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November 3, 2018

The Pulse of Digital Health in India

Chandana Fitzgerald
32 degree centigrade, the sun bright in your face in the Northern Hemisphere in November. That's the Mumbai we came to for HealthXLs Global Gathering with Abbott. Bang in the middle of Embarcaderoseque Bandra-Kurla Complex, Trident BKC is where healthcare leaders from India and abroad came together to discuss healthcare in India in its digital era. The healthcare infrastructure in India is mixed- some state of the art, planned centers and some understaffed and unequipped centers, lack of clear regulatory guidelines, varying demographics and affordability among its people, a booming economy with a burgeoning population. A mammoth challenge at hand indeed. HXLGG participants were more than ready to embrace it.  

Patient Centricity: India Has Made the Patient its Most Important Consumer

We decided to focus on topical issues and solutions to the Indian society. One thing India has done extremely well is catering to patients as consumers. The benefit of a tech-empowered population is that patients are very ready to partake in their health via e-means. Mail order pharmacy, e-prescription, e-diagnostics, e-health education are all things India has championed and mastered. When you have a large population, guess what you learn to do well - supply chain management, scalability and affordability. All our speakers and panelists on the patient-centricity session echoed these ideas.

Opening the day was Gaurav Agarwal, CTO of 1mg, India's largest platform for healthcare e-commerce. 1mg allows end-to-end management of a patient's wellness/ sickness journey - from e-consults, to e-prescription, home delivery of meds, and e-diagnostics.

Naiyya Saggi, CEO of Baby Chakra, the bundle of energy that she is wowed the audience with how her online platform for mums to be and infants has truly impacted increased antenatal awareness and care, and made the journey through pregnancy less stressful for the mother and ensured better breastfeeding, weaning and nutrition practices for the baby.

Dr Ram Narain, Executive Director of one of the top tertiary centers in Mumbai, Kokilaben Hospital, highlighted the gaps that exist in the way providers are currently delivering healthcare in India (comparing the hospital industry with the aviation industry, he drew how hospital committed errors have led to more deaths than aviation accidents). Technology could bridge those gaps - India has good technology and great people (providers). The focus needs to shift to educating patients on their wellness and sickness in the times between visits to decrease the dependency on the 'hospital' or the 'doctor'.

What ensued was a gripping panel discussion where the above folks were joined by Sachin Malhotra, CEO of TC4A and Raghu Gullapalli, Exec Director of Emerging Technologies at LVPEI. The panelists were all in agreement about what constitutes a 'patient-centric' solution in the context of India - that affordability and scalability are key. While Sachin emphasized on how many of the frugal innovations from India can be exported to similar settings and this is a shining example for the world, Raghu spoke of how they're taking tertiary care to the hinterland.

Not for one moment should we doubt the quality of offerings in India - the panelists hammered home that evidence of efficacy and validation of various technologies is a must and that this cannot take a backseat in the name of making a solution more economical. Through their offerings, some of them have mapped out patient journeys so they are able to personalise the offerings to each patient because in India, no two regions are the same in cultural practices/ beliefs, language, etc, and a one-size fits all approach is simply not going to work on a billion people. It is pretty clear to us that in India, patient centricity is not merely 'nice to have'.

The Growing Burden of Non-Communicable Disease

Gerald Jaideep, CEO of Medvarsity, an online education platform for HCPs in India, opened the session on NCDs (non-communicable disease, a.k.a, chronic disease, cancer, mental health conditions etc). Education is what helped Indians become more aware about polio immunization that ultimately led to its eradication in 2014, and it was education delivered via print and AV media several years ago that encouraged people to observe family planning that limited family sizes to two children per couple. What China accomplished with policy, India did with education.

Dr Prof Srinath Reddy, President of the Public Health Foundation of India who also wears many other hats as a researcher, teacher, policy enabler, advocate and activist cast a spell on the audience while he spoke of how health policy in India is changing with the changing healthcare ecosystem. He outlined the Ayushman Bharat program, India’s own Obamacare, just way bigger, and the implications it may have for comprehensive primary healthcare, in expanding service delivery package and promoting wellness, and providing universal health coverage, something India has struggled with over the last many decades due to sheer scale.

