Focus shifts to integrating digital solutions into standard systems of care
It is the worst of times and, perhaps, the best of times as the pandemic unleashed a wave of unprecedented disruptions. Lives and livelihoods were lost and people suffered in every conceivable way as economies around the world crumbled. But like any sweeping crisis to shake up the foundations of human existence and undermine time-tested institutions, the coronavirus also gave us an opportunity to reimagine and revitalize healthcare and finally overcome decades of inertia in the healthcare system. The ‘new normal’ necessitated the adoption of new technologies and digital solutions to improve access, affordability and quality of care for a large swathe of the population, including the underserved sections. On World Health Day, Dr Kshama Kothari, Clinical Director, MedTech, Social Alpha tells us about the transformations that have the potential to democratise India’s healthcare system with both the government and private sector accelerating change. Edited excerpts of the interview.
We know the corona pandemic has irreversibly changed our lives. How has it exposed the inadequacies of India’s healthcare system?
The pandemic exposed the limitations of India’s healthcare delivery system in more ways than one. Before the pandemic there was a marked dependence on institution-based care. Most records were manually documented and siloed. Treatments largely relied on specialists’ opinions. Our protocols and systems were needlessly burdened because of our propensity to carry out things manually and a breakdown was imminent. Given the status quo, there was hardly any incentive to adopt digital solutions for care delivery. Also, the virus exposed how healthcare access is still a privilege (rather than a right) for most of the population. It also laid bare the inequities in access to care and information on services.
We missed out on addressing the needs of the ‘non-Covid’ patients because the response to the pandemic became a national priority. Hence, people with other infectious diseases and chronic illnesses as well as their caregivers suffered as access to even routine check-ups became arduous and expensive.
Interestingly, during this crisis, while the frontline workers were battling it out on ground, we had several innovators and entrepreneurs in the wings building solutions. These innovations weren’t just for emergency response to Covid such as ventilators, PPEs, and CPAP machines, but also for digital healthcare and remote-monitoring. So, what we witnessed in the early months of the pandemic was a social change. The government and the private sector collaborated to facilitate the accelerated development, iterations based on industry feedback, and adoption of suitable innovations in the care delivery systems. Consequently, there was availability (in vernacular languages) and uptake of information as well as home-based monitoring solutions to address the pandemic. Such shift to digital settings would have otherwise taken years to establish in mainstream healthcare. Simply put, the distancing norms, necessitated by the pandemic, paved the way for adoption of digital solutions.
So, the pandemic did throw up opportunities for new ways of doing things… Going forward, what will be the new trajectories for healthcare delivery systems?
In the first response to the pandemic, the government, philanthropic institutions and private sector put out urgent calls for curation of scalable innovations. There were calls for procurement of protective equipment from manufacturers across India. However, the most difficult challenge was for the devices and diagnostics sector. The journey from innovation to market is dependent on clinical safety, efficacy, and regulatory approvals. This is the phase when enterprises spend maximum time and money before their products hit the market. And, the success and completion of these steps are mandatory for adoption and clinical protocol. However, for digital solutions, the pandemic offered a great opportunity as it could crack the decades-long inertia of the healthcare system. The wearable-based diagnostic aids and automation for remote monitoring became part of the clinical protocols. The government also gave primacy to the direction by introducing the National Digital Health Mission to build digital architecture and Ayushman Bharat announcing the first market-access cohort — all these efforts working in the direction of integrating this pool of innovations and upgrading our health systems to provide timely access and high-quality care across geographies. The government’s focus on technology to drive healthcare solutions has been one of the positive outcomes of the pandemic. So, now there is an opportunity to truly democratise access via technology that would benefit a large swathe of the population, including the underserved sections in remote areas.
The umbrella term ‘healthcare’ is the meeting point of our health goals, socio-demographics, the health systems, i.e., the public and private sector, the entrepreneurial ecosystem and the markets influenced by policy and advocacy initiatives. Promotion of impact innovation and entrepreneurship requires collaborative partnerships with society, markets and state (SAMAAJ, BAZAAR and SARKAAR). A cross-industry collaboration focused towards rapid venture acceleration and clinical integration of Digital Health Tech is in the works at Social Alpha, and will soon be launched.
