We have managed to serve more than 500+ villages, done 1500+ OPD consultations and screened more than 1 lakh patients," says Nimith Agrawal, CEO, DoctCo.
Government Initiatives
Agrawal points out that the advent of technology platforms coupled with digitalisation and the promise of AI at scale has led to a drastic uptake in the Indian healthcare sector. "The government is introducing a slew of initiatives, fast-tracking the approval processes and providing necessary support to the health tech startups to drive digital growth. Healthcare companies are rapidly adapting to global practices, and we will soon see India emerge as one of the most developed markets for healthcare services shortly. We believe that precision medicine, 3D printing of organs, big data, Internet of Medical Things (IoMT) devices and connected health will be the norm. Digitisation will also help in capturing, storing, securing and analysing data. However, accessibility and proper healthcare infrastructure is still a concern in the smaller towns and cities. To harness the full potential of health tech, investment by the Central and the State governments in internet connectivity, the right tech platforms, and physical health infrastructure is imperative. The real challenge lies in providing support to innovative and disruptive models trying to solve for access to healthcare in remote locations," adds Agrawal.
Agrawal says that the NDHM initiative is still nascent, and the government needs to provide more clarity on the framework on data privacy and access to health for all. "Also, how they plan to manage the collection, storage, processing, and sharing of health data as there is no independent regulatory authority overseeing it for now," explains Agrawal.
How do B2B health tech players assess this situation?
Afsal Salu is the CEO of BestDoc, a B2B HealthTech company focused on improving hospital patient experience. BestDoc has more than 250+ hospitals as its clients, including national brands like Narayana Health and Apollo Hospitals. "Bridging the digital divide in healthcare requires innovative solutions that put patients at the centre. Our organisation creates inclusive solutions that allow patients across digital literacy levels to get a caring and empathetic healthcare experience. We enable care providers to adopt patient-centric solutions with simple, SaaS-based solutions that can be easily implemented. We are helping hospitals become NDHM compliant to provide a superior patient experience while adopting nationalised standards for digital patient care and getting integrated into a digital health ecosystem," says Salu.
Digital Health or Scarcity of Resources
Salu points out that it might appear that digital health infrastructure is not a priority for a developing country like India, where the biggest problem is access and availability of healthcare due to scarcity of resources. "However, when you look closely, one realises that digital health is a solution to the problem. Telehealth and AI technologies will go a long way in the early diagnosis of diseases in the population where basic healthcare services are not available easily. Another advantage of digital health will be to reduce costs and improve the affordability by improving the operational efficiency of healthcare providers. BestDoc offers a suite of digital health technologies to enable healthcare providers to improve healthcare access, availability and affordability," he explains.
He also notes that ABDM and UHI will revolutionise healthcare by putting the individuals in charge of their health data and giving them the ability to share relevant information across the ecosystem. "Getting all providers and patients onboard the platform will require an initial effort from all stakeholders. Our goal at BestDoc is to support ABDM and support healthcare providers with our suite of omnichannel and self-registration and appointment booking applications using Digital Health ID," he adds.
Best Practises from Other Countries
Salu notes that smaller countries like Singapore and Finland have successfully integrated health management systems using technology. "Globally, FHIR/HL7 technology has standardised interoperability across the healthcare ecosystem. BestDoc is working with ABDM to incorporate these global standards on the platform as a partner. India has taken a great leap forward with a federated consent-based PHR that will set the standards for others to emulate worldwide," he adds.
Does the Government need to Speed Up?
Vibhav Joshi is a co-founder and Director for maternal and child health at InnAccel. InnAccel (IA) is an institutionally backed health tech company bringing disruptive technologies to critical care and maternal & child health. IA's core technologies have been granted seven patents, two CE, and one US FDA certification. Since launching in 2019, 730+ devices have been deployed to 90+ hospitals across India, treating >20K patients. IA products have also been exported to 7 other countries.
Joshi notes that the government of India is the largest purchaser of medical equipment. "PHCs and sub-centres are the first levels of access to healthcare for majority of India's population. To drive earlier disease detection, remote monitoring and consultations, and timely interventions, the government needs to create startup-friendly procurement processes at a policy level. There need to be mechanisms for six months to a year-long paid pilots for such systems to gestate and mature. Fitting such systems in a tender process is often difficult for startups. One way to deal with this would be to identify innovation clusters where such projects can be implemented with relaxed tender requirements and M&E budgets. On the startup side, more emphasis needs to be on needs identification and building low resource, low skill compatible products. Products need to be rugged, have a low recurring cost and designed for easy servicing and replacement," concludes Joshi.