Changing How Healthcare is Delivered, MediAngels, The World's First Online Hospital

What do you do when you are sick? Go to a doctor, get a diagnosis, take your medicines and wait to feel better. You trust in your doctor that their diagnosis was correct and that eventually you will feel better. But what if you don’t get better or if the best doctor for you is 200 km away? And more importantly. What if you can’t afford the best doctor to save your life?

A personal experience of a medical misdiagnosis of his father in 2008, spurred Dr. Debraj Shome to find a way to make healthcare accessible and affordable all across the globe. Dr. Debraj Shome partnered with Dr. Arbinder Singal to create the world’s first online hospital, MediAngels, which is working to provide affordable access to healthcare across the world. SocialStory spoke to Dr. Debraj Shome about the workings of the current healthcare system, the gap MediAngels is working to fill, and the future role that technology will play in healthcare delivery. Excerpts

SS: Tell us more about why you started MediAngels.

Dr. Shome: What saved my father and allowed him to live for three and a half more years was the fact that we were able to seek a second opinion from one of my colleagues at MD Anderson in Houston, who was doing research on my father’s particular type of lung cancer. I have treated cancer all of my life, but I wasn’t prepared for this situation. My father’s cancer opened my eyes to the perils that face healthcare. This also brought me face to face with the fact that I could have the best specialist looking at my dad, because I have worked in healthcare; yet, you could be the richest person in the world but not be able to access those networks.

Healthcare is extremely human capital intensive so the best doctor for a particular disease may not be in your locality, state, or even your continent. In this situation, what do you do? Go to someone who isn’t the best and therefore jeopardize your own outcome or can you figure out a system by which you can change how healthcare is delivered? The only means of accomplishing this seemed to be through technology and this learning funneled into the thought process, to create MediAngels.

SS: What do you think is the future of healthcare in developing markets, and what role will technology play in this?

Dr. Shome: One thing absolutely clear to me is that we do not have the time or money to build physical hospitals that can cater to last mile healthcare in all countries. The one story I would like to share: when I was in the US, and found out that the entire state of Arkansas only has one rheumatologist. Thus, if you had knee pain and a rheumatology problem by the time your insurer decided when you could see the rheumatologist your appointment could take as long as six weeks to three months out. Imagine living with knee pain for three months; that doesn’t make sense.

These problems exist because the supply and the demand curves in healthcare don’t match each other. This is not only a developing country problem, but exists world over. I have worked in healthcare in Singapore, UK, US, and India and have yet to see one single healthcare system that is perfect. In India, if you are living in a city like Bangalore or Mumbai, sure you think you have access to the best quality healthcare, but try taking a car and driving 20 km north of Bangalore. You will struggle to even find a primary care center. The problems of healthcare are worldwide.

The problem is very clear – in order to serve the last mile or the last human being in the ever-increasing population of this planet, we are not going to have enough doctors or enough quality doctors to serve the last mile. If you decided to build physical structures like hospitals to solve this problem, it would take India $1 trillion dollars to build enough to touch the last mile. Even if you build the hospitals, so what, there is just no way that you can make it worthwhile for specialized doctors to go and practice in a village. So what is the point of hospitals and spending so much money, time, and effort when we are not able to guarantee healthcare to everyone anyway?

I think the future of healthcare has to revolve around the use of technology in order to make the supply and demand curves match better, and to make whatever healthcare is available, available and affordable for everyone. If it doesn’t do that, then I don’t think we are serving our purpose as healthcare leaders.

SS: How do you ensure the quality of healthcare increases with online global e-Hospitals? Furthermore, how do you ensure quality control with every stakeholder that you have integrated into your consultation process?

Dr. Shome: Quality is easier to implement online than offline. Imagine you have 2 hospitals, Hospital A & Hospital B. Hospital A has physical patient records and Hospital B has electronic patient records – which one will be easier to audit? Clearly it’s Hospital B with the electronic records. I have worked at some of the top Indian hospitals, before I started MediAngels in 2011, and in general wherever I’ve worked in India the physical records might be chewed up by rats or would disappear because someone did not keep them in the right place. It’s a mess, an absolute mess. It is much more efficient to use technology because it’s much easier to store records electronically, audit files, transport records outside to the payor, and even make them available to the consumer on a smartphone.

The problem is not whether it’s an online or offline hospital. The problem is if it’s a hospital, how to you manage quality control; hire the best doctors, ensure that doctors have the best possible qualifications, and do rigorous background checks? MediAngels ensures there are processes and procedures in place for hiring doctors, rigorous auditing either when a consumer is upset or another doctor disagrees with one of the doctors, and rigorous auditing at random.

It’s about getting our mindsets right. We live in a world where if in 1997 you told me the postal service would not be carrying any more letters, or that booking tickets would be mostly over the Internet, I would think that would be an overkill and not possible. These things have happened, and they have happened really quickly. The easy thing would be to say this can’t be done. My job as a leader is very simple: it’s to visualize what’s going to happen to the world. If I have to deal with the world as it happens and after it happens, how does that make me a leader or a visionary in any case?

SS: How are you ensuring that MediAngels is a sustainable and scalable business?

Dr. Shome: Every business has to be sustainable and scalable to survive. MediAngels is a social business, and I am a capitalist, but I’m a social capitalist. It is very important to be doing good if you are doing well. If making money was everything, and making an impact was not important, I don’t think a lot of businesses would run. If you ask Larry Page and Sergey Brin what gives them excitement, is it the fact that they make a lot of money or the fact that you or I can’t get through the first hour in the morning without opening their creation, Google?

It is about creating scale, and if scale has not been created until now that doesn’t mean it won’t be in the future. Most of the time healthcare tech folks are technology people. This is not a technology business, MediAngels is a healthcare delivery business, delivered through technology; therefore, having a deep understanding of the healthcare domain and having expertise in it is very important. If you don’t understand the payor psyche, the consumer psyche, or the provider psyche there is no way you would be able to develop a business in the healthcare sector. I am very hopeful that this sphere will develop scale, because healthcare as a business is not like other ecommerce businesses. It takes a lot of time to get it going.

Check out the MediAngels website to learn more.