(Honorary) Brig Dr Arvind Lal, Executive Chairman, Dr. Lal PathLabs Ltd in his keynote address at the third edition of Elets Diagnostics Leadership Summit shared how the pandemic has forced to envision and co-create more resilient Health Systems. Edited Excerpts:

The world has been battling against the COVID-19 pandemic for almost two years now. The impact of COVID-19 has been devastating for the world, pushing back our efforts in public health and economic growth by at least a decade. But at the same time, it has also forced us to envision and co-create more resilient Health Systems for the world’s growing diverse health needs. For e.g. in India, while our agenda to control common infectious diseases is still unfinished, now the disease burden has actually shifted and 65% of all mortalities in India are accounted by Non-Communicable Diseases (NCDs), or what we popularly call- Lifestyle Diseases. These 65% deaths can be averted or significantly reduced with early diagnosis.

Diagnostics emerged as the backbone in our strategy to control and manage Covid-19, which relied on Testing, Tracking, Treatment or isolation, and Vaccination. The diagnostics sector has gained more prominence due to its crucial role in preparing for any new Covid-19 variants that as you all know are identified by genome sequencing which is also a sophisticated laboratory investigation. Diagnostics also play a key role in the identification of many other infectious outbreaks that may include the newer influenza viruses, Japanese E encephalitis, dengue, malaria, chikungunya and many others.

COVID has taught us that in this complex and changing world, it is impossible to succeed alone. Finding better solutions and creating value requires collaboration between different stakeholders and organisations. This was further amply demonstrated by the ICMR asking the private diagnostic labs to start testing for COVID-19. Today, out of the total 3,000 odd labs carrying out RTPCR for COVID-19, more than 60% are private labs.

I take this opportunity to congratulate Elets on having selected the theme of the Summit as ‘Co-creation of a Futuristic Diagnostic Sector’ because collaborations between various stakeholders will form the backbone of a Futuristic Diagnostic Sector only.

I envision collaborations in the Diagnostics Sector that will be constituted by 3 As:

  • The 1st A stands for Access to essential diagnostics for all
  • The 2nd A stands for Accreditation to standardise quality of diagnostics services
  • The 3rd A stands for Advancements in technology

First A stands for Access.

This is an area where we must focus on collaborations between the Government and the private stakeholders in Diagnostics sector. In modern evidencebased medicine, 70% of all clinical decisions are taken on the basis of lab reports. However, a vast majority of our population, living beyond tier 2 cities, lack access to essential diagnostic services. We need to invest in diagnostics capacities at the primary healthcare level.

The Government has a vast existing network of public primary health facilities in smaller towns and rural areas of the country. Strengthening diagnostics services at these primary health facilities can significantly improve utilisation of these facilities and patient outcomes. The required framework or roadmap for this has already been laid as:

  • In 2019, India became the first country in the world to compile a National Essential Diagnostics List (NEDL), which was an adaptation of the WHO Essential Diagnostics List. The government is committed to provide Essential Diagnostics as per the NEDL at all levels of care.
  • Under Ayushman Bharat- Health and Wellness Centres (HWCs) 1.5 lakh HWCs are to be created across the country by 2022. The Government has envisioned to provide Essential Diagnostics as one of the key components for the success of these HWCs.
  • Further, in the Union Budget 2021-22, the Government announced creation of public health labs with expanded range of diagnostic services in 3,382 Blocks across 11 High Focus States and Integrated Public Health Labs to enhance diagnostic capacities in all 730 districts

These announcements highlight that the government recognises that quality diagnostics will play a major role in the provision of Universal Healthcare. The government must continue to partner with the private diagnostics industry players to create and successfully run these diagnostic services, as was done for India’s COVID response.

The second A stands for Accreditation

In India we have reportedly about 3 lakh diagnostics labs across the country, as proclaimed by Indian Express. However, the industry is highly fragmented with standalone labs accounting for 47% of the total labs. Less than 1% of these labs are accredited by NABL that is India’s largest lab Accreditation body. The quality of services and care is adversely impacted as half of these labs operate merely as ‘Testing Shops’, without any concern for quality and accuracy.

