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Gopi Katragadda
What drives me is the unknown..

What does it take to make Healthcare more accessible?

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.

Gopi's blog HC-Pic1

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.

Gopi's blog HC-Pic2

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.

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Dr. Vinay Jadhav
This article is really nice. I got lot of new information. We have to take care of rural area's patients mostly.
Thank you for this nice and informative article on health care is more accessible in india
I find the personal health insurance in India is most ineffective in the sense the health insurance company does not honour their commitments. It look as if in India health insurance is only to get premium for tax saving. I had online policy from Royal Sundaram Health policy, when they want to renew the policy they keep calling on the mobile till they get the policy renewed. When I submitted an emergency hospitalization at Vikram Hospital first the hospital informed they do not entertain Royal Sundaram Insurance and I had to pay the amount first. When I submitted the reimbursement claim which was 6 months after the commencement of the policy, the claim is rejected and the policy is cancelled because in the discharge form the doctor mentioned the patient had known for Gilbert's syndrome. As per doctors Gilbert's syndrome is not require any medication and the current hospitalization had nothing to do with Gilbert's syndrome it was only due to Upper GI bleed secondary to NSAID. infact the Gilbert's syndrome was also know many months after the policy was taken online. The government should come on these corrupt insurance companies whose only interest to get Corporate insurance as it is big money for them and private policy is never honoured. I would urge never go near Royal Sundaram Health Insurance
Telemedicine is one of the most promising tool for creating a cost effective model to access genuine healthcare. The problem in our country is not only the limited number of quality healthcare professionals but their accumulation in the urban centres. Technology can help bridge the urban-rural divide effectively and affordably. Many hospitals and agencies have started taking the concept seriously and pushing it aggressively. A commercially sustainable model is yet to be established but not very far. While efforts like Apollo's telemedicine network foundation(http://www.telemedicineindia.com/) have pushed the concept over the years more efforts like Medanta's Telemedicine Portal ( http://www.medanta.org/telemedicine ) are trying to bring telemedicine to the mainstream. The tipping point for telemedicine is going to come sooner than anyone expects.
I read about two exciting technologies this week relating to healthcare. First, we need technologies to monitor our health so that we do not need to wait till disease symptoms occur. One such tool in the making I learnt about is called Scanadu that tracks six physiological essential parameters and can transfer data via Bluetooth. Second, once we go in for a treatment, various imaging modalities are available giving complementary information. This adds to cost, dose, and ultimately needs a good registration of these information. One interesting solution is called Omni-tomography, which does targeted interior tomography, and claims to support multi-modality. These ideas look just amazing.

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Vijay Ogirala
End – of – life to preventive care the healthcare accessibility and affordability is an amazing and challenging game today . A very well thought out article . Providing primary healthcare to the rural community is more of a fundamental right. They shouldn’t be prevented from getting the care they need because of the time or cost associated with getting it.The rapidly changing lifestyles in the urban population necessitates top class healthcare for complex diseases … typical scenario in ICU – a battery of life support systems . Our task should be to continue to promote biotechnology by funding more research programs . What it takes for a healthcare professional to preempt an emergency situation is vital signs and health symptoms to recognize emergent conditions. Expanding the use of telemedicine would go a long way in that direction . At the end of the day , we realize that to make health care more accessible and affordable the hospital networks and the health insurance companies need to collaborate in a big way.
Dr Mahesh C. Jain
I think we three are thinking on identical lines. But we have to keep in mind that only 9% patients actually read their EHR and only 5% patients use patient portals. So utility of these devices can't be denied but great majority of patients are driven by their felt need and want the simplest solution to their felt needs with minimum application of mind and minimum expenditure of resources. It does not mean that they are not willing to shell out more should the need be felt. We as doctors are able to reach reasonable conclusions in great majority of cases without resorting to expensive and time consuming modalities and much of the data that is generated in the course of our working has no historical value and is beyond comprehension by patients. So to keep the things simple, let individual health care providers decide about the data to be electronically recorded, preserved and propagated. So we shouldn't be perfectionist if we want to keep costs under control and life reasonably simple and convenient. Instead of seeking perfection through systems, we should keep situation specific vigilance so as to be able to act in-time in case of need.
Dr Mahesh C. Jain
The more fundamental issues are aligning delivery of healthcare with the way people want to receive it and ensuring continuity of health care. With this core strategy in mind, entire pyramid of health care has to be built so that resources whether immovable or movable are optimally utilized by people who are the focus of our attention. This has to be coupled with reemphasizing clinical acumen based medical practice.
Gopichand Katragadda
Dr. Mahesh and Varadh are both right - strategy and execution have to be iterative field experiments to reach the goal of accesible healthcare.
Even if we start with EHR and Mobility solutions(telemedicine) with respect to referral cases(between professionals and/or with them), we will make great strides in this direction. While thinking has to be big, activity has to start small and built from bottom-up involving stake holders.
 
 
Gopi Katragadda
(Gopi Katragadda is the Managing Director at GE India Technology Center)

Be it going down unknown roads of a new city, or peeling the onion of a known fact to discover fascinating unknown layers, what drives me is the unknown… The amount I have learnt trying to decipher the Indus script is as valuable as the eventual goal of decipherment. As a boy, one summer, I learnt to make soap from my English teacher, and I sold the soap to neighbors and friends.
I made soap because I enjoyed the act of creating and I sold soap because it was a validation that what I created had value… Today, deep down, I am still that boy who makes and sells soap…
Leading GE Technology in India provides me the ultimate platform to probe unknown corners of Energy, Healthcare, Transportation, and Aviation. We create intellectual property and put it into products that solve some of the world’s toughest problems. Over the last decade, the work done by inventors at GE India has resulted in over 1500 patents being filed by the Parent General Electric Company.
My book on innovation titled ‘Smash Innovation,’ explores the barriers to innovation in India and how we could break those barriers. This blog is again my exploration of how to make this a century of Indian Innovation.
 
 
 
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November 04, 2014 17:17 pm by Dr. Vinay Jadhav
This article is really nice. I got lot of new information. We have to take care of rural area's patients mostly.
August 12, 2014 16:27 pm by Noble Hospital
Thank you for this nice and informative article on health care is more accessible in india
June 13, 2013 11:39 am by Abbey Thomas
I find the personal health insurance in India is most ineffective in the sense the health insurance company does not honour their commitments. It look as if in India health insurance is only to get premium for tax saving. I had online policy from Royal Sundaram Health policy, when they want to ...
May 23, 2013 22:36 pm by Akhil Kumar
Telemedicine is one of the most promising tool for creating a cost effective model to access genuine healthcare. The problem in our country is not only the limited number of quality healthcare professionals but their accumulation in the urban centres. Technology can help bridge the urban-rural divid...
May 22, 2013 15:45 pm by Sohan Ranjan
I read about two exciting technologies this week relating to healthcare. First, we need technologies to monitor our health so that we do not need to wait till disease symptoms occur. One such tool in the making I learnt about is called Scanadu that tracks six physiological essential parameters and c...