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The Net of Healthcare

Healthcare

[This article was published in the June 2011 issue of the eHEALTH Magazine (https://www.ehealthonline.org) ] By allowing doctors to have immediate access to the patient


By allowing doctors to have immediate access to the patient’s medical record, online healthcare services can become a new conduit for exchange of health information

By Dhirendra Pratap Singh

While the internet has been considered to be a rapid and valuable source of information to a majority of the world’s population, advancements in mobile communication have made the world smaller with the advent of wireless technologies. The convergence of wireless communication, wireless sensor networks and other ICT based technologies could impact healthcare options to a larger extent amongst other industries and reshape the scenario as a whole.

The healthcare industry by itself has seen a transition from the traditional paper based records to electronic records. Now, another revolution in this field has been the incorporation of wireless technology.  The increasing cost to plug in wired devices has paved way for the usage of wireless technologies in several hospitals. There has been a need to get fast information due to the number of healthcare regulations in place, ever escalating healthcare costs and the rise in technology savvy patients. In rural areas, there is shortage of healthcare infrastructure, which has raised an enormous amount of concern in the recent past. Considering all these factors, it has become pertinent for the healthcare industry to consider incorporating ICT in order to have a better tomorrow and survive the challenges of today.

Health services through internet

Services offered by online health portals range from creating and maintaining personal health records to selling health insurance policies—the list of services is unlimited. The sheer convenience of such services is one of the major factors leading to the rising popularity of online healthcare in India. There has been a gradual change in mindset as even traditional healthcare providers are now moving towards offering services through the internet. The use of online healthcare can make communication more effective and efficient, ease diagnosis and help achieve a higher quality of patient care.

Online healthcare is in its infancy stages in India and looks to be promising future option to cater to the primary healthcare needs of urban and rural India. This form of healthcare delivery is not a replacement to the conventional method but will compliment it in a big way. India’s advantage in this space is advancements in technology, growing phone and online user base, affordable resources, and global image and demand. With growing occupational health issues in urban population, growing 50 plus population and healthcare supply issues in rural areas, eHealth can play a big role in the government’s vision of access to quality healthcare for all. While this is going to be the next big revolution in healthcare delivery, there are challenges like regulatory changes required in India enabling this form of healthcare delivery to be as efficient as the conventional method.

We have seen how online services have revolutionised delivery of services in communication, banking, trading and transport industry, which again cater to a vast population. Healthcare too needs to adopt best practices from other industries. Access to medical records at a single click for consultants, as well as patients helps deliver quality care and avoid medication errors by quickly reviewing past medical history. The end goal of the healthcare ecosystem in India, to adopt online healthcare services, should be focused on providing benefits to the citizens at a transactional level and easy availability of personal healthcare information in a high secured way.


Online healthcare is in its infancy stages in India and looks to be promising future option to cater to the primary healthcare needs of urban and rural India. This form of healthcare delivery is not a replacement to the conventional method but will compliment it in a big way

Technology trends With the increasing aging population and healthcare requirements in rural areas, technological advancements have led to the development of databases that provide ready to use healthcare information. These databases provide information on pivotal clinical studies, development in disease management to the physicians while few others provide A-Z information regarding diseases, health and drugs to patients. Examples of these include WebMD and Epocrates Rx. Telemetry: This refers to the use of a wireless technology that is used to monitor patients with the use of radio waves. However, the usage of this technology has some guidelines in order to prevent the interference of other radio waves with telemetry signals as this can be hazardous to the life of the patient. A recent development in the area of wireless patient monitoring has been the introduction of the GE CARESCAPE Telemetry Platform that is capable of simultaneously leveraging and coordinating cell phone, Wi-Fi and other wireless technologies on a single platform.Bluetooth: These are user-friendly networks for communicating through cellular phones, PCs and personal digital assistants and falls under the wireless personal area network (WPAN). This technology is low-priced, consumes lesser power and is all set to replace the currently existing forms of wired connectivity.

