Six Key Transformational Shifts that are Transforming Healthcare in India

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This month India kicked off one of the largest vaccination programs in the world. This time the focus is Covid 19. This is not the first time that India has taken on such programs. Earlier India has successfully eradiated Polio, through one of the largest initiatives country wide. Given the size, number of people and the geographic spread of India it is not an easy task. But we have done it through a concerted effort involving Government (National, State and Local), Healthcare Institutions, Hospitals, Pharmaceutical companies, Technologists, Public Health Policy among others.

While the changes in the Indian healthcare system are not apparent, but the numbers give us a positive indication of the improvement over the decades.

Our overall life expectancy has gone up over the years. During independence, we had a life expectancy of around 45 Years and today it has risen to 69 years. Overall infant mortality is down along with maternal mortality during birth. This improvement will now be accelerated due to certain key transformational shifts that are happening in the country. Let’s discuss them below.

• Smart Phone Penetration – Very often changes in one industry impact the parameters in another one. The production of reliable cars led to the suburban boom in the United States. Similarly, one of the biggest Impact in India has been the advent and propagation of smart phones. During the lockdown, the government and the local authorities have sent public messages repeatedly to citizens on corona virus. Smart phones have been used for education, banking and promoting local businesses during the pandemic. This has had an impact on the access to healthcare services, information and essentials like ordering for medicines and receiving lab test reports. With more than 500 million internet subscribers, India’s digital transformation is the faster than most countries and this is a big driver for healthcare transformation as well.

• Telemedicine – On my 43^rd birthday last year I received an unexpected gift from the medical council of India and Niti Aayog and that was the guidelines for the roll out of telemedicine services in India. It was an issue that has been debated for the last 10 years and as a ruling from madras High Court, it was illegal to offer medical services on the digital platforms. But the pandemic changed all of that. I have been a big proponent of the telemedicine services as this I believe is the Uberisation of the available medical experts in the country. Let me explain, when I was practicing, there were weekdays and mornings when I was free, but extremely busy on the weekends and most evenings. I had no way to balance the load as I had to physically see every patient and they would be available oy after work- weekends and evenings. With Telemedicine we can balance out the time for the doctor throughout the day and also open up the medical expertise available in the cities to the patients in tier 2 and Tier 3 towns and villages. The consultation would be online and through the smart phones. Even post the pandemic the number of telemedicine consultations are stated to be around 15% of the total consultations and reach a market size of $ 5.5 Billion by 2025, growing at 31% annually. Together with the smart phone penetration this would have a multiplier effect on the healthcare transformation of the country. We had covered this aspect of telemedicine in the one of the articles on Healthcare India, the article can be accessed here.

• National Digital Health Blue Print –  Niti Aayog in July 2019 has finally released the digital health blueprint policy for India. The focus of the digital health blueprint is in line 2017 National health policy which focuses on long with a strong emphasis on the care continuum. National health policy also plays a lot of emphasis on the Triple Aims that include
• Accessibility
• Affordability
• Quality of care

National Digital Health blueprint truly recognises that there is no one entity or organisation that can solve the Healthcare problems of India it calls the blueprint for the entire Healthcare system this is a strong departure from the traditional ideology that the government is the sole provider of healthcare for all citizens.

National health blueprint focuses on three major components

• Digital health infrastructure number
• Digital data
• Standards and regulations

The key objectives of the national digital health blueprint include establishing the core data model for storing and using healthcare data that would be generated from this ecosystem. Standards for the infrastructure required for its seamless integration using standards for all the components of the ecosystem.

The other interesting aspect is creating a system of Personal Health Records, based on international standards, and easily accessible to the citizens and to the service providers, based on citizen-consent.

There is also a provision for declassifying data for usage for analytics and doing population health management. In addition to these, there is guidance on governance, leveraging information systems already in place.

I believe that this would create the foundation for a strong Electronic Health Records Policy and interoperability of patient data among systems. This would be built on the India health stack, and following the common health stack would help many organisations across the country to build their health infrastructure on similar lines.

• Transformation of Primary Care – As a country of billion plus we cannot rely on traditional healthcare systems and what has been successful in the west. Our best strategy is to focus on primary care and ensure that we build a strong foundation of health in the country.

At the front line for the fight against disease and other illnesses is the Indian Primary Care system. This system is mostly run by ASHA (Accredited Social Health Activists) If something is coming our way, they are the first to know. And while they have been around since the recommendations of the Bhore Committee recommendations were given in 1943. The growth in smart phones and the availability of the India Stack would give a much needed boost to these ASHA workers and strengthen our primary health system.

What needs to be done is giving these workers life skills in order to leverage and use the smart phones effectively. Today that is not happening as most of them are not even aware of how to use a smart phone. But imagine the power of the system when the smart phone is in their hands. Along with the India Health Stack, these workers would be able to real time update records and access any information on improving the health of their local communities. We had covered it in a detailed article some time last year.

• Advanced Technology – The healthcare system of the future will be consisting of organisations that have access to patient data and are able to get meaningful insights out of them. Technologies like analytics and predictive modeling, can help us identify and proactively treat disease patterns. This is already happening in large hospitals in India like Apollo and Manipal, as well as healthcare systems like ESIC. But this transformation has to be more broad-based, involving the entire healthcare ecosystem. Technologies like AI and Machine learning are being used to understand, identify and track disease patterns. . Blockchain is another promising technology that can really impact healthcare especially in areas like security and privacy

• Disease Surveillance can help us predict the disease patterns and develop models of care for the same. Disease Surveillance is an important tool today with the advent of new and fast spreading diseases. In some healthcare systems, it is used not only to check the spread of the infectious diseases but also to monitor communicable diseases. India has had a disease surveillance system in place since 2004 and systematically the disease data at the district level has been collected for states and collated at state and then national level to five us an idea of disease patterns in the region. More on Disease Surveillance can be found here.

To summarize healthcare in India is at the cusp of change and that is being driven by 6 key transformations, as evident from the model below

• Smart Phone Penetration
• Telemedicine
• National Digital Blue Print
• Primary Care Transformation
• Advanced Technologies

The pandemic has taught us many things and one of them is how we are uniquely positioned to build a healthcare model that works for us.  This is a model unlike any others have seen and would carry us far as we transform healthcare in India.

About the Author

Dr Vikram Venkateswaran

Dr Vikram Venkateswaran is a doctor turned technologist who has worked with major healthcare systems in the India and overseas and is part of leading healthcare technology policy think tanks in India. He is the Founder of Healthcare India, rated among the Top 100 healthcare technology platforms in the world.  Dr. Vikram studied at DPS PK Puram, New Delhi, the Manipal College of Dental Surgery and IMT Ghaziabad. He lives in Bangalore, India, with his wife and two children.