Patient-Centric Digitisation of Indian HealthCare – The Holy Grail?

Patients and family members queued up at hospitals, awaiting their turn to see a doctor. Each person is carrying large bags with files of their past medical records and test results. Familiar images? Can we move to a digital model where patient records available at the click of a button? Read on.

GOI spending on healthcare inadequate

GoI spends only about 1.7 % of GDP on healthcare. Massive plans are underway to increase it to at least 2.5% by 2025. But the question is how should this money be spent: (a) in modernizing the woefully out of date IT infrastructure and digitization, (b) in improving availability of medicines & medical supplies, or (c) in training & development of medical and para-medical professionals. It’s beyond this article's scope to establish with certainty what the priorities should be, given that all fronts need attention. Still, it can highlight the importance of digitizing healthcare records in the country.

The IT-enablement agenda at a hospital

A hospital has diverse areas to consider, such as medical, financial, administrative, legal, and compliance. The hospital needs to integrate these areas so that information is easily accessible to the authorized person. The data resides somewhere; it should be able to flow and flow only to those authorized to fetch it. There has to be a BI tool sitting atop, which guides decision-making to reduce operating costs and maximize revenue cycles. Typically some of the areas for integration are Outpatient and Inpatient Management, Pharmacy, Laboratory, Radiology, Inventory, eClaim, Mobile Apps, Tablet Versions, Online Scheduling, Secured Messaging, Doctor and Patient Portals, Accounting, HR/Payroll, Blood Bank, Mortuary, Alert Software, Dietary, Feedback, Lab Machines, and Biometrics,

The ‘Kerala model’ as a solution?

In India, healthcare services have to be designed/innovated in a way so that it’s easily accessible and affordable. There are about 450 million mobile internet users in India, and one way of looking at it is to enable a digital environment that caters to this massive population. The other angle is the trickier one – how do you address the needs of the 850 million others who don’t have access and are maybe using a feature phone. And, the urban-rural divide is massive. The population ratio is about 33:67, but the latter accounts for only 30% of the healthcare infrastructure (NASSCOM Study). How do we build cost-effective & accessible solutions that cater to the masses and often under-privileged?

Carrying bulky files of health records is a cumbersome affair, and that's why Electronic Health Records or EHR should find greater adoption at the earliest. According to a January 2020 report of ETHealthworld.com, Kerala has done remarkably well in this regard.  It has successfully collected and stored electronic health records of 2.58 crore people through its 'eHealth project.' The state government initiative allows patients to walk into any government hospital without carrying any papers. In India, except for a handful of large healthcare institutions, the adoption rate has been rather dismal. It’s hardly a tech challenge and more of a massive mindset shift that’s required. Moreover, data needs to be stored in defined formats to make it sharable and transferable when required. From client experience, we know that budgetary allocations for digitization and IT-enablement vary significantly from hospital to hospital.

Only 30% of the national healthcare budget is spent improving the infrastructure in public hospitals and clinics. Of this chunk, a large part is reserved for premier national institutes such as AIIMS and PGIMER. Without adequate investment in IT, widespread adoption of EHR and EMR remains a distant dream, yet. Of course, things are not as grim in the private sector. But in most cases where EHR has been implemented, the use is restricted to hospitals' internal functioning. Patients' data are still not shareable across platforms, and this means that newer insights about diseases and their treatments are not easily obtainable, despite the large data set and population. ML or AI can bring us the desired results only when we have fed the systems with useful data.       

The need to move away from a doctor centric model

On paper, this looks so simple, and one wonders why it's not being done. The important thing here is that every time the link is broken, information is lost. If the information isn’t being stored and retrieved, then the doctor and patient fall into an infinite loop every time, and the past medical history is not captured effectively.

The healthcare sector has traditionally been doctor-centric because that’s where the expertise lies. We need to get into a system where it’s patient-centric. The patient must have access to information; they can choose the physician of their choice, rate them too, and take the matter in their own hands. That's why sites like Practo have done so well – the patient is in control and can take a call on whom to consult.

The pandemic has taught us the importance of real-time data capture. We have entered an age where we should know at a click how many hospital beds are available in our locality and where exactly (as an example).

Slowly but inevitably, it’s the data-led patient who should drive the market.