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For a country with India's socioeconomic variation and demographic diversity, the COVID pandemic has been a litmus test of its national healthcare architecture. Essentially a problem of scalability and standard, the contagion at its peak tested our ability to precisely diagnose and deliver effective healthcare for the masses.
However, rather than succumbing, we emerged stronger from the crisis, flanked by the ever-resilient Indian spirit and an innovative application of tech to amplify triaging and improve treatment outcomes. Today, valued at ₹ 675 billion and predicted to register a CAGR of 10%, the Indian diagnostic sector is expected to experience top cycle conditions for the next half a decade.
How has technology been a harbinger of affirmative shifts in domestic medical practices in this New Normal? More importantly, how is clinical diagnosis, fundamental for constructing an impactful patient journey, increasingly conforming to the global standards by leveraging its marriage with the Digital? In Worldline Rise 2022, conducted in partnership with ETHealthWorld on 30th May, we searched for answers.
Moderated by Dr. Archisman Mohapatra, Executive Director, Grid Council, a panel of industry stalwarts and distinguished members of the Indian medical fraternity like Dr. Harsh Mahajan, Founder, Mahajan Imaging, Dr. Arjun Dang, CEO, Dr. Dangs Lab, Sougat Chatterjee, CEO, Apollo Preventive Health Check, Apollo Hospitals, Dinesh Chauhan, CEO, Core Diagnostics and Ramesh Narasimhan, CEO-India, Worldline takes a closer look at the future of technology in medical diagnosis and its implications for public wellbeing in India.
Here are the key insights from the discussion:
Standardization as a key to sustaining the benefits of digitalization: At the height of the disruptions, India's ability to rapidly scale and deliver medical services digitally proved a critical success factor, saving lives. A case in point is the COWIN platform that leveraged the Aadhar database to drive a penetrating immunization drive across the country. However, as Ramesh Narasimhan observes, "for these services to scale, and be interoperable, it is necessary to establish standards for the unified digital health system."
In fact, having the proper protocols, standards, and touchpoints in place, diagnosis data can be accessed at velocity and on-demand by healthcare professionals and early responders to intervene effectively. In this context, the experts unequivocally agree that the National Digital Health Mission is a step in the right direction.
Universalization of healthcare using industry 4.0 technologies: In India, geographical barriers, cultural bias, and poor lifestyle choices have been prohibitive to preventive health checks, leading to a persisting disease burden. However, industry 4.0 constructs like 5G, IoT, and autonomous systems are poised to drive a radical shift bringing diagnostics to our doorsteps. For instance, using drones to collect samples and deliver value across the remote and inhospitable terrains in the country. Further, currently, wearable devices have brought continuous health diagnostics to our wrists, in turn opening up immense opportunities for monetizing the massive volume of physiological data of the users that are being collected. In fact, it has now transcended sick-care into a flourishing well-care industry.
Discovering strength in localized innovations and unorthodox practices: COVID hit India at an inopportune moment, leaving it with a sketchy response framework. But the journey since then has been an ode to India's self-reliance and innovative zeal. For instance, radical scaling of RT PCR testing bandwidth, domestic production of export-grade PPE kits, breeding of advanced genome sequencing capabilities, and much more.
Dr. Harsh Mahajan says, "our entrepreneurs, our startups, established labs, and med-tech companies found that innate capability to improvise and innovate, and today, not only do we make in India for India, but we are exporting to the west." Similarly, the medical fraternity is now convinced that along with the conventional treatment pathways, unorthodox interventions like consultation through video calls and remote diagnostics can also bring much-needed resilience amidst the crisis.
Liberalizing healthcare expansion under central oversight: Considering that we will be no stranger to large scale medical disruptions in the days ahead, expansion and scaling of the diagnostic services in Tier 2, Tier 3, and Tier 4 locations should be fluid, using the central mandate to bypass local bureaucratic complexities. Also, the medical fraternity feels that just like infectious diseases, ICMR should become the central agency for issuing guidelines on non-infectious diseases like cancer, cardiac problems, and strokes, which are otherwise prevalent in India.
