September 10, 2018

A Guide To Patient-Centricity: Solutions Addressing Real Needs

Commentary
Chandana Fitzgerald
India is the world’s fastest growing economy - it is no surprise that the Indian healthcare market is going to rapidly rise in value over the next years from $100 billion in 2015 to $280 billion by 2020. The large size of this market has led to simple, mindful digital innovations that are unleashing the power of technology to fundamentally change how patient care is delivered in India. These innovations span across a wide range of areas such as telemedicine, appointment management, e-pharmacies and adherence tracking.

Telemedicine for access and for urban hustlers

Have you had a cold, but you are super busy, and don't want to be stuck in choc-a-bloc traffic driving to the doctor's clinic for an hour? Enter - the urban Indian working professional and their need for telemedicine.

One of India’s core healthcare challenges is that it has the lowest number of beds and doctors per 10,000 people across all the BRIC countries. This healthcare accessibility challenge is exacerbated by the urban-rural divide. 60% of hospitals, 80% of doctors and 75% of dispensaries are located in urban areas that service only 28% of the population. The vast area and population of the country makes it difficult to provide access to quality healthcare to all areas. But, Indians have mobile phones and they want to use them. Telemedicine offers significant hope of improved healthcare accessibility and quality to rural India.

India Healthcare Accessibility - The Urban/Rural Divide
India Healthcare Accessibility - The Urban/Rural Divide

As an Indian, I know it gets my goat if all that we associate with India are the rural problems. Urban India, with world-class hospitals and treatment facilities, has busy individuals pressed for time - telemedicine to the rescue. Either through real-time interactions via video-conferencing, or through asynchronous models that capture patient and disease-related information through dictation, photos and videos, patients can simulate an actual visit to the doctor without having to do so.

A public-private telemedicine partnership between the government of Andhra Pradesh and Apollo Hospitals has delivered promising results. It facilitated 1,898,170 consultations and 123,596 specialist tele-consultations in the space of 18 months.

According to research, only 15% of patients who visited telemedicine clinics found it necessary to visit a hospital for further treatment which indicates that 85% of patients felt that their issue was properly dealt with during their telemedicine consultation.

However, the telemedicine market in India still has huge untapped potential. India has approximately 26,000 Primary Health Centres (which are the backbone of rural healthcare) and less than 10% of these centres use telemedicine.

E-Pharmacies: India knows mail-order!

The growth in the e-pharmacy market is being driven by the rise in the number of Indians suffering from chronic clinical conditions coupled with the increased convenience and access that such services provide for customers. In 2018, the Indian e-commerce market is projected to grow by 31% to reach $32.7 billion.Offline pharmacies have left customers with much to desire:32% of customers say that medicines were dispensed by an unqualified pharmacist.63% of customers say they do not receive proper counseling on the administration of medicines at the pharmacy.48% of customers visit multiple pharmacies to purchase the required medicine.Online pharmacists can solve these issues through a variety of means, such as their ability to stock a much wider range than local pharmacists, their ability to access tier 3 and 4 towns (think small towns of population <50k) which have a dearth of pharmacists, and their ability to provide authenticated and trustworthy services to people all over the country.

Medicine Delivered

Take for example 1mg who are speaking at our Global Gathering in Mumbai on Nov 1. Not only can you order OTC and prescription meds online, but also order lab tests (phlebotomist comes home, collects your blood sample, and results are delivered online - voila!) and also consult with physicians on their platform.

Caredose creates proprietary technology and packaging products to promote medication adherence. Medication is delivered pre-organised by dose, each dose is labelled with the exact dosage directions in vernacular languages. They track the pills back to the manufacturer, and track patient consumption - an end-to-end solution, indeed. Very slick.

Partnerships are another way that digital health companies are providing an end-to-end service. One of India’s leading healthcare technology companies Practo, partnered with Uber to make it easier and less stressful for patients to make their appointment.  When a patient books an appointment on one of the Practo apps, they are able to see the closest uber available when they get their reminder notification. Users can then click on the notification and complete the booking process. In addition to receiving the estimated fare and how soon the the Uber will arrive, the doctor’s address is pre-filled automatically to simplify the process for the patient.

By engaging in these partnerships, companies like Practo are trying to provide a solution in one place that comprehensively covers all the patient’s needs in a customer-centric manner - from assessing health issues, finding the right doctor, getting to an appointment, booking diagnostic tests, purchasing medicines and learning about healthier ways to live.

Artificial Intelligence, Wellness, and More

I’ve never been one to be so wowed by AI and ML - too much jargon, so much hype. But let’s take a step back and think about how it may actually attain meaningful potential in a society like India - lack of skilled doctors for the population and geographically disparate populations.

Breast cancer screening is one example worth noting. In India, one out of every two women diagnosed with breast cancer die within five years (compared to one out of every five in the USA). A lack of early detection is the reason for the high breast cancer mortality rates in India. This lack of early detection is due to the lack of facilities, radiographers and the cost of regular screening (which is unaffordable to some). Breast cancer has overtaken cervical cancer as the leading cause of death from cancer among women in India.

The Bangalore based startup Niramai is using machine learning algorithms, data analytics and thermal image processing to improve breast cancer diagnosis. Niramai uses a low-cost device that takes high-resolution thermal images which require no radiation. AI is applied to images to detect breast cancer. This provides a cost and time-saving alternative to traditional mammography. In India, cost is one of the factors that discourage women from undertaking breast cancer screening. Niramai’s breast scan costs only $22. This cost will fall further as volumes pick up. By comparison, a digital mammography costs around $54.

Cure.fit have received a whopping $174 million funding. Cure.fit offers both digital and offline experiences across fitness, nutrition and mental wellbeing through its 3 products. Cult.fit boasts of state of the art workout facilities to train at - plenty of these springing up all over the country as you are reading this. Eat.fit offers affordable, calorie counted meals in a subscription model or for a one-off purchase (online, of course, to be delivered to your doorstep). Mind.fit aims to bring about a lifestyle change and focuses on relieving day to day stress and improving overall mental wellbeing through yoga and guided meditation via an app.

All this sound very familiar, things you’ve seen before? I bet. But I guess that’s what we wanted you to see - that countries like India are doing all the same things as the rest of the world, dare we say in a more cost-effective (if it is too pricey, you are certainly not catering to the varied demographics that make up India) and scalable manner (bottom up approaches to prevent exclusion of any strata of the 1 billion and growing population)? India is set for digital healthcare, and they have certainly put the patient first.