How have healthcare startups kept pace with the new trend?
We are seeing an increased focus on providing a digital framework to innovations in Social Alpha’s pipeline — the new age hardware devices are enabled with easy-to-use software and are progressively moving towards automation by building ML / AI tools in R&D pipeline. The objective is to provide affordable, accessible (remotely if needed) and high-quality care and it is in sync with the most important problem statements of primary and specialised healthcare. For instance, SA’s portfolio company AI Health Highway is using its digital stethoscope technology to provide access to remote care to over 3000 industry workers at their work site. Blackfrog Technologies, another portfolio startup, is building last-mile cold chain transport solutions that can enable vaccination coverage, monitoring as well as reducing wastage of vaccine. Ubiqare Health provides tele-healthcare solutions for a tertiary care hospital to maintain the continuum of care and treatment of its patients in home-settings. Nurithm Labs is providing solutions to assisted diagnostics for oral cancer and 140-plus skin disorders by way of image analysis. TrustCircle is able to provide access to mental healthcare services via a platform, overcoming the barrier of physical meeting with a therapist. Most of these technologies are using the basic setup of a smartphone and a specialised software — with or without a specialised device. These innovations are augmenting the current capabilities and capacities of our healthcare workforce. So, essentially, by way of technology, we are freeing up hours of practice of the healthcare workforce to focus on human-to human care and deliver more important information to the patients and their families rather than focusing only on carrying out documentation of diagnosis and treatment. For the patients and their families, technology can eliminate the barrier of travel, waiting-room hours and the indirect costs towards accessing a short consultation, and also easily maintain the continuum of medical care by accessing follow-on consultations from home.
Portfolio company AI Health Highway is using its digital stethoscope technology to provide access to remote care to over 3000 industry workers at their work site
Healthcare is now moving towards the primary care model again, where we are deploying the capabilities of our healthcare workforce onto the field (community) and the primary healthcare centres, rather than directing them to tertiary healthcare centres. So, healthcare is now moving closer to the homes of people in remote settings rather than calling patients to a centralised facility for care.
So, with digitisation becoming the buzzword in healthcare delivery systems, are we seeing increased adoption of digital innovations benefitting the end user?
We are at an inflection point and have to still facilitate the actualisation of the abovementioned benefits because only when the innovations are integrated into the new normal, we will see the full scope of benefits. There are multiple challenges on the way. The most common barrier to adoptions in the ‘market’ environment pertain to:
1) Financial considerations:How much it would cost to procure/build the infrastructure to host these innovations, and keep them running? ‘Price’ remains a key constraint, so the design and development of the technology has to optimise for affordability continually.
2) Commercial procurement considerations: What is the cyclic cost saving and added utility benefit compared to conventional / international brand? What are the essential and good to have regulatory approvals for these innovations? While ‘pilots’ opportunities come by frequently, translation into revenue remains a challenge.
3) End-user resistance: The behavioural-shift challenges are more likely to influence the success and integration of solutions. Behavioural shift operates on two levels: One, is for the healthcare workforce to adopt these innovations into their daily working. Even more crucial is their participation in the continuous development and iterations of these technologies to keep them relevant and contextual to the current healthcare system as well as its future trajectory. 
The second behavioural shift depends on the consumers’ adoption of technological tools to keep pace with their health and wellness goals. So, what we are looking at is a potentially sustainable marketplace where healthcare service is not just procured in a hospital but also in an online setting. The individual chooses to use data or process their own data towards personal health goals, continually and collectively reducing the ‘healthcare burden’ and avoiding escalation to an acute or emergency situation.
4. Unlock maximum value by minimum disruption: While disruption is celebrated in innovations ecosystem and ‘ease’ of use helps the uptake, but it’s the value created for the engaged stakeholders and the target market that dictates the market share. ‘Shared Success’ and socio-economic opportunities for the community realise and secure success for entrepreneurial ventures.