Health IT is generally viewed as the most promising tool for improving the overall quality, safety and efficiency of the health delivery system. With many innovations coming up in the health IT segment, the question is how innovation will benefit the fraternity. A closer look! By Sharmila Das, ENN

They say a country is prosperous if it has a culture of innovation. In our countrys patient-centric health system you must innovate. This does not mean adopting every fancy new piece of equipment. Over the years,Indian health IT is too bringing innovations but may be the required amount of innovations are not happening at the expected pace. Therefore, the market
for Health IT products in India is too unsettled. Sumanth Tarigopula, VP, Apps Global Delivery India, Enterprise Services, HP shares, Generally, IT market constitutes around two percent of revenue of the healthcare market. With enormous investments that are going to come through next five year plan, IT should see corresponding growth.

Can innovation save our bacon?
In the dynamic and ever changing healthcare environment, health IT innovation is one of the key driving forces for reducing costs and improving the quality of care. Nilaya Varma, Managing Director, Health & Public Services, Accenture India shares, I feel Indian healthcare is not only fertile, but is a fit case for big innovations, especially those focused around increasing penetration and affordability. One thing which Indian healthcare institutions have not really been focusing on is clinical efficiency, which I feel if not addressed, would become a big problem in the coming years.

Tarigopula says, Indian industry is fertile for innovation. The healthcare delivery has been very fragmented and inefficient. The innovation in heart health delivery and diabetes related care through mobile devices will help drive the next generation healthcare model.

Vijay Simha, Partner, Vita Path-Finders LLP & CEO OneBreath Inc shares, Indian healthcare desperately needs innovations in order to
be operationalised. The constraint that we face in taking healthcare to the masses is not only about capacitating but also the tools and methods that would help operationalise the programmes. It is about time that the talent from the industry, as well as from the academia begins to team up and find solutions for our local healthcare problems. We need to understand that once we have identified the problem, we also would need innovative solutions to solve those problems thus completing the cycle of care.

Nilaya Varma, Managing Director, Health & Public Services, Accenture IndiaI feel Indian healthcare is a fit case for big innovations. One thing which Indian healthcare institutions have not really been focusing on is clinical efficiency, which I feel if not addressed, would become a big problem in the coming years

M.Vennimalai, CEO, Aavanor Systems says, Healthcare is definitely one of the most fertile and vibrant industries in the Indian context and Indian healthcare is a very exciting and high growth segment in the international healthcare industry. Many new models of healthcare delivery are being experimented within India to effectively care for a large underserved local population, and to cater to a growing inbound international healthcare tourism market. In this context innovation is highly favoured and indeed, is a necessity. Along with innovations in the delivery models, India needs innovation in the medical devices and in IT space. Innovation to help serve the entire population as well as to speed up the process of preventive care by early diagnosis and supportive care, post the engagement between the client and the healthcare provider.

Vasukumar Nair, Director,
Marketing & Sales, 21st Century Informatics

Vasukumar Nair, Director, Marketing & Sales, 21st Century Informatics says, India as an emerging market is definitely fertile enough for innovations. Over last two decades, the Indian healthcare industry has witnessed advances in several fronts “ whetherin treatment sector or associated care services. Indian companies should definitely continue the quest for bringing in further innovations to their products and services while continuously working on incremental innovations to match the changing requirements of the field.

Aravind Sitaraman, President,
Inclusive Growth, Cisco Systems

We have launched Cisco Education Enabled Development (CEED)-2700 to educate healthcare fraternity with the help of a cloud network to train auxiliary nurses of Bihar

Innovations in the offing It is true that Indias innovation story has many times envied our peers/competitors and it has proved the capability of the country to produce innovation. Aravind Sitaraman, President, Inclusive Growth, Cisco Systems shares, We have launched Cisco Education Enabled Development (CEED)-2700 to educate healthcare fraternity with the help of a cloud network to train auxiliary nurses of Bihar. Initially, we have launched it in the remote areas of Bihar, however gradually we plan to introduce it in
the other states of the country. The system works with the help of cloud network and equipments like camera,
computing environment, cloud infrastructure, router etc. Using this technology, one can watch a live surgery and thus can have better knowledge sharing. The technology can be used in many training courses too. The primary objective to launch this product was to do something to combat inadequate number of paramedic and medical staffs in the country. Tarigopula says, We are at the forefront in terms of innovation by deploying a platform called smart health in a box that would deliver healthcare through remote models. The remote platform would help the rural patients to step in to a health delivery van and get the medical advice from the doctors through interactive platform.

