(ED NOTE: It is interesting to see how mHealth is faring in other parts of the world; this author, Ruchi Dass MD,  is a recognized tech leader, mHealth Evangelist in India)


April 17th, 2014

According to you, how is mobile phone penetration transforming healthcare landscape in India?

While the Government is building more and more hospitals, the gap between the patient-doctor ratio is huge. For the next 20 years, the infrastructure will not be able to match the growing population of India. Hence, the next step is to create a model where one hospital supplies its service to 10 -15 nearby villages through the use of technology. Technology facilitates remote patient monitoring, enables safe data collection and dissemination, while reducing service costs. To give a data point, every citizen in rural area has to travel a distance of 20 kilometers to avail healthcare facility. The need is to decrease the travel time, decrease the cost and make it more affordable and convenient. For this, the government started disseminating information and awareness through mobile phones. It also started educating rural citizens about the various free campaigns being conducted in their district. Also, today the mobile phones worth only Rs 5,000-6,000 have smartphone capabilities. One can run apps that tell us if a person has got flu or not. This has empowered the rural population too.

Please give an example of how technology is improving the quality of healthcare services in rural areas?

I truly believe that the future of healthcare is tied to efficient use of technology in healthcare. For example, there are a host of companies that use technologies to maintain patient records and transfer those records to tertiary and secondary hospitals to get them best aid in their villages. Take the case of a rural person suffering from a heart ailment, which is non-curable without a surgical intervention. If the person is informed about the treatment, the doctor and, the hospital or clinic can proceed with the treatment. This is possible provided he is diagnosed on time and a doctor is referred to him. There are a few companies that collect data of these patients through electronic records and refer the patient to the local physician, or center where the ailment can be provided. These services are on cloud and are available for the doctors who can review the data and can suggest the cure.

Mobile technology is propelling innovation in healthcare. What is your perspective?

Mobile technology is definitely exciting innovation in healthcare and is poised to play a significant role in healthcare. Take the example of Doctor SMS, a service launched by Kerala State government. The idea behind this service was to disseminate information regarding the free polio drops and government campaigns. If a person needs a doctor, say for example a heart specialist, then one just needs to send a message to a particular designated number in a stipulated syntax which is pin code, state, specialty, where you live and then the individual receives the SMS with all the government empaneled clinics or hospitals where the treatment is provided fee of cost or is provided at a subsidized rate. The person also receives any information regarding government camps.

Could you brief us about your Mediphone initiative?

If a person is at home and does not have access to the doctor, but wants a prescription say for a baby who is ailing and weeping the whole night, then he can avail the Mediphone service. With this service, one can call 54444, and get connected to a panel of doctors. The panel will ask you questions, which comes from the 25 years of experience of this mediphone software. They will, for example ask, if the baby has headache, nausea, and yellowness. One can then provide further information and have the problem diagnosed. This decreases the doctor’s time to give a prescription. Also, often when one goes to a clinic, a doctor might miss a question due to human error. However, through mediphone service, this is eliminated and one gets proper advice and medication. After the problem has been diagnosed, one receives the SMS at the end of the call, which is the prescription and the same is also e-mailed to the patient. This is as good as a doctor’s prescription and then the patient could pass-on the SMS to the pharmacist and ask for a home delivery. This is very effective for lower middle class and for upper rural class as one gets a prescription for just Rs 55, which would have otherwise cost no less than Rs 250.

Can you tell us about the challenges with portable devices and what hampers the uptake of these initiatives?

Policy is the primary concern; at the policy level use of such devices and Big Data handling, medical data analysis and portability is not yet defined. As the protocols are not defined, some of the portable devices create a lot of security threats, mismanagement of data, and false reporting of data and treatment. Challenge for policy not being defined is the lack of evidence — people do experiments in silos and no one puts them into central records for the government to see what works or what fails. Thus, many innovations die out due to lack of visibility, funds, support and no business models. Secondly, if we connect a medical device to Bluetooth then the data that we receive is mostly noise. The effort to separate that noise from usable data is a challenging task, so somebody has to look into the framework of the infrastructure. Right from the policy level to statutory level, to standard protocol and operating procedures, the entire system is very complex. Hence, need for standardization is required. Also, doctor to patient ratio is another challenge. Doctor-patient ratio varies significantly from area to area — in urban area it would be somewhere around 1:8 and in rural areas, it is very steep. Imagine a situation where a doctor transfers data from Glucometer to a Big Data center, but the doctor has no time to look at that data, then what will one do of that portable device? We need to create an education pool or hub from where this education can be pooled back to the patient when he sends the data.

Please shed some light on the role of analytics in mHealthcare?

Business Intelligence plays a crucial role in mHealthcare. For example, with BI we can determine the need for a certain product in a certain area, and also get to know which areas are averse to a certain product. Then we can plan our policies, programmes, campaigns and bring the reconfiguration to the process. To give a data point, Narayana Hrudayalaya Institute of Cardiac Sciences in Bangalore uses some of the advanced analytical tools on daily basis to analyze which department performed well in terms of margins, and which department had more influx of patients, and there is a gain and return policy in place.

For example, if you want to make 25 percent margin on your daily services and you have achieved that, then whatever you earn you try and subsidize the cost of treatment so that more number of people can afford it. Narayana Hrudayalaya Institute of Cardiac Sciences does this on only daily basis, thus providing services at an affordable price. Also, pharmaceutical companies use a pill reminder service, which provides complete details about patient data — which disease the patient is suffering from, which doctor treated him, which drug was he prescribed and in which area.

Then with a histogram mapping of the whole country, it helps them know which company’s drugs do well in which part of the country. It helps pharmaceutical companies understand the whole supply chain management.


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