Dr YK Gupta, former Dean of AIIMS Pharmacology and the President of the Dept of Biotechnology for India waved the flag for AI (artificial intelligence) and outlined how patient safety while managing their NCDs, better therapeutics for NCDs can be created by channeling data we have on drug history and interactions, nutrition history, and other such person-specific information.

Three strong entrepreneurs, Manjiri Bakre of Oncostem Diagnostics, Abhishek Shah of Wellthy Therapeutics and Ramakant Vempati of Wysa brainstormed over a panel discussion the role for technology to assist in the management of NCDs. These entrepreneurs are the torch-bearers for partnerships and collaboration - whether it is partner labs for novel biomarker detection, or pharma to dole out drug-device combination therapeutics for diabetes mellitus, they spoke of the importance of collaboration between different stakeholders of the healthcare ecosystem. Dr RR Kasliwal, practising Cardiologist and Chairman of Medanta Medcity, a large provider in India, gave a thumbs up to the groundbreaking work that entrepreneurs are doing to make healthcare more empowered with the use of digital. He is a believer and alluded to his experience with using cardiac imaging for early diagnosis and timely intervention as an example for why technology is of utmost importance to Indian providers and patients today.

It isn’t all rainbows and butterflies, though. The panel clearly conveyed that a chasm exists between those designing/ building these technologies and clinicians who prescribe or use them - if Europe and the USA complain of lack of physician adoption and buy in, the burden of the problem in India is much larger.

Digital Health Moolah in India

Sandeep Singhal from Nexus Ventures, and our very own Martin Kelly and Jim Joyce (CEO,Health Beacon/ Director HealthXL), sat together in a casual discussion on the investment landscape for digital health in India. Sandeep, through his work in Silicon Valley (USA) and Silicon Valley + beyond (India) drew comparisons, and spoke of the need for more doctor-entrepreneurs and doctor-investors in India. The blossoming intersection of business, tech and healthcare that exists in the USA, making it ripe for investment is only nascent in India. But having said that, there is growing appetite and rupees going into digital health in India. Entrepreneurs, it is more important to first focus on engagement, and monetisation will follow.

Big Data for Improved Patient Outcomes: Case Studies from India

The size of the Indian population creates many problems, but it also generates tons of data. If harnessed properly, such large amounts of data have the potential to guide many healthcare decisions.

In the final session of the day, Arvind Sivaramakrishnan, CHCIO of Apollo Hospitals (an integrated healthcare services provider and has a robust presence across the healthcare ecosystem, including Hospitals, Pharmacies, Primary Care & Diagnostic Clinics), suggested that healthcare is definitely late to the digital party in India. But Apollo hospitals are ahead of the pack - using big data analytics, they have created India specific CVD risk scores based on hundreds of thousands of patient data points, and several risk factors. This is an important milestone as existing CVD risk scores (such as Framingham) are not wholly applicable to the Indian population.

Nakull Gupta, COO of Everwell, showed us how they are using the abundant data they have collected via their tracking solution as part of the TB (tuberculosis) DOTS program in India. They have identified patterns of medication adherence for better intervention (imagine reducing the number of community visits by a social worker to only those that really need it based on their medication taking patterns).

On the panel was data big-wig Amit Mookim, Managing Director of IQVIA India, Arun Kumar, Head of South Asia for Bayer Environmental Sciences, Kishor Joshi from Teleradsol who are using ML to run imaging analytics. There was consensus across the team on the onus on all parties to share and pool data to have more enriched insights, the importance of collaboration between public and private players because one has the data and the other has the tools to interpret it effectively, data driven insights have reduced healthcare costs and increased revenues. It emerged that there is already some semblance of value based care emerging in India and if we can harness the power of data that we have as a nation (and not just view it as too much unmeaningful, confusing data), the outcomes can be a shining example for the world.

Things We Learned

All in all, a fantastic and stimulating day of discussion and exchange among key individuals in Indian healthcare. HealthXL enjoyed its first Indian rendezvous. And for me personally, it was a wonderful coming together of my Indian and Irish personal and professional lives. Check out the event report below for an overview of the sessions, agenda and some pictures.


Event Report

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