Simhas venture One Breath has designed low-cost, portable  ventilator. He elaborates, The low cost ventilator falls in the category of possible solutions and addresses the need to make healthcare delivery  more accessible. The need comes from the fact that most healthcare facilities suffer from an acute shortage of ventilators not only due to the high cost of capital acquisition and its attended maintenance costs but also due to their tendency to breakdown due to wear and tear and rough handling. The original intent was to address the issue of reliability, the low cost happened as a result of innovation through design thinking.

What the Government stalwarts have to say

IT is a great enabler, however it is not itself a solution. IT can help use information better; IT can be just the tool and should not be used as replacement.

Varma says, As for Accenture, we have some very innovative solutions, both in the clinical and non-clinical aspects of healthcare. It is a very exciting time for us, as we are deploying some of these solutions in various parts of India. Most notable among these is our eICDS solution, which we  believe, has the potential to be a big enabler for streamlining of ICDS services in India. We also have several innovative solutions in the mHealth and Health Analytics space which we have customised to our clients across the globe.
Tarigopula informs, From HP, the innovative products are mobile based diabetes management solution. HPs diabetes management solution is a mobility based solution that directly fits in to the tools that enable the patient self-management as part of the diabetes disease management programme. The key trackers for patient in a self-management programme are controlling the glucose level and the calorific intake of the food for each meal. Though there are multiple solutions available in the market to cater to the tracking glucose level or food intake, there is no single solution that would combine the two trackers as unified solution. In addition, HP solution will provide the ability for health plans to post the reading materials and videos about diabetes management directly to the users devices through analytics.
Nair informs, Last year we launched our global innovation centre in Thane, Mumbai. Our innovation team is currently working on launching our new platform Componium, which is aimed at empowering the entire value chain of Business Software Application IT lifecycle. With this platform, different stakeholders will be able to contribute to enrich the habitat and build newer functionalitiesfor a specific or generic need of businesses.
Vennimalai says, Aavanor is focussing its R&D efforts and we are working on a number of innovations to broad base care delivery, early identification for prevention and supportive care to enhance effectiveness of care plans and the prevention of relapses.

Intervention versus innovation (Regulations and challenges)

The complex healthcare regulatory environment in India gives such impression  that the healthcare professionals need to use most of their time in complying with the healthcare regulations than to their work. However, the industry experts have different opinion on the subject. Varma says, I feel the biggest challenge which would limit the acceptance levels of the Indian healthcare fraternity is the dumping of west-focussed solutions on Indian systems. There are several firms who have developed products and solutionswhile working with Payers and Providers in US, Europe or Singapore and then try to implement the same out of box solution in India without any significant alignment to local requirements. What this ends up doing is increase the skepticism of healthcare professionals, especially clinicians. However, the positive news is that I am seeing firms increasingly becoming aware of Indias unique needs and customising their offerings.

Vijay Simha, Partner,
Vita PathFinders LLP & CEO OneBreath Inc

We need to understand that once we have identified the problem, we also would need innovative solutions to solve those problems thus completing the cycle of care Vijay Simha, Partner,Vita PathFinders LLP & CEO OneBreath Inc

Simha says, The challenges I see would be in the standardisation and interoperability of data structures such as HL7 and DICOM. Until we have the industry formulate and comply with both interoperability and interconnectivity standards; we would be left with fragmented islands of operability. It would also be clinically
very important for the Big Data Analytics to incorporate the sensitivity of data that is generated by a variety of sensor specifications such as sampling frequency, signal processing modes and the sensitivity and specificity of the modality.

Nair says, I think there is still lack of awareness in certain segments of the provider industry about the advantages of IT automation and IT is still not considered as an effective enabler that will improve organisational performance. This lack of knowledge is reflected in the low IT budgets allocated for innovations. There are also instances where IT innovation suffers from lack of support during implementation. These are the challenges that need to be overcome. Simha adds on this by saying, Lack of a watch dog in such an important area is definitely scary. However, this could be a double edged sword. The regulatory system could in many situations become a bottleneck in the innovation process. That is something we could ill afford at this stage. I feel an industry led self-regulatory framework would be a good starting point.