When we talk about a Futuristic Diagnostic Sector, we must address this. All medical labs, irrespective of whether they are Government or private labs, should be 100% accredited. But as all of you will agree that it is not possible for NABL to do this. Therefore, the first step towards provision of quality laboratory services has to be proper implementation of the Clinical Establishments Act across the country. This step alone, ladies and Gentlemen, will result in shutting down of more than half of these so called ‘testing shops’. But, implementation of CEA requires maturity of political thought and has to be recognised by the lawmakers of all political parties, both at the Central and the State level.

The next step is to strengthen the capacity of NABL and leveraging NABL’s leadership in creating possibly smaller accrediting bodies to supplement its efforts. One such effort is the accreditation of labs being undertaken by NABH. The time has come for NABL and NABH to work closely with Healthcare industry bodies, like FICCI, NATHEALTH and CII to further the cause of standardising quality of services provided by all medical labs.

The Government, on its part, should also provide financial and tax incentives to diagnostic labs for investing in accreditation and mandate accreditation for participation in various government programmes, as was done in case of COVID-19 testing. Empanelment of only accredited healthcare providers for mega health schemes like Ayushman Bharat PMJAY, will promote quality healthcare in India in a big way.

A vast network of accredited diagnostic labs will also ensure collection of accurate and realtime data for disease surveillance, healthcare research and policy planning.

Last but not the least, the third A stands for collaboration for mainstreaming Advancements in technology

Technology and its adoption are pivotal to providing quality healthcare in a cost-effective manner. Technology is the answer to, how we provide better disease surveillance, better patient engagement and better care delivery. I think technology, and our experiences during this public health crisis will lead our industry to progress more intelligently.

India has also been ushered into a digital revolution, especially in healthcare with the Prime Minister’s vision of Ayushman Bharat Digital Health Mission or AB-DHM. The Govt. has formally given recognition to tele-medicine along with releasing detailed telemedicine guidelines, which was seen by everybody during COVID-19. If we had talked about a doctor prescribing 4th and 5th generation of drugs without physically examining the patient, what we call palpation and auscultation, 10 years ago, people would have laughed at us. But, ladies and gentlemen, 90% of COVID patients were managed by doctors by telemedicine.

A similar revolution is long due in the pathology or Tele-pathology-as the world calls it. Keeping in mind the fact that there are 3 lakh labs and only about 12,000 qualified laboratory specialists in India, we urge the Govt. to formulate and release guidelines for tele-pathology, so that satellite labs can be run remotely but by keeping a strong vigil on day to day quality parameters. Whether we like it or not, this is the writing on the wall and it is high time that tele-pathology was utilised for the benefit of people living in rural India. These remote labs will be operated by qualified DMLTs with the help of qualified phlebotomists. A person like Dr Avinash Phadke or Dr Ravi Gaur would be monitoring all quality parameters sitting 100s of kilometres away and will take the responsibility of giving quality services to such far flung remote areas.

Further, with the escalating demand for personalised care, innovations that target specific subgroups of patients are becoming increasingly relevant. Health systems will need to place a greater focus on shifting from reactive to proactive care and from sick-care to health-care.

The diagnostics sector has already witnessed acceleration in adoption of advanced technologies such Artificial Intelligence (AI), Machine Learning (ML) Analytics, and Robotics. The use of Artificial Intelligence driven clinical decision support tools to analyze images, detect and grade cancer in biopsies and distinguish other clinically relevant factors, help pathologists reduce error rates and deliver more efficient, metric-driven, objective and accurate reports. Today, they are a complimentary tool for the oncopathologist and are expected to impact critical areas affecting both cost and efficiencies in healthcare diagnostics by reducing diagnostic errors, accelerating access to AIbased second opinions, improving patient care and increasing the body of knowledge in healthcare.

However, there is still immense scope to truly build a futuristic diagnostics sector, leveraging technology. Therefore, for mainstreaming advancements in technology, we need stronger collaborations between the Diagnostics labs, MedTech sector, Academia or research settings as well as innovators.

Collaborations and investments in R&D can help increase research capacity, bridge the gap in technology commercialisation and sustainable deployment of advanced technology in real life settings.

In our response to COVID-19 we have witnessed, the journey from R&D to commercialisation happened faster than ever seen before, whether it was for testing kits, tracking apps, ventilators or vaccine development.

From this important platform, I call upon policy makers, technology providers, academicians and researchers, diagnostics service providers and innovators, to join hands to build a conducive ecosystem for a Futuristic Diagnostics Sector in India.

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