I spent quality time in the recent weeks with a small working group developing an understanding of affordable healthcare. As a part of this exercise, I visited several hospitals and met with technology providers. Also, I researched a good amount of literature on the future of healthcare across the globe. I was surprised to learn that affordable healthcare is a significant problem not only in the emerging economies, but in the western world as well. In the US, as an example, 27% of the population has serious problems paying their medical bills. In India, lower unit costs for healthcare are accomplished through higher throughput; however, cost in general and accessibility in rural areas still remain areas of concern.
Based on my observations so far, mobility, simplicity, and automation are the three primary axes of making healthcare more accessible.
Mobility: In India, there is a significant need to focus on mobile solutions given the access issues, especially in rural areas. A rural patient requiring care does not want to travel to a town or city as it would mean loss of daily wages in addition to the expenses for their travel and stay. In this case, affordability and accessibility accomplish similar outcomes. An example of mobile healthcare delivery is the mobile eye surgery unit developed by the Healthcare Technology Innovation Center (a joint initiative of IIT Madras and the Department of Biotechnology, Government of India) for Sankara Nethralaya (http://www.youtube.com/watch?v=rp_Eqrl1zbg). Here, a world class patient preparation room and a world class surgery theatre are created in two buses that are connected to each other with a custom designed walkway. The two buses travel to remote locations and aid the doctor in performing cataract surgeries.
Mobile Eye Surgical Unit - MESU™; Source: Dr. Mohanasankar Sivaprakasam, Healthcare Technology Innovation Centre (HTIC), IIT Madras
Another example is the Sri Sathya Sai Mobile Hospital (SSSMH), which has delivered mobile healthcare to close to 6 lakh patients since its inception in March 2006. SSSMH is not a medical camp, as its director Dr. Narasimhan pointed out to me during my visit to the Gownipalli nodal center on May 7th 2013. It is an entire hospital recreated on the premises of government schools for a day (same of the month, every month for a specific location). The mobile bus unit is the diagnostic center and the generator. All other equipment required to recreate all the departments and corresponding pharmacies (Radiology, Medicine, Surgery, Orthopedics, Obstetrics & Gynecology, E.N.T, Dentistry, Ophthalmology, Pediatrics, Dermatology, and Psychiatry) are carried in a separate bus.
Sri Sathya Sai Mobile Hospital; Source: http://www.sssmh.org.in/
Telemedicine, where the physician supports rural delivery of care through nurse practitioners while being available for consultation from the home hospital is applicable in some cases where the criticality is not high. Here, the ability to transmit data quickly and reliably as well as good processes to ensure zero errors in delivering treatment is essential.
The ability to access patient information electronically at the hospital bedside as well as from the physician’s home is another mobile solution that will enhance the ability to provide care. Also, many hospital systems are now providing home healthcare options where access to patient information on the go becomes even more critical. Data security is a critical aspect of any mobile solution to ensure data privacy.
Simplicity: There is a need to develop simple solutions with the right features and the appropriate technology specific to the given care area. Another aspect for the rural segment in India is that the solution needs to be robust to heat and dust! As an example, detecting fungus inside the eye can be accomplished by mobile phone based photographs and processing.
While affordability is desired, quality of clinical outcome cannot be sacrificed. Typically, only 20% of the features of a product are used by 80% of the users (as an example, consider the use of ultrasound imaging products by cardiologists). Hence, the trick of achieving both affordability and clinical outcome is to create a core product based on that 20%.
As another example where simplification would help is in serum bilirubin (SRB) tests for infants. A well respected physician I met suggested that the equipment and process for SRB tests for infants with jaundice needs to be simplified and made non-invasive as the test is repetitive and causes infant discomfort and maternal distress. As a GE example, while we do not work on the SRB tests, we do work on the treatment for infant hyperbilirubinemia with our Lullaby LED Phototherapy (PT) device. With a removable head, omnidirectional small wheel, ultra compact foot print, Lullaby LED PT is also technically more advanced with the combination of optimal wavelength, high intensity and uniform light distribution helping faster bilirubin breakdown. This is a simpler and much more effective solution compared to the previous generation of PT devices. I am of course proud of the fact that we developed this device in India.
Automation: Larger volumes of procedures in India and lower availability of trained personnel drive the need for automation. Automation could also further improve throughput, thereby lowering the unit costs.
In the case of a magnetic resonance (MR) imaging machine, 50-70 patients are scanned per day in India (vs. 20-30 in the US) and 5-8 sequences per day are used in India (vs. 15+ in the US). This makes the case for automation as in India we process – larger volumes with less variation in protocols.
As another example, automated standard plane selection and biometric measurements in ultrasound will decrease variability and also enable training.
Mobility, simplicity, and automation will enable the efficient spread of care between hospitals, clinics, and homes and empower the care providers including doctors, nurse practitioners, and relatives of patients with appropriate technology.
In India, there are more than 165,000 primary and sub-care centers. These centers typically have no equipment and run on paramedical assistance with periodic access to doctors. These centers can be redeployed with a strategic plan including mobile, simple, and automated technologies as part of making healthcare more accessible across India. Another step for accessible healthcare through the private sector would be for hospital systems to spread the right resources at the right location – tier I hospitals vs. tier I clinics vs. tier II hospitals vs. tier II clinics vs. mobile units; and also doctors vs. nurse practitioners vs. home management.