Dr Adheet S Gogate, Partner & Head, Philips Healthcare Transformation Services, India, discusses the digitisation of hospital information system becoming more patient-centric to deliver better care services, in conversation with Romiya Das of Elets News Network (ENN)
How do you see the Healthcare infrastructure market in India vis-a-vis global market?
India’s healthcare infrastructure development market is more or less similar to those in mid-sized economies. Driven by factors such as rising standards, expectation of better ambiences in the enduser spaces, it is also constrained by patchy construction quality, questionable labour quality and productivity, poor fits and finishes, high variability across cities and locations, regulatory uncertainty. Few other challenges come in the form of disproportionately, high property prices, especially, in the strategic locations that are important for hospitals. With complex regulations, healthcare infrastructure development is more challenging, costly and risky than it needs to be.
Please throw some light on Philips contribution in enhancing healthcare infrastructure?
Philips recognises that the world of healthcare that we are entering is fundamentally different from the world that we have lived in. Earlier healthcare was paternalistic, physician centred and with poor data management. Tomorrow’s healthcare is going to be patientcentric, empowered and comprising rich data. The change is happening at varying paces, but its direction is undeniable and will deeply transform how care is provided, for instance, earlier to get registered as a patient in a hospital required them to visit multiple counters, to make a card, to plan insurance, to make payments, to get an appointment and so on. This process represented how hospitals are organised in their department of records, management, cashier, booking clerk etc.
However, it is not about how the patient wants the healthcare. We at HTS are working with hospitals redefining their experience easing the patient’s comfortability by regular interaction with their care providers. We work with both new hospitals and older ones looking to transform their systems. For instance, we are working with one 50-year-old hospital helping them thoroughly revamp their infrastructure. Some of our recommendations were seen as radical in reducing beds and increasing intensive care and theatres. Our rationale was simple, in the future, admission to hospital will increasingly happen purely for interventions or surgeries, and not for basic medical c o n d i t i o n s . Hence, the entire space allocation needs to be changed to enable more intervention, more critical care and less old fashioned ‘lying in’.
For example, hospitals then had beds assigned by departments in some wards, you had only surgery patients; in others only ENT patients and so on. But this is inefficient as one department may be empty and another may be full, turning away patients. In our estimation, running inpatient beds enables more efficient usage of capital and scarce talent – something that has significant impact on reducing prices. These require new mind-sets, processes, infrastructure and resources.
In other areas, we are working with our customers to bring technology to patients that enable them to diagnose illnesses faster or manage their own chronic diseases most efficiently. A decade ago, managing diabetes meant testing your blood sugar every month. At present, one can not only measure it daily, but you can upload it to the cloud. One can correlate this data with when medications were taken, caloric information of food, tracking of movement and exercise, monitoring of ECG’s and scores of other data, to give a rich picture of overall wellness and illness. In this environment, patients, with help from their devices and caregivers, will have tremendous visibility into managing their illness far better than they ever have in the hanging.
Working with doctors and patients to make this happen is what we are focusing on. The goal is to improve overall system outcomes which are the core of transformation.
What are the policies or regulations required to build a robust healthcare infrastructure?
This is quite a complex subject, but we need to change our mindset quite fundamentally.
We need to shift our focus from infrastructure to outcomes. I say that because having infrastructure may be necessary, but it is not sufficient. Going forward, the nature of infrastructure required may itself need a change. We may no longer need so many PHC’s for instance, if we have effective telephonic primary care, we may need better telephony bandwidth, reliable power and drug availability. In such an environment, should we really be obsessed about how many PHC’s we have? At the highest levels, our overall policy must be directed towards ensuring better outcomes – what that means in terms of infrastructure is transient and keeps changing. We need to stay abreast of trends and technologies.
How helpful do you think is the adoption of PPP model to improve healthcare infrastructure?
Basically, a good Public-Private- Partnership (PPP) model is one that combines the strengths of the public sector (usually legal standing, trust, ability to deploy resources) and for those of private enterprises (innovation, efficiency, performance orientation, focus on financial sustainability & profitability, competition) to deliver a service that would not have been possible by either type of agency on its own. If the PPP developing agency has established a good understanding of a healthcare problem and its root causes and has determined that a mix of private and public skills are essential, then you are off to a good start. The key to success is to make sure that both parties are incentivised and accountable for clear goals – and that these goals are critical to overall success.
A good PPP model is one that combines the strengths of the public sector and for those of private enterprises to deliver a service that would not have been possible by either type of agency on its own
We have several good PPP’s in India. Ambulance service such as 108 is commendable example where PPP’s can work well, get the public sector to pay for it and have competing private agencies run it efficiently, professionally and to continually improving standards.
We are already working with governments to bring the PPP idea into diagnostic imaging. There are opportunities in poor areas where imaging being expensive, private players cannot achieve sustainable financial results. To close this gap, we have designed and developed a PPP model by which private clinicians and technology providers can deliver these services to the poor as a contracted government service provider.
How do you see the health technology evolving in the coming years?
At present, the technology operates in silos and provides pieces of diagnostic information or therapy. In the near future, informatics and digital technology systems will stick together. Patient data will go from being a jigsaw to a composite picture. This ‘full picture’ will have dramatic impact on patient care.
To emerge ahead in the healthcare landscape by 2020, care providers have to move beyond traditional care and get onto a ‘patient centric care’ delivery model. Please elaborate.
As mentioned above, with so much information, insight and planning, patients will be far more knowledgeable of their disease than ever before. They will also own their data. Earlier, patients could not even interpret the most basic results such as diabetes. But all this is now transforming.
For chronic diseases, it will be a game changer. It will have deep implications, even the role of surgeries and interventions for maintaining health will change