Sumanth Tarigopula, VP, Apps Global
Delivery India, Enterprise Services, HP

The healthcare delivery has been very fragmented and inefficient. The innovation in heart health delivery and diabetes related care through mobile devices will help drive the next generation healthcare model

Tarigopula says, The regulation is kind of mixed. Regulations would help if they could standardise the healthcare transactions similar what had been done in USA through HIPAA regulations which would help standardise the model across the industry. He adds further by saying, In my view, it is not the regulations which are stifling the growth of innovations/ innovative products, but their improper implementation.
where members can be drawn from a cross section of manufacturers, users, Governments, other related watch dog organisations, judiciary and civil society. We already have many of the manufacturers of medical technologies adopting the ISO 13485 quality management system voluntarily. However, it is also important to ensure that there exists a mechanism, such as a website, where adverse events are managed in a more transparent manner. A warning or a recall needs to be broadcast publicly in a definitive way and equipment or devices posing a threat to life should be removed from the shelves and points of use.

 M Vennimalai, CEO,
Aavanor Systems

Many new models of healthcare delivery are being experimented within India to effectively care for a large underserved local population, and to cater to a growing inbound international healthcare tourism market

Vennimalai says, Currently the lack of regulation on accountability and patient safety and the acceptance of paper as a medium of data storage are the biggest issues facing innovation in IT. Not only should it be mandated that IT must be used extensively, there must be a penalty levied on late
adopters of technology who continue to deny patients the benefits of IT. As far as IT is concerned, it is the lack of effective regulation requiring technology adoption, which is restraining the growth of IT in the market.

Seetharam Malur, CEO, IdeaObject Software Pvt Ltd says, Capturing data is critical in healthcare. Unfortunately, the mind set for the value of capturing data and usage of data for analysis to improve upon performance has not yet taken an effective root in the healthcare sector. Making end-users who input the data realise that there is critical need to enter the right data is a primary challenge.

How cost-effective is Indian health IT market
Every investment has a direct link to  the kind of return it can yield. The health IT players are optimistic about the growth of the market and they expect good return too. However, the scenario is slightly different with Indian healthcare fraternity. The fraternity feels, the kind of modern medical equipment they need are little expensive and they are not cost-effective. Varma opines, This depends on what you really mean by cost-effectiveness. I describe it as getting benefits in multiples of the amount spent on implementing the solution. This also depends a lot on the adopter as well. I feel the environment is right for firms like us to think about innovative payment structures as well, such as linked to successful adoption, of a pay-per-click model, depending on the type of solution. As Accenture, we have a very strong culture of what we call value-based-deals where we partner our clients and our payments are linked to actual monetary benefits realised by them.
Tarigopula says, When compared to international market, Indian market players are very fragmented and does not provide enough economy of scale thus resulting in small investments rather end-to-end platform modernisation.

Simha shares, The impact of IT and its role in clinical outcomes is still a concept that needs to mature in the Indian health IT markets. Most health IT products or services focus predominantly on the workflow of a healthcare process and this is understandable, since most professionals who have migrated their technologies from their enterprise planning experience. We have also seen a plethora of activity in areas of personalised medicine integrating physiological monitoring sensors, mobile telephones and offering a backend support service for guidance. Cost effectiveness should not come as a trade-off for efficacy or safety, it probably requires some form
of disruptive technology or design thinking.

Nair says, Indian healthcare services are definitely cost effective, especially in comparison with the other global market players. By combining innovative healthcare technologies, processes and vendor collaborations, we have started filling up the huge healthcare requirements such as reach, convenience and quality care. Vennimalai says, The Indian health IT market offers some of the most cost effective solutions and the pricing of solutions in this market is very low compared to international levels. While many of the Indian ITproviders have not focussed on developing clinical solutions, there are a number of companies offering very effective hospital administrative solutions. Not only are they particularly suited for the Indian market, they are also priced very attractively. To conclude, it would be safe to say that innovation is half done without appropriate ution; these are the two sides of the coin and thus we must as a growing health IT nation pay attention to both innovation and ution.

IT is a great enabler, however it is not itself a solution. IT can help use information better; IT can be just the tool and should not be used as replacement.

The IT initiatives are working in isolation, we should make effort to bridge the gap. Also continued ownership of data is important.

We should keep patient in mind while developing health IT systems. Telemedicine can help the patients to get healthcare at their district hospitals, so that they dont have to come to a tertiary care. In this regard, we can think of linking medical colleges with the district hospitals.

Spending in healthcare should be in a very synergestic manner so that it can bring holistic result. For this public health, health governance and patient care should be linked in achieving good healthcare.

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