With its multiple tools and across-the-board usability, technology is a force that can — and should — transform India’s healthcare services
Healthcare delivery — the provision of treatment and medical supplies to people — is undergoing a transformation as it transitions rapidly from the longstanding episodic, disease-centric and volume-based archetype to an integrated, patient-centric and value-based model. As with anything that’s truly transformative, this is a phenomenon that brings with it a big basket of challenges.
Realignment of the healthcare services blend, the need to increase patient engagement, shifts in customer base and diversification into other types of businesses are parts of the emerging landscape and they need to be balanced with access and quality of care. Technology is the differentiator in this rapidly changing environment, a reality that healthcare providers have taken to heart. But that’s not enough.
Though providers and other stakeholders understand the power of technology in healthcare, a huge portion of the population is still unaware of how it can make services more accessible and affordable for them. After all, healthcare is not like other commodities that people consume, where need and demand are clear-cut.
The impact technology makes can be illustrated through a look at the general reluctance among people to seek medical care when the need surfaces. Multiple studies state that this reluctance is attributable to three main barriers — physical (lack of healthcare availability); mental (perceived need for treatment); and traditional (high cost of care, absence of health insurance, time constraints, etc). Technology has the power to break through each of these barriers.
The multifaceted role technology plays in making quality healthcare accessible and affordable for all can be explained through four points that are interconnected (each of these are drawn from projects implemented by the Tata Trusts).
A lady was against her pregnant daughter-in-law visiting the local government health centre for a check-up due to bad road connectivity and uncertainty about doctor availability. The daughter-in-law resolved the issue by getting connected — from her phone and at home — to a gynaecologist through a 24/7 helpline. Her doubts were cleared and this was followed by a home visit by a nurse, who set up a video consultation with the gynaecologist on her tablet.
The cited example depicts how telecommunications makes it easier to connect provider and patient, while also showing how telemedicine can be employed for a better patient experience. Given the context and circumstances of healthcare in India, these are approaches that can pay rich dividends.
Huge capital investments are required to establish health infrastructure up to the last mile. Meanwhile, the huge available health infrastructure is undermined and underutilised due to a range of maladies, not least a general lack of quality. Telemedicine has the proven potential to deliver an alternative through its hub-and-spoke model and remote-monitoring ability.
The availability of general and specialist consultations at nearby spokes — provided through telemedicine from a hub hospital — not only reduces patient expenses but also saves the cost of setting up ever more health facilities. Technology enables the linking of health providers to a patient, no matter where he or she is.
Wearable devices, high-definition cameras and interconnected medical devices are changing the way healthcare is delivered, with the obvious gain being in improved patient experience. Consider scale as well. Estimating the disease burden of the populace through mass screenings is unthinkable without technology, but that’s what the tablet-based detection of various noncommunicable diseases (NCDs) has made possible. This is a vital piece in ensuring efficient and cost-effective healthcare delivery.
A 25-year-old woman suffering from tuberculosis was avoiding a physical visit to the local health facility because of the stigma surrounding the disease and fear of a social boycott if her condition was revealed. The patient got a call from a helpline maintaining a tuberculosis patient registry, a video consultation was arranged with a medical officer and medicines were prescribed. Appropriate and uninterrupted treatment resulted in the lady being rid of the disease.
This is a story that highlights how digital technology can help patients overcome the mental block that so often prevents them from seeking healthcare services. Dealing with such patient behaviour is a challenge across the world. The costs are deadly. High maternal and infant-mortality rates are always coupled with delays in the decision to seek health services, often times due to the lack of women doctors at designated facilities.
Tuberculosis, Covid — in its initial days, at least — and mental illness are other conditions that push patients towards a reluctance in accessing healthcare. This psychological obstacle can be overcome through confidential electronic medical records, virtual consultation with the desired service provider and by demystifying medical conditions with tech-enabled behaviour-change tools.
A 60-year-old diabetic stopped going for follow-up consultations at a public health centre (PHC) because the place almost never had the medicines he required and going to costly private clinics was out of the question. The government’s tech-enabled platform for NCD consultations flagged the patient and a call was made to him. After knowing about his and other patients’ experiences, PHCs were provided with adequate medicines and monitored with an electronic supply chain software. The diabetic patient now not only gets his medicines regularly but also receives SMS reminders for follow-up consultations.
This case reveals the potential in technology to track a patient’s journey across the care continuum, especially those who discontinue treatment and, consequently, face the threat of increased disease morbidity. The case also highlights how the optimal utilisation of tech innovations enables the voices of beneficiaries to be heard and how gaps in the healthcare delivery system can be plugged.
The worry of high out-of-pocket expenses, leading to the hesitancy in seeking care, can be eased with health technology and innovations. The cost of screening for NCDs through lab-based tests has come down considerably thanks to point-of-care diagnostics (glucometers and similar digital devices). Telemedicine applications have minimised the distance between doctor and patient, saving time and money on travelling long distances.
The recent mass immunisation project for Covid in a populous country like India is a perfect example of the application of technology for bulk enrolment and a smooth supply chain. Also, when the pandemic hampered movement and access to healthcare facilities, there was a surge in tele-health services. This indicates the readiness of people, patients and providers alike, to adopt technology.
A primary care physician wanted to treat a snakebite with available equipment and drugs at a PHC, but he needed expert advice and this was available at a tertiary care medical college 300km away. There was no time to transport the patient to the medical college, so the physician connected with a team of specialists at the facility and got guidance about treatment procedures. After successfully saving the patient, the specialists conducted virtual debriefing and mentoring sessions for primary care physicians handling similar emergencies.
Technology had a critical part to play in this life-and-death situation, where remote monitoring of the patient and virtual handholding of the only available human resource by specialists was made possible. Such measures should be the norm given the shortage of medical and paramedical professionals in India.
The severely limited number of medical colleges, the huge cost and time involved in creating specialty cadres, and their equitable distribution are serious shortfalls that are difficult, if not impossible, to cover in a country such as India. The only option when it comes to providing specialty care, particularly in remote regions, is to use — wisely and optically — the available primary healthcare workforce and to mentor them properly.
Technology can play a pivotal role in the virtual monitoring and mentoring of primary care providers and tech-enabled initiatives (e-ICUs, remote monitoring services, virtual capacity building, etc) are essential to make the most of human resources and infrastructure. Additionally, technology can enable the standardisation of disease codes, treatments guidelines and the digitisation of medical records.
This is a unique time at the global and national level to adopt and implement tech-enabled health programmes more quickly than ever before. The goal of universal health coverage can and must be achieved, and technology is the most potent force to make that happen.