The health care system in India has always been a system with paradoxes. As of Jan 21, India had a population of 1.4 BN people, 1.29 BN Aadhaar digital biometric identities, 1.1 BN mobile connections, 761 MN smartphones, and 624 MN internet users (45% of the country’s population).
No doubt, the country has made great strides in:
- Informational Technology Development and Outsourcing
- Cloud Computing
- Financial Technology
- Adoption of ICT in sectors like Banking, Railway reservation, Commerce and Industry, etc.,
- Near-universal Mobile phone Penetration
- Universal availability of Unique ID Systems, and
- Evolving Privacy and Data Protection Laws
We would probably consider these as very strong signs of a developed / advanced nation. But, Despite all such developments, India’s:
- Digital Health Ecosystem is in nascent stages
- Health data is mostly not digitized or not standardized, not interoperable, and not readily accessible to Clinicians, Researchers, or Policymakers.
- Healthcare sector receives low public spending (~1% of GDP)
Healthcare is considered an integral non-income component in any measure of economic development. India’s Digital Health Mission seeks to challenge and change the health care system in India.
Source- IHME, National Health Profile 2018, OECD Statistics
Strides to Improve Quality of the health care System in India
Addressing the poor level of health outcomes will be foundational for India’s progress. Efforts to improve the quality of care are particularly challenged by the lack of reliable data on quality and by technical difficulties in measuring quality. Ongoing efforts in the public and private sectors aim to improve the quality of data, develop better measures and understanding of the quality of care, and develop innovative solutions to long-standing challenges.
The National Digital Health Mission has set up powerful objectives to accelerate progress towards UN Sustainable Development Goal 3.8 of Universal Health Coverage, uplift the healthcare scenario and improve the quality of care.
The objectives are to:
- Establish Digital Health Systems and Managing Health Data.
- Improve the Quality of Health Data Collection, Storage, and Dissemination.
- Provide a Platform for interoperability of Healthcare Data.
- Fast-track creation of updated and accurate health registries for the entire country.
Spanning across Personal Health Records, telemedicine, and E-Pharmacy- the new healthcare shift is offering promising opportunities.
The New Healthcare Paradigm, the Vision and its Players
The improved health outcomes would bring increased productivity and in turn, an additional benefit of $200- $250B to India’s GDP” over the next ten years*.
*Source: Boston Consulting Group
The Key players in this paradigm shift are Government, Health Professionals and Insurers and an Emerging breed of Health-Tech startups (to play an increasingly central role in driving innovation. The Digital Health Mission is already creating multiple opportunities, both at the macro and micro levels.
Let’s have a look at some stats-
- The Digital market of health care system in India stood at US$ 116.6 BN in 2018 and is expected to increase to US$ 485.4 BN by 2024 (CAGR of 27.4%).
- Digital Health and Technologies are creating capital investments – in 2019, 53% of angel investments were made in healthcare. Q1 2020 saw a 50% rise in deal volumes (21 vs. 14 in 2019) and 14% in value (US$ 452 MN vs. US$ 398 MN in Q1 2019).
- Start-ups such as NanoHealth and BeatO are providing/ensuring care for patients suffering from cardiovascular, and hypertensive diseases and diabetes.
- Start-ups such as Netmeds, 1MG, and Myra are already playing the role of pharmacists, threatening the removal of traditional pharmacists from the healthcare ecosystem.
- Karma Healthcare, is providing telemedicine solutions by connecting patients in the remote parts of the country to physicians in urban areas.
- The mHealth (Mobile Health) segment is estimated to dominate the market (with 40% share) by 2024, as a greater number of people are likely to use health & fitness apps to track and monitor daily activities, thereby propelling the market growth.
- Medix Global, a London-based innovative digital health management solutions provider is setting up a pan-India digital infrastructure for telemedicine and offline medical solutions.
- Medix Ventures, a venture capital fund of the Medix Group is also investing US$ 20-30 MN in innovative medical tech start-ups, with a focus on India to promote digital med-tech solutions
- Start-up HealthPlix is focusing on making convenient clinical practice by digitizing instructions associated with prescriptions for patients beyond metros and tier-1 cities
- com is providing services to international markets by connecting cancer patients to distant specialists and facilitating sharing of standardized reports between patients and oncologists.
The Health care System in India- A Roller-Coaster Ride
However, India continues to highlight multiple paradoxes and challenges within the healthcare sector. While there is a simultaneous success and failure, healthcare is clearly on a sustainable edge.
Sources: OECD.org, National Health Profile 2019, IBEF blog, BusinessToday.In
India tremendously lags in quality of medical care, with relevant information at point of care also lacking.
- ~2.4 MN Indians die of treatable conditions every year, the worst situation among 136 nations (The Lancet).
