Bejon Misra, Founder & Director, PSM India Initiative

In my perception, the smart city concept should provide the following with respect to healthcare:

Emergency service like ambulances should reach all patients within maximum 5 minutes after making a call on a three digit toll-free helpline like 108 or SMS service with a call back facility. The ambulance must arrive with a doctor and provide care at the called location, then neither further process time nor burdening of the care centres or hospitals is required. In case further action is required, then the patient should be shifted to an appropriate hospital for emergency care provided free of cost or based on an insurance cover. All such expenses need to be FREE for the poor and senior citizens. Smart city must have a dedicated lane for prompt passage of ambulance, fire brigade and emergency healthcare related cases and any person not adopting lane driving should be heavily penalised or legal prosecution initiated on a fast track mode. Healthcare treatment should be subsidised for the poor and not a single citizen should be made to create a debt or sell assets to access quality healthcare. We must increase the healthcare budget of our Government from 1 per cent to at least 5 per cent of the gross domestic product (GDP) from 2017.

We must have health records of all the citizens since birth on one single portal similar to Aadhar. We must also have a robust tracing and tracking system for all medicines sold in India to ensure the rational use of medicines, especially antibiotics and prescription drug abuse, which are addictive in nature. We must train all medical practitioners to start using e-prescription and all the records of healthcare should be properly monitored by the Government to ensure safety and quality to the patients. E-pharmacies with proper regulations must be implemented immediately and healthcare should reach the doorsteps of the patients, especially senior citizens. Telemedicine in India has been a flop show, which is only due to poor connectivity of broadband facilities and lack of trained manpower. India is the worlds software centre, but we Indians are denied the benefits of such discoveries in our own country. Healthcare services in India have to be patient centric and technology enabled to ensure userfriendly systems are made accessible and there is universal health coverage without compromising on the safety and quality of the healthcare delivery system.

Dr Rajendra Patankar,Chief Operating Officer, Nanavati Super Speciality Hospital, Mumbai

The Indian healthcare industry is projected to grow to a staggering USD 280 billion by 2020. An ageing population with increasing lifespans, growth in income standards owing to better paying jobs, advancing economic prospects and a shift in disease pattern veering towards lifestyle diseases has made it imperative for policy-makers and stakeholders in the domestic health market to conceptualise new age disease monitoring standards and modern treatment protocols. With a shift from a predominantly provider market to a user (patient) dominated market, the dynamics of the healthcare business has changed. Earlier, patients were largely dependent on doctors and healthcare professionals for prognosis of their medical conditions. With the advent of information tools like Google, patients have starting going online to seek health information from online portals. Medical blogs and patient communities have also proliferated on the net, which offer real-time medical advice and have made people aware of diverse treatment methodologies. With technological innovations and digital connectivity bringing paradigm changes in the patient-doctor interface, it is estimated that on a global level, around 70 per cent of healthcare entities will expend substantial investments in health mobile applications, remote health monitoring devices and virtual diagnostic platforms in the next 2 years. A huge demand is foreseen for data-driven digital health start-ups with an emphasis on big data and analytics. A large number of corporate employees are being incentivised by organisations to maintain accurate checks on their health through the increased use of latest technological inputs like medical wearables and apps, which can be freely downloaded on mobile phones. Wider accessibility and easy adaptability are the buzzwords in the new technological revolution in the medical space. Telehealth and mobile health initiatives are proving to be the key triggers for pharma players and device manufacturers to invest in data tracking devices. With the provision of reimbursement by insurers and cost reduction, these devices are acquiring a huge clinical utility in monitoring the patients health and treatment progress. Health players in the private and public space are increasingly using health data of patients for tracking their progress in the postdischarge stage and reducing the chances of disease relapse. Clinical research organisations (CROs) and pharma companies will bring innovations in research and accuracy in clinical trials through effective monitoring of data. Data is also increasingly utilised by companies to create incentive structures revolving around increased physical activity and healthy living.

By 2025, around 58 per cent of the global population will be living in urban areas. A blueprint for the development of 100 smart cities has been prepared by the central government. Smart healthcare systems largely determined by the convergence of technologies, innovative clinical practices, state-of-the-art facilities and advanced health standards will be a defining element of the modern Smart City programme envisioned by the government. With the smart cities concept gaining ground, cross device connectivity is slated to achieve the next level progress, with an emphasis on remote patient monitoring. Internet of things (IoT) is also rapidly bringing healthcare within its gamut and rapidly advancing communication technologies are resulting in healthcare services becoming more accessible and innovative. The success of the smart city programme will also largely depend on the ability of doctors to leverage the effectiveness of health monitoring devices for initiating diagnostic care, undertaking preventive measures and tracking the results of treatments administered. The smart city model would also enable residents to receive periodical alerts for health check-ups and taking medicines through advanced technological inputs. Electronic medical health record (EMHR) is an effective mechanism that can be used for setting up notifications at periodic intervals concerning medications of patients or medical test schedules and appointments. For the smart city initiative to become a resounding success, there should be large-scale emphasis on the deployment of processes, such as cloud computing and advanced data analytics. Synergistic collaboration between diverse platforms, such as Cloud and IoT, will form the essential base of a successful smart city ecosystem. Optimum utilisation of modern technological models, when viewed in a smart city context, will prove largely effective in scaling down operational costs and bringing in much-needed automation in disbursal of services. With enhanced quality and improved delivery services in the healthcare sector, smart care has the potential to become a key trigger in driving the success of the smart city programme.

Aditya Gupta, Director, Neurosurgery, Artemis Hospital, Gurgaon

As a healthcare stakeholder, I recommend the following key measures:

Planned access roads into the city and also within it to allow fast access to healthcare facilities, given the state of traffic today.

World-class energy & civil infrastructure for healthcare facilities to enable them to be operational 24×7 and being green facilities at the same time.

Separation of primary, secondary and tertiary care facilities to enable unnecessary clogging up.

A well-planned network and emergency response system for citizens, including medical evacuation.

A public-private partnership structure to use the advantages of both the systems and for the spill over to be taken care of by the either stream.

Integration of preventive healthcare aspects into education and retail for wider penetration and propagation. The key advancements happening are:

Smart sensors linked to widespread devices, such as mobile phones and other devices, for early warning for critical ailments.

Appointment scheduling and medical data transfer using smartphones.

Electronic second opinions and opinions from super specialists.

Expert systems for prediction of risks of having a particular disease, its severity and outcome.

Genetic tests being used for determining outcome and prognosis

Quicker & faster imaging modalities with easier data portability.

Expanding repertoire of ability to image function of various organs.