WiFi: Wireless fidelity (WiFi) is yet another revolutionary technology that has been in use to boost efficiency and enhance care in hospitals. These wireless networks provide secure infrastructure and flexible access than wired solutions.

RFID: Radio Frequency Identification (RFID) is an enabling technology that uses radio frequency waves to monitor tagged objects and personnel. The principal components of the system include the RFID tags and the reader apart from the software that is being used. RFID has been used both in pharmaceutical industries and hospitals. RFID covers a wide array of applications in healthcare ranging from tracking medical devices such as pacemakers and defibrillators to monitoring patient safety and quality assurance applications.


Dr SB Bhattacharyya

President, IAMI and Head – Health Informatics, Tata Consultancy Services
Online Healthcare is a rapidly emerging segment in the healthcare delivery process propelled greatly by mHealth. It is bound to radically transform the way healthcare services are provided by both individual and institutional care providers and paid for by the payers while permitting the state to regulate it all in real-time. With patients able to exchange health-related information with their providers instantly irrespective of their physical location, compliance with treatment protocol requirements and increased adherence to wellness-requirements are expected to accrue. Better care can be provided as errors of omission and commission are minimised while maximising efficiency and productivity. 

Software Applications: Software applications are an integral part of the hospital environment that can assist the healthcare providers with their point of care applications.

Palm OS: This typically represents an operating system that has a touch screen graphical user interface. The wide range of applications in the system along with ease of use and lower memory requirements has been considerably gaining importance across the healthcare industry over the past few years.

Pocket PCs: Microsoft first developed an operating system for hand-held devices which was very similar to the well known Windows version. This was known as Windows CE. However, these require larger storage capacities when compared to Palm OS and hence are less preferred as opposed to the easy to use Palm systems in healthcare.

Laptops: These are similar to the desktop PCs in terms of functions and appearance. However, these are easily transportable in a hospital environment and if connected with a WLAN, can enhance functionalities in both administrative and patient care environments.

Tablet PCs: This is a relatively newer development and carries the same function as a laptop but is equipped with a touch screen and a pen based capability. This enables the user to directly write prescriptions instead of the more tedious process of printing the entire document and later writing on it. Microsoft again has been a major provider of tablet PCs.

Nitin Mathur
Business Head, Health PA
Healthcare has for long been one of the most searched subjects online. However, online healthcare was limited to users scanning content on medical conditions. The last couple of years in India have seen the emergence of new and innovative ventures, with strong local content and services, ranging from doctor-on-call services, online diet planning, ‘Find a hospital and doctor’ services, sales of discounted diagnostic packages etc. However, the industry is still in its infancy, as businesses are figuring out what really works online, India being a large but unique healthcare market. Ventures and services that confer higher convenience (assist in finding a doctor or hospital) or a cost advantage (example- finding cheap diagnostic packages) will be the ones that prevail, judging by how other industries in the online space in India have evolved.

Rising costs

A rising concern across public healthcare systems and healthcare insurers is the rising costs of delivering care to patients. With the ever escalating treatment and therapy costs, it is indeed favourable for the industry and hospitals to adapt to mobile and online means of patient care.

A considerable amount of investment in pharmaceutical industries goes into drug discovery and development. Although several drugs are being developed, only a few get into the market while others still remain at the research and development phase. Implementing wireless applications into these stages of clinical R&D could significantly reduce time up to 30 percent whilst also saving costs.

Realising the benefits of wireless technologies, several healthcare providers are resorting to using electronic medical records (EMR) and electronic health records (EHR). The e-prescription and EMR markets are estimated to reach US $166.7 million in 2013, says Frost and Sullivan.

Wireless and online technologies considerably reduce burden on nurses and therapists. Technologies such as PDAs (Personal Digital Assistant), smart phones and Ultra-Mobile PC (UMPC) can also aid in patient-centric healthcare by providing details of patients including clinical histories, lab reports, ongoing and past treatments and so on.