- India’s death rate (122 per 100,000) due to poor care quality is worse than that of Brazil (74), Russia (91), China (46) and South Africa (93), and even its neighbours Pakistan (119), Nepal (93), Bangladesh (57) and Sri Lanka (51).
- Apart from poor quality care, insufficient access to care caused a major share of deaths from cancer (89%), mental and neurological conditions (85%), and chronic respiratory conditions (76%).
Fig- Mortality due to poor quality versus non-utilization of healthcare by condition type.
The Opportunity The health care system in India has the opportunity to move forward using the HIMSS EMRAM 8-staged Maturity Model as a roadmap which comprises of 7 levels encompassing everything from Ancillaries to EMR.
The Challenge
Yet, the health care system in India has been grappling with very slow adoption rates of an HMS / EMR. “Electronic health records were never a technology challenge but an adoption challenge, which only dissolves when clinicians realize the potential of EHR or when there is mandate either from a top management or from the government,” – Prashant Singh, Director, and CIO at Max Healthcare.
The Challenges in adoption were primarily on the financial considerations of high costs of procurement and maintenance. Designing the system without considering fundamentals (e.g. number of clicks just to prescribe a sleeping pill) and well-known standards and medical codes such as:
- Health Level Seven (HL7)
- Digital Imaging and Communications in Medicine (DICOM)
- Continuity of Care Record (CCR) & Continuity of Care Document (CCD)
- International Classification of Diseases (ICD) of the World Health Organization
- Systematized Nomenclature of Medicine – Clinical Terms (SNOMED-CT) published by SNOMED International
- Logical Observation Identifiers, Names and Codes (LOINC)
- Inflexibility of the software; IT Support
- Poor electricity supply and internet connectivity
- Limited digital / computer skills of primary users
- Lack of regulations for privacy protection.
Research-based Evidence
International Finance Corporation (IFC) panel discussion (Sep’20) called out key aspects of EMR in emerging markets.
Challenges and Solutions in EMR Adoption
Understanding Market Challenges
- Global Diversity in EMRs: EMR needs vary greatly across regions. For instance, systems in the USA differ significantly from those required in India or South America.
- Emerging Market Barriers: In countries like Nigeria, less than 10% of hospitals use EMRs. Paper-based processes, low internet penetration, poor computer literacy, and high costs hinder widespread adoption.
Solutions for Effective EMR Implementation
- Flexible and Modular Systems: EMR organizations should provide scalable pricing models like “pay-as-you-go” to make systems affordable. Modular designs allow facilities to adopt what they need without overburdening their resources.
- Interoperability and Standards: Adoption of HL7 FHIR standards can drive seamless data integration. Standardized reporting formats and platform integrations will ensure data efficiency.
- People-Centric Adoption: Successful implementation requires training and educating staff and doctors. Technology alone won’t succeed unless people are onboard.
Key Takeaways
- Technology should empower, not control. Tailor solutions to regional needs for maximum impact.
- Collaboration between technology providers and users is essential for driving large-scale adoption and better patient outcomes.
Ensuring the affordability of EMRs in the health care system in India will be important. Flexible pricing structure for different facility sizes needs to be designed and offered. Cross subsidization across large systems and smaller facilities is another option. This could also be achieved through local government initiatives and funding.
Think global, act local for EMRs
“Think global, act local for EMRs” Use international libraries like ICD 10 and others. Data should be transmittable for research and development. Standards should be global.
Hospitals should be a combination of both digital/paperless and paper based for now. Some services can be completely paperless, but in some, it must be a combination. Hospitals should try to be paperless as much as possible and have a timeline for eventually going fully paperless.
In India’s context, the adoption of EMR has been drastically low. This is due to a) several gaps in the system, b) lack of awareness & computer literacy, c) perceived high cost of implementation, d) lack of technological resources, e) complicated EMR interfaces, and f) legacy issues to adopt new systems. The usage of EMR is limited to the big corporate hospitals in the metro cities and some select states and districts in India
These challenges must be tackled head-on, especially with initiatives like Ayushman Bharat presenting a valuable opportunity for building a person-centered health system. When this system is fully implemented, Ayushman Bharat will be the world’s largest healthcare program that’s digitally driven.
Leveraging the Healthcare Technology Opportunity
With all said, multiple drivers indicate that the Healthcare sector will be the one to create value and impact.
Source: SMERGERS Industry Watch–Indian Hospital Sector
Health IT providers can help their clients address questions by being a bit more in tune with the innovation that is available to them and adopt that in a nimble, agile manner. You don’t have to deploy everything at once, but if you have a vision and implement in succinct stages, I think that will help the market get to where they need to go.
It’s not about regulatory clicks; it’s about care delivery anywhere and technology addressing the cloud, mobility and Internet of Things that will allow patients to achieve wellness through participating in their own health management – moving them along an awareness to wellness continuum.
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