Combining AI/ML efficiency with medical talent: In India, where healthcare is mostly fragmented and unorganized, attempting to transform is like changing the wheel of a moving car. However, intelligent technologies can transcend several gaps, empower institutions, and level the field. For instance, the expanding application of AI in Radiology and Pathology, improving value delivery, promises much to be hopeful for.
But, replicating the success in other medical diagnosis verticals will call for more professionals who are equally adept in their respective medical specializations and simultaneously possess strong technology foresight. "Finding doctors who understand both the tech side and the subject will require a lot of focus on training, education, skilling, and encouragement to further take that path, and build tools to do something different and something niche," feels Dr. Arjun Dang.
Enriching post analytics: While the pre-analytical journey like patient communication and standard advisory has already been elevated using technologies like Chatbots, the tag-team of human medical acumen and machine intelligence can achieve much in post analytics. Even in the foreseeable future, the role of doctors will be irreplaceable in interpreting medical diagnosis reports and recommending action points. Nevertheless, now AI allows practitioners to foresee and make informed decisions. For instance, India is the 'Diabetes Capital' of the world, bearing 17% of the global disease burden. Here an AI algorithm can predict the diabetic trends in patients and forecast their glycerol levels a few months from now. A physician can advise lifestyle changes based on the finding, allowing the patient to preempt health risks.
Universalization of effective healthcare: India has sworn to be a welfare state. Therefore, while value-added experience can be subjected to a variation in price tag, efficacy and access to healthcare are non-negotiable. With a population of over 1.3 billion, this is only possible by using technology as a vehicle to deliver impactful healthcare. However, technology needs to target specific drivers to make healthcare equally accessible across diverse demographics rather than operating in isolation.
Such drivers include enabling effective teamwork, driving reliable diagnostic processes, engaging patients and family members meaningfully, optimizing cognitive performance, and fostering robust learning systems. Sougat Chatterjee says, "technology interventions can push incremental changes by targeting individual drivers. But typically, we have a way greater impact and effectiveness, while multiple drivers are targeted using technology. For example, tech that permits patient, family and the caregivers access to clinical documentation enhances the service experience and also the quality of the output."
Integrating systems and findings: The COVID situation completely upended the traditionally low adoption rate of digital in pathology, peaking at as high as even 58% in the recent past. From sample pickup to the delivery of the reports, several aspects of the journey have been successfully automated, optimized, and transformed. But systems are still primarily operating on an ad hoc basis.
Dinesh Chauhan says, "We are not trying to solve healthcare problems holistically, and we are yet to integrate the new findings that the doctors and pathology labs are coming up with every day." Here, the Core Diagnostics CEO believes that Blockchain will bring in exceptional value, including clinical trial management. "With Blockchain, data interpretation will be much faster, secured, and decentralized without compromising patient confidentiality," he observes.
Digital payment is pivotal to simplified healthcare of the future: As medical diagnosis becomes more experience-driven and oriented around customer convenience, service providers can transform operations and profitably explore new business models using agile digital payments solutions. Ramesh Narasimhan says, "During the pandemic, we've provided many diagnostic centers with digital payment solutions, allowing them to collect the sample and payments on the spot, using POS terminals or UPI."
Further, with the proliferation of wearable devices and the buildup of an entire ecosystem of healthcare services and solutions around them, the future for a considerable chunk of the medical diagnosis vertical appears to be in the cloud. "The ability to correctly price services and collect payments digitally will be crucial in running medical diagnosis businesses sustainably," he says.
Digitalization is inevitable, and medical diagnosis providers, standing at the inception of the clinical value chain, are under an absolute imperative to embrace it and transform at scale. However, all the experts are convinced that today, the incentive to change is higher than ever. Investment in the technology aspects of medical diagnosis is poised to reap rich financial dividends for the businesses and lay the foundation of a robust and responsive healthcare system that India truly deserves.