Poor medical infrastructure
There are not enough hospitals, doctors, nurses and para-medical staff in the country to meet the growing healthcare needs of the people. India can absorb one lakh doctors per year and we only produce 18,000. Poor healthcare could severely impact economic growth. India needs 7,415 community health centres per 100,000 population. We have less than half the number. Worse, at the healthcare facilities we do have, the basic staff is not in place. Only 38 percent of our primary health centres have all the required medical personnel.In the 3,043 CHCs that we do have, only 440 have a pediatrician, only 704 have a physician, only 780 have a gynaecologist and 781 a surgeon. So not only is the infrastructure inadequate, we don’t even have the staff to use the existing infrastructure. We need 76,622 midwife nurses (one per PHC and seven per CHC). We have planned only for 44,143 and only 27,336 — barely half the requirement — are in place. Thus, the Indian healthcare sector is suffering from an acute shortage of healthcare professionals and facilities delivering quality healthcare services to the citizens.According to the NCAER, in nearly 20 percent of cases rural households travelled more than 10 km for treatment. In Meghalaya, in 54.56 percent of rural illness cases and in Orissa in 33.47 percent of rural illness cases, patients travelled more than 10 km. Even when patients do get to the health centre there is no guarantee that the staff will be present. According to a survey by the Jan Swasthya Abhiyan, only 38 percent of all PHCs have all the critical staff. A survey by the International Institute of Population Sciences found that only 69 percent of PHCs have at least one bed, and only 20 percent have a telephone.Opportunities

Asia Pacific has been characterised as a region that has significantly low quality healthcare when compared to the western world. There are opportunities galore for online and mobile healthcare due to the deprivation of quality health to those in the underprivileged areas.

The introduction of web cameras and internet in rural areas along with other mobile technologies can aid in extending health services in these areas. Another area would be to improve healthcare surveillance in rural areas. With the advent of mobile technology in the rural areas, efforts can be taken to provide real-time monitoring of health related issues. SMS alerts can be used to target people in areas where clinics and healthcare workers are limited.
Last year, Bihar State Government has announced to give free mobile phone services to its doctors in an attempt to reduce truancy. Many government doctors neglect their official duties by practising privately on the side. The main purpose of the move is to be able to get in touch with the doctors at any time. Their movements will also be tracked by a system. Similarly, for the first time in India, a mobile phone doctor-to-patient service called ‘Doctor on Call’ was launched. The 9 to 9 service that provides live interaction was pioneered by BPL Mobile, Mumbai’s leading mobile service.

Data collection is yet another area that is of vital importance in healthcare. Data collection programs can be offered through smart phones, mobile phones and PDAs than manual entry which can contribute to bridging the gap that exists in the current scenario. Implementation of remote monitoring applications can improve the outcome of various chronic diseases whilst also opening newer avenues of treating patients in an outpatient setting.

Usage of mobile phones can be helpful in improving communication amongst the healthcare providers to enhance patient care. This can also be used to monitor the incidence and outbreak of infectious diseases. The use of mobile phones as a point-of-care device can enable patients to receive diagnosis and treatment assistance at their homes and villages itself thereby averting expensive hospital visits.

The fragmented state of the healthcare services in India today leaves a lot of room for innovation and a potential for aggregation from a patient’s perspective. There is a great push now to make IT work in healthcare both in developed and developing countries, especially in areas such as telemedicine. The developed countries have an ageing population, not enough medical professionals, and very high cost of healthcare. In developing countries, healthcare is not accessible to the entire population and they lack basic infrastructure.

There are some challenges gaining acceptance from medical fraternity, interoperability, broadband coverage across the country, and funding. But there is awareness and convergence across quarters in addressing these challenges in a systematic manner. Although healthcare needs still require visiting a doctor, it is still worthwhile to have minor issues sorted out virtually. By enabling patients to video conference with their physicians and allowing doctors to have immediate access to the patient’s medical record, online healthcare services can become a new conduit for exchange of health information. With the widespread use of mobile phones, deployment of 3G and Wi-Max services, and leveraging India’s IT expertise, we will be able to see more innovative, creative and low-cost healthcare IT based solutions.

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