When it comes to healthcare service delivery in the country, there is need for improved results – better access, faster diagnosis and treatment, more convenience, affordability and so on. The challenges faced by our Indian healthcare system calls for a radically different approach through innovation. A Vijayasimha, Director and Co-founder of OneBreath, shares his insight with Elets News Networks (ENN) on the adoption of innovation in healthcare service delivery.
Underlying Need for Innovation in Indian healthcare
In India, our healthcare vertical faces a growing need to fix its basic health concerns and has many gaps in our healthcare infrastructure. Likewise, many of the equipments designed in the west or more developed countries are not designed considering these gaps. In India, only a small part of the population has access to quality healthcare, thus, raising issues on the equitability of our fundamental rights.
• Infrastructure: It includes gaps like transportation, availability of infrastructure involving air conditioning, power supply or uninterrupted power supply. The infrastructure issue can be addressed by standardising diagnostic procedures, building rural clinics, and developing streamlined health IT systems, and improving efficiency.
• Second kind of gap is need for knowledge and skilled workers in healthcare sector, especially in the primary care and to a large extent in the secondary care system. We have scarcity of doctors and nurses who are either not equipped or trained adequately to be able to handle advanced equipment optimally or not highly trained to handle different types of equipment processes. Facing this, patients are unable to get quality treatment. Majorly, we lack expertise or knowledge in the healthcare system. The need for skilled medical graduates continues to grow, especially in rural areas which fail to attract new graduates because of finance. A sizeable percentage of the graduates also go abroad to pursue higher studies and employment which is a sort of drawback for the country.
• Rising expenses on treatment: Third and most important gap is rising treatment expenses which is unaffordable for patients that is there or being offered by healthcare system. It is mainly unavailability of affordable services. Besides the rural-urban divide, high expenses are like another key driver of India’s healthcare landscape.
Due to complete dependence on imports of medical technology we end up facing the challenge of the inappropriateness of these technologies and they end up being not used. Many innovators in India have attempted redesigning and developing these products to overcome some of the limitations in resource and infrastructure and stripping away features that require greater skill or knowledge. A few other innovators use the existing building blocks, like lego blocks, to bring in new functionality to overcome the resource gaps such as we see in the telemedicine projects across rural India. These innovations do not majorly disrupt the clinical workflow and provide enhanced outcomes. What could be a third kind of innovation are the new path-breaking ones that challenge existing clinical practices by providing faster, better (with higher sensitivity) and cheaper diagnostic and therapeutic outcomes. This requires deep science, clinical knowledge and multidisciplinary multi-stakeholder partnerships. This kind of invention based innovation is uncommon in our country.
Disruptive innovation could require that we look at very different ways of looking at how and where we provide healthcare and wellness support vis a vis sickcare, for critically ill patients that need hospitaliation and intensive care. Disruptive innovation would bring powerful diagnostic and therapeutic tools into the hands front-line care workers. As an example, in India, it is being observed that prevalence of breast cancer in younger women is on the rise. With the poor performance of mammography, its attended need for a regulated infrastructure and skilled reading, India needs a solution that works in the primary care setting and should be rapid enough to screen the millions at risk.
The major drivers defining the solutions for Indian healthcare
Major drivers are basically based on gaps that are needed to be addressed which are accessibility and affordability.
In terms of accessibility, patients are now able to access some of these technologies through their primary care system i.e. through the PHC. People will be more encouraged to come down to avail such facilities in their local areas rather than travelling long distances. Additionally, treatments in an early stage of disease, will help patient save lakh of rupees.
Hence, major drivers are basically based on the fact that since we do not have accessibility it is leading people to spend lakh of rupees, first. Second, accessibility will drive people to adopt preventive healthcare measures and an adequate awareness about the diseases, that if one come early, treated early, will help them save time, long treatment processes and save money.
Having said that, the key drivers affordability and accessibility are needed to be kept in mind while designing medical devices, equipment or infrastructure.
Interestingly, government has been taking certain steps to create affordable healthcare services for the last mile. Based on the fundamental rights, the government is responsible for providing screening to patients in time to prevent diseases at an early stage which leads treatment to be done in much lower costs. On the regulatory side, the Indian government plays an important role in running health insurance plans for high-risk diseases.
Innovations into the routine clinical practice
Disruptive innovations developed in the emerging economies have the potential for being adopted globally and used by the more developed countries. This was termed “reverse innovation”. This term is at most a short sighted expression of utility of the product. There are plethora of innovations that have moved from an emerging country innovation into the the developed economies. However, its still young days for India.
“Disruptive innovation creates greater access by moving the service proximal to the population. However, the challenges in purpose of the primary care which is prevention and management of disease versus the goal of intervening and curing the disease requires the recognition that a single technology cannot perform both these functions optimally.”
On Changing Paradigms
Preventive and promotive healthcare and sickcare represented by their different goals need their own unique gold standards of measure, almost to the point that may use completely different biomarkers and scores. The gold standard test usually refers to a diagnostic test or benchmark that is the best available under reasonable conditions. Other times, gold standard is used to refer to the most accurate test possible without restrictions. Developing a new gold standard of practice must anchor its references to absolute standards and this would need
• An extensive clinical evaluation of the technology in the country where the study is being carried out. This addresses the clinicians need to gain confidence the device being safe and reliable.
• technology adoption can happen only if doctors are re-trained, and they can start practicing the same to produce best results for their patients. Even students who are looking forward for their careers in healthcare can be educated about the new technology.
• Lastly, the medical device sector is one of the growing sectors in the country but number of regulatory challenges has prevented its growth and development. According to reports, the medical devices sector is seen as the most promising area and will play major role in development of healthcare.
IT integration in healthcare
IT is a tool and which works according to available information. Although, it has made things communicable between patients and doctors in much easier way. But, another area of technology is artificial intelligence which will play as major catalyst of change in healthcare.
In terms of healthcare and medicine, artificial intelligence could organize patient routes or treatment plans better, and also provide physicians with literally all the information they need to make a good decision.