Technology convergence in healthcare will play a key role in improving accessibility and meeting the challenges of infrastructure and manpower shortage. With greater deployment of tools, such as telemedicine, teleradiology, Hospital Information Systems (HIS)/Hospital Management Information Systems (HMIS), and Online or Electronic Medical Records (EMR) gradually finding their ground in the country and more expected in the times to come, tech transformation will engulf the healthcare sector. Technology-enabled care (TEC) in the healthcare domain, using cloud computing and wireless technologies, will enable easy accessibility irrespective of geographical location, fewer errors, quick response in times of emergencies and patient convenience among others. Romiya Das of Elets News Network (ENN) discovers the reach of tech-enabled healthcare in 2015 and the road ahead

Preventive, patient-centric and reaching out to the masses Year 2015 saw technology enabling healthcare with a aim to achieve a wider and deeper presence in the country. The technology enabled care (TEC) telecare, telehealth, telemedicine, mHealth, digital health and eHealth services have and will be driving the healthcare domain in the times to come. The healthcare industry involuntarily stepped into digital space with the introduction of the term Health 2.0 in the early 2000s.

And almost two decades down the line, digital space is redefining the patient-doctor connect with ventures like Doctor Insta Pvt Ltd, which provides healthcare consultation through video conferencing, receiving pre-Series A funding of US$ 500,000 (`3.31 crore) from angel investor Rishi Parti and BrahmaX Ventures, a US-based venture capital firm. The company, which launched its services early in 2015, is also planning to raise an additional funding of up to US$2 million (`13.26 crore). Riding high on the increasing spent in the segment, the healthcare sector is expected to reach the market size of US$ 280 billion by 2020 at CAGR of 16 per cent, predicts an FICCI-KPMG report.

Apart from technological advancements in the fields of research, surgery, diagnostics and treatment, the IT revolution has also changed the way our hospitals and clinics function. Computerisation of records, diagnostic results, faster sharing of reports, the possibility of sharing case studies and seeking advice from doctors in distant countries through email have made healthcare reach out to the masses. Mobile apps and the startup ecosystem too have helped the market to expand.

Startups Pushing the Market

In 2014, nearly 7,500 startups across the globe looked to develop digital solutions in the healthcare domain, while year 2015 saw around 300 startups focused in the health domain itself. On one end where Indian startup companies are working to bring medical practitioners and patients closer using technology, governments Digital India initiative and the startup revolution is bringing game-changing products and software that have dominated the Indian healthcare IT industry. The software and the product driven industry registered a double digit growth (12-14%) in financial year 2015- 16. ICT has spawned new platforms for vendors offering more products, cloud based services, tech geeks and young entrepreneurs by developing a host of apps for enterprises and diverse industry verticals.

The Digital India initiative will not only benefit the established players but also the startups across the country as the programme envisages investments of `4.5 lakh crore (US$ 68 billion) over the next decade. With ICT connecting devices and people, the industry players are investing substantially in developing new platforms and hiring more tech geeks to serve their clients in India and across the globe. The industry is expected to add US$ 20 billion in 2016 to the exisiting revenues of US$ 146 billion in the year 2015. The new wave of healthcare startups, a blueprint for technology enabled, personalised, participatory, and preventive medicine is required to drive the transformation in healthcare delivery.

With time, more healthcare providers will be advocating, participating, and driving innovation co-creation to accelerate the flow of ideas and advances in healthcare delivery. The healthcare startup companies are using technology to bridge the supply-demand gap in this sector. The Indian startup sector focuses on healthcare discovery platform connecting patients to hospitals and doctors helping them to book appointments such as Practo and CrediHealth.com; medical equipment and diagnostics where companies use technology to simplify diagnostic procedures such as Perfint Technologies, and Biosense Technologies; startups focusing on specialty care such as MyDentist, and Vasan Eye Care Hospitals; digitising and tracking platforms integrating patient medical records and putting them at one place such as Practo Ray, and eKincare; ecommerce websites that help people to order medicines online or healthcare equipment online such as HealthKart, Medidart and Medist.

Industry Outlook

The Indian Healthcare IT market is reported to grow at a CAGR of 14.02 per cent over 2014-2019, as reported by Research and Markets. The market is categorised into three segments hardware, software and IT services. DELL, HCL, HP, TCS and Wipro are among the key vendors in the Indian market. Healthcare industry is striving to address the triple aim of improving the quality of care, enhancing the patient experience and reducing cost. It is focused at making quality care affordable to patients wherein connected health is a new model: a mix of technology and information, to enable patients and clinicians to make better decisions. A cumulative data collated through multiple initiatives of telemedicine, telehealth, telecare, digital health devices, mHealth, eHealth and remote-monitoring solutions, provides access to the verifiable, real-time patient-generated data enabling physicians to plan progressive care and avoid negative health events to keep patients healthy even when out of the clinical facilities, says Shakthi Nagappan, CEO, BioAsia.

