Reimagining digital healthcare in India for the new normal

Digital technology has permeated all aspects of life, and in recent times, it has transformed the delivery of healthcare in new ways. The National Digital Health Mission, launched by the Government of India, is expected to bring in a digital revolution for the health sector in the country, and enable the creation of an inclusive ecosystem that supports universal health coverage.

"Reimagining healthcare is critical and is the way forward," said Dr. HS Subramanya, Director, Institute of Bioinformatics and Applied Biotechnology, as he inaugurated the panel discussion on 'Reimagining digital healthcare' at the Bengaluru Tech Summit 2020.

Holistic digital health

Dr. Prashant Mathur, Director, National Centre for Disease Informatics and Research - ICMR, moderated the panel and spoke about how digital health as a concept has become the talk of the town, thanks to COVID-19. According to him, digital health is a cultural transformation of healthcare and is the convergence of digital technologies with health, healthcare, and society. "It enhances the efficiency of healthcare delivery and makes medicine more personalised and precise," he said.

The current healthcare system is plagued by several problems, including the absence of an integrated health system, no district-level electronic database, no personal health records systems and so on. "The scope of digital health spans across prevention, curative and rehabilitation, but the key driver is data and its collection, management, analytics, and dissemination," said Dr. Prashant.

Prashant said that digital health is not merely doing away with paper records, it’s more of a shift from a centre-based approach to a patient-centric approach.

"Digital health will not replace the conventional system but will supplement and complement it. To do so efficiently, we need collaboration across different professions for a holistic digital health programme."

Telemedicine as a service

Prof. SK Mishra, Head, Department of Endocrine Surgery & Faculty I/C, SGPGI Telemedicine Programme, Sanjay Gandhi Postgraduate Institute of Medical Sciences (SGPGIMS), spoke on how to build futuristic systems with digital technologies.

"Telemedicine service is a must-have for all healthcare organisations," he said, adding that the onset of COVID-19 has disrupted the healthcare system worldwide and rapidly accelerated the adoption of telehealth solutions.

Telehealth has demonstrated benefits such as access to care service at any time, any place. Earlier, telemedicine platforms focused heavily on technology. But today, there are affordable and simple technology platforms that empower citizens. To measure the value of telehealth, there are key performance indicators such as improved patient retention, lower claim expenses, reduced hospital transfers, decreased waiting time for urgent care, among others.

"We need to brand telehealth across the care enterprise. The healthcare industry has always been slow to adopt innovations in technology, but due to COVID, it has made this process faster," said Prof. Mishra, adding that while new technologies pose challenges for public health ethics, they also present an opportunity to develop health ethics for digital technologies.

Digital transformation of public health

Sunita Nadhamuni, Head, Digital Lifecare, Dell Giving and Social Innovation Dell Technologies, said that at Dell, they create technologies that drive human progress. As part of their CSR, they have come up with a 10-year project 'Progress Made Real' to advance sustainability, cultivate inclusion, transform lives and uphold ethics. One of the flagship programs under this is Digital Lifecare, where they are working with the government to improve the way public health services are delivered.

Sunita said there has been a huge shift in India from communicable to non-communicable diseases (NCD) with troubling statistics - 1 in 5 suffer from an NCD, while NCDs cause 61 percent deaths. In this context, the government launched the NCD programme through the health systems, which includes ASHA workers, health workers, primary health doctors, community doctors, district specialists, and tertiary care centres. Dell came on board as a technology partner for this three years ago. "The idea was to develop a comprehensive tech platform with a suite of applications that will help the health system deliver this program," she added.

Dell has developed applications for each of the six people - ASHA Mobile App, ANM Tablet App, PHC Doctor Web Portal, CHC/DH Portals, Administrators Portal, and Health Officials Dashboard. These are connected apps on the same cloud platform and highly scalable and user friendly, with availability in 10 local languages. It has been rolled out in 26 states and has 25,000 active users.

"We believe that once systems like these are set up in place in the country, this can lead to futuristic transformation in the public health space," said Sunita.

Different models for different questions

Prof. Gautam I Menon, Professor, Departments of Physics and Biology, Ashoka University, spoke on the different models they are working on that will aid the fight against COVID-19.

The three models are: epidemiological compartmental models called INDSCI-SIM, network models for testing, and agent-based models called BharatSim.

The first model incorporates features to improve district-wise healthcare accessibility, and responds to different age groups. The second model lets you choose the quantum of testing, the testing mix, the sensitivity of tests and who to test.

"The issue in the country is that the medium-accuracy test is inexpensive and higher-accuracy tests are costly. This model lets you ask specific questions to check what makes for good testing," said Prof. Gautam.

The third model is an ongoing project with Ashoka University, ThoughtWorks, and a number of collaborators around the country. In BharatSim, each individual is simulated as an 'agent' on a computer. The properties of agents are chosen to match those known from the district and state-level demographic studies including age distributions, sex ratios, population densities and health indicators.

“It’s a computational model to simulate agents, you need networks for agent interactions and you need a synthetic population for agents,” said Gautam.