Information Technology In Healthcare – Promise And Mirage
As the second phase of Covid-19 vaccination rolls out across India, the technology glitches are a reminder of how little we have been able to harness a potent tool that has transformed industry after industry - from telecommunications to financial services, especially in rural areas.
In healthcare, technology has made powerful inroads in India in fields such as diagnostics and computer-aided surgeries. But the field has very much lagged in so far as its use is concerned in managing consumer health records, computer-aided decision making, and consumer health-risk management based on those records.
Digital Patient Records
Patient records are still being maintained in physical files which are either kept with the patient or within hospitals in large record rooms, and doctors continue to rely on brief patient conversations to guide all of their clinical decision-making, with little or no information technology support. In several other countries, the movement away from physical records has happened so long ago that there are generations of doctors that are entirely unfamiliar with that environment, and several have no memory of it at all.
There is little doubt that comprehensive electronification of patient records will have to become the norm in India and every day of delay in ensuring this hurts our ability to serve patients in the best way possible. In the current pandemic, it has hampered our efforts to track and trace, to quickly identify high-risk patients, and to ensure that vaccination efforts proceed smoothly. Enabling efforts such as the National Digital Health Mission will go a long way in facilitating this transition, particularly when backed by pressure from the government’s Pradhan Mantri Jan Arogya Yojana as a powerful purchaser, and from the commercial insurance regulator, and need to be urgently implemented.
A Network Of Connected Primary Practitioners
It is clear from repeated domestic and global experiences that primary care has to be the foundation of all healthcare in any country. Even during the current pandemic much of the load of contact-tracing, treating moderately ill patients, and vaccinations, has been borne by our extremely weak primary care networks.
Developed countries such as the United Kingdom have historically relied on highly trained general physicians, each serving small populations of 2,000 to 3,000 patients, to be the first line of defence. This is however not a luxury that many countries can afford and even in the U.K., there are several parts that have been left unserved because of a shortage of GPs.
The use of non-physician healthcare providers has therefore become a norm for primary care in many parts of the world. There is also evidence that no matter how much training is offered, even somebody as well-qualified as the U.K. GP tends to under-diagnose conditions that are rare—such as cancers—because her training and her experience with serving small self-contained populations simply do not adequately prepare her for it.
A much more scalable solution is one in which a vast workforce of healthcare providers is built-up, which is much more rapidly and broadly trained, and, as a part of a strongly supervised network, relies intensively on technology to guide their practice by analysing patient-data and guiding them to get to the appropriate diagnosis and treatment plan for their patients, at the primary care level.
- Companies like Babylon, having first started in Rwanda, have now launched ‘GP at Hand’ in the U.K., based on this technology. Their GPs are able to effectively serve a much larger population of under-served patients than a traditional GP.
- ‘Internet Hospitals’ that have been licensed in China are another example of linking primary care providers to platforms that help them serve their patients better, and when necessary, manage referral services smoothly.
- Iora Health in the United States is an example of an approach where information technology is being used to maintain continuously updated longitudinal patient health records which are used to generate an internal risk score for every patient and to ensure that there is proactive engagement with their highest risk patients, so that they can be prevented from falling ill and helped to stay well.
- Within India, for example, Portea offered non-hospital-based quarantine services to over 2,00,000 Covid-positive patients using such approaches.
Additionally, with such an approach when a primary care provider encounters a more complex case which neither her broad training nor the decision-support technology that she uses can properly guide her on, using approaches such as those built by ECHO at the University of New Mexico, she can receive real-time guidance and training from a specialist in that field who is based elsewhere.
In highly specialised fields such as psychiatry, the technology can potentially go even further, and when ‘prescribed’ by the primary care practitioner, U.K.-NHS approved solutions such as ‘Wysa’ are able to, for example, directly offer evidence-based cognitive behaviour therapy using an intelligent chat-bot. These solutions were made available during the current pandemic through, among others, a platform built specifically for this purpose by the Swasth Digital Health Foundation.
Getting Secondary Care Connectivity Right
In secondary care, while base levels of service are possible for most hospitals to offer even in relatively remote areas, the added capabilities required for running an intensive care unit are often not locally available. During the current crisis, as more and more patients started to need advanced care, Cloudphysician, a Bengaluru based tele-ICU provider, was able to assist many hospitals in setting up and running ICUs both in large cities such as Mumbai as well as in the remote Himalayan region of Ladakh.
A somewhat less useful trend that has gained popularity in India is that of enabling patients, through video and chat, to directly connect with remotely located specialists, entirely bypassing local providers, with no attempt at creating a comprehensive life cycle approach. In the near-term, such an approach has indeed allowed patients to get access to medical advice without actually visiting a physician, thus overcoming the fear of a Covid-19 infection. Unfortunately, such an approach brings the core transactional culture of secondary and tertiary care that is already prevalent in India, to primary care encounters.
And, instead of enabling primary care providers and strengthening the link between them and their patients, this approach attempts to entirely bypass them, and connect patients directly to high priced specialists, thus risking further exacerbation of the acute shortages of specialists on a national basis, without necessarily benefiting the patients.
The platforms that provide these services have combined them with easy access to home-delivered diagnostic and pharmaceutical services and use high-octane (‘year-end sales’) advertising campaigns to promote them, potentially leading to irrational overuse and over-consumption of these services.
Even though they do provide consumers with some immediate relief and have become popular as a result, these approaches are, sadly, not beneficial for them in the long-run and, as they gain further momentum, run the risk of further fragmenting and weakening the already deeply flawed Indian health system.
If the Indian healthcare system was better regulated or had a much stronger payor landscape, as is the case in other countries, such approaches would not have gained currency, but they have thrived in the current environment of out-of-pocket payments and weak oversight.
The only hope here is that as the health system evolves further, either these medical e-commerce platforms change or newer technology-based competitors emerge which recognise this gap and start to build truly consumer wellness-centric offerings that are able to take consumers away from them.
Nachiket Mor is Visiting Scientist, The Banyan Academy of Leadership in Mental Health, Tamil Nadu. Views are entirely personal.
The views expressed here are those of the author, and do not necessarily represent the views of BloombergQuint or its editorial team.