Startup Push

• Practo and CrediHealth. com – connecting patients to hospitals and doctors to book appointments
• Perfint Technologies, Biosense Technologies – medical equipment and diagnostics where companies use technology to simplify diagnostic procedures
• My Dentist, Vasan Eye Care Hospitals – startups focusing on specialty care
• Practo Ray, eKincare – Digitising and tracking platforms integrating patient medical records and putting them at one place
• HealthKart, Medidart and Medist – ecommerce websites that help people order medicines online or healthcare equipment online

The Gartner study predicts an expenditure of US$ 1.2 billion on IT products and services by Indian healthcare providers (such as hospitals) in 2015, which is a seven per cent rise from 2014. This includes expenditure by healthcare providers (including hospitals, ambulatory service and physician practices) on internal services, software, IT services, data centre, devices and telecom services. The vertical specific software (VSS), which includes hospital information system, electronic health records, health information management, patient financial management etc., is expected to grow six per cent in 2015 to reach US$ 28 million.

Rajiv Nath, Forum Coordinator, Association of Indian Medical Device Industry (AIMED) says, In medical devices, innovations are incremental and are patentable. But, there is no IP protection and we are recommending that government should introduce it, particularly in a utility model. The Government of India can carry out a study to see that the medical devices, which are innovative and useful in public healthcare, are cost effective and yeild quality result.

Looking from a global perspective, markets and markets research predicts that the healthcare IT market globally is poised to reach US$ 228.7 billion by 2020, growing at a CAGR of 13.4 percent during 2015 2020. Here, the market growth can be attributed to the growing need to adhere to regulatory guidelines, government initiatives for eHealth, high return on investment, and rising needs to curtail escalating healthcare costs.

North America is accounted to be the largest regional segment of the global healthcare IT market and is accounted for the maximum share of 45.5 per cent in 2014 followed by Europe, Asia-Pacific, Latin America, Middle-East and Africa. The growth in the largest regional segment is attributed to the stringent legislative and accreditation requirements regarding healthcare, the high adoption rate of HCIT (for reducing high healthcare costs), regulatory requirements regarding patient safety, and the presence of a large number of IT companies.

Some of the major global players like McKesson Corporation (US), Allscripts Healthcare Solutions, Inc. (US), Athenahealth, Inc. (US), Epic Systems Corporation (US), GE Healthcare (UK), Siemens Healthcare (Germany), Cerner Corporation (US), and Carestream Health (US). Globally, cloud, analytics and open source technologies are now playing a major role in transforming the way healthcare is delivered.

Smart Technology

The rapidly transforming medical technology, change in practice pattern of the doctors, and availability of state of- the-art diagnostic and therapeutic equipment has revolutionised the present healthcare delivery. IT has simplified the services with error free data registration starting from patient registration till he/she is healed.

Technology has eliminated handwritten entries and tags helping to remove duplication and ensuring smooth, seamless flow of qualitative information. The modern technologies have enabled the digitisation of health records and accessibility of healthcare to the remotest areas along with making healthcare delivery a seamless task. The recent collaboration between All India Institute of Medical Sciences (AIIMS) and Tata Consultancy Services (TCS) has culminated in a transformed, patient-friendly outpatient department (OPD) process. As a part of the much-needed change, TCS introduced a new technology and streamlined processes that will benefit more than three million patients visiting 21 OPDs in the main hospital each year.

IT has revolutionalised the way doctors and patients interact. Leveraging IT products and services, the doctors will have the detailed information about the patients health, along with the appropriate treatment required. Many hospitals have come up with various innovative ways to use technological support to enhance personalised patient-care. Hospitals have come up with unique identification cards that enable the doctors to keep a track of the medical records of their patients. It also helps the patients to present their medical records when seeking a second opinion.

Today, many doctors advise patients, especially elderly ones, who require regular consultation, to avoid regular visits and stay in touch with them through WhatsApp or email. Doctors are also advising drugs to customers via mobile apps and gadgets, reducing costs of travel and visit charges. Further, electronic records offer many advantages over the conventional paper-based methods of recording patient data. These help in reducing costs, and minimizing human error while improving the efficiency standards. These electronic records can also be equipped with authentication systems and act as a major deterrent against security breaches, says Dr Dharminder Nagar, MD & CEO, Paras Hospital.

Mobile Health

India will overtake the US as the second largest market for Smartphone by 2016 as smart mobile devices are becoming affordable, according to a global research firm eMarketer. This further implies a critical mass that signifies an immense opportunity for the healthcare sector to leverage the mobile-based tools to provide better care delivery. Mobile connectivity and infrastructure is not only driving the market but is also providing solutions to the industry, especially in chronic disease management. There are various mobile health applications and services platforms providing solutions both to the doctors and the patients. These services include clinical decision support, remote patient monitoring, maintaining patients healthcare records, analysing future diseases, treatments and prescriptions etc.

IT is playing a leading role in the hospitals state-of-the-art operation theatres, blood bank services, laboratory and radiology services. The intensive care units of the hospital are equipped with excellent digital monitoring systems and electronic records which are highly beneficial for patients. IT-enabled diagnostic services have reduced time of report sharing and has enabled centralised record keeping which allows multiple departments to share diagnostic results of patients.

In developing countries, such as India, mobile technologies have impacted the consumers in a big way by extending their reach to the remotest locations. There are many healthcare apps catering to various healthcare needs calling ambulance under 108 Emergency Response Service, medical consultation, app for diabetes patients, managing blood pressure through Smartphone, mobile clinic to treat the economically weaker section, app for cardiac arrest victims, to book appointment with doctors, to find doctors, reading healthcare articles, apps for doctors discussing cases and many more. With the increasing rollout of 3G and 4G along with fibre to support opens up the possibilities using mobiles and internet to address healthcare challenges. Video calling and high speed data transfer with 3G network support can help in telemedicine services, while 4G network would enable superior picture quality with reduced image distortions in the video calls and quicker data transfer.

Connecting the Unreached

Healthcare in rural India is still awaiting improvement as the doctors refrain from serving there due to nonavailability of proper infrastructure. Telemedicine is acting as a bridge between the urban and the rural gap. This advancement has allowed the doctors to perform medical diagnosis, consultations, procedures, surgeries and treatments while staying miles away from their patients. The potential benefits of telemedicine include reduction of medical costs, expanded access to quality healthcare, and increased specialty knowledge amongst medical professionals.

With four major scopes of opportunity tele-consultation, tele-monitoring, tele-education, and tele-surgery the growth opportunities are immense. In rural areas, where affording a smart device is not feasible, innovative diagnostic virtual health programmes provide technology services at a nominal fee. Such services have given a boost to the telemedicine effort to connect doctors from urban areas to remote villages through video conferencing. With the access to ICT, people are getting useful health information from the internet and improving their quality of life.

The Game Changer

Technology adoption of cloud is transforming the healthcare domain and expanding its reach. In one of the recent initiatives, eClinicalWorks, a USbased firm in healthcare IT solutions, announced a $30 million investment to further digital healthcare in Asia, specifically India and additional countries in the region. This investment will develop talent and cloud-based technology infrastructure, coinciding with the Digital India initiative aimed at ensuring various services, including healthcare-related ones.

The cloud computing technologys potential is helping the healthcare IT infrastructure to adapt and transform into flexible and efficient platforms.

Cloud computing provides infrastructure allowing hospitals, medical practices, insurance companies and research facilities to tap improved computing resources at low capital outlays in initial levels. The healthcare cloud infrastructure will lower the barriers for innovation and modernaisation of HIT systems and applications. Of course, technology brings more accurate diagnostics, digital images, digital diagnostics are far more specific but I think the key element that we kept missing out is affordability aspect and we need to make technology more affordable, says Indira Behara, Senior Manager, Strategies, Global Health Strategies Emerging Economies Pvt Ltd.

Hospitals and physicians have started having access to cloud based medical records and medical image archiving services. The objective is to lessen the burdensome task from the IT departments of the hospitals and allow them to focus on supporting imperatives such as adoption ofEMR and improving clinical support system. And with the sector gravitating slowly towards private cloud, the avenues seem endless.

Roadblocks

While the advantages of technology enabled healthcare are manifold, challenges including accessibility, infrastructure and quality also exist. A lot still needs to be developed in the segment of Healthcare IT. Breach of information security and the inability to trust healthcare service provider with chances of a patients health information remaining private through electronic records being negligible are some of the potential technological drawbacks that exist.

Further, in adoption of IT, healthcare providers have to face several problems while designing and implementing healthcare management systems as there are no standard systems in place. Most of the hospitals focus on care delivery with a low investment in IT. There has been reluctance of medical, nursing and other staff in adjusting to the change and apprehending the technological failures, as some still see the paper system to be more reliable.

While the above challenges do exist, technology-enabled healthcare solutions and disruptive technologies will definitely show the way to improve patient care in the times to come.

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