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Entrepreneurial Opportunities In Digital Health

By Kishore Kumar, Senior Vice President, Siemens Healthcare

He is extremely well versed in green field application development by the implementation of the delivery model, and has leaded teams in successful delivery and production of cutting edge, green field software solutions for worldwide customers.

Healthcare in India offers tremendous opportunities for tech entrepreneurs. The vast landmass of our country coupled with the disparity in access, quality and cost between rural and urban centers creates a dreamscape of opportunities for companies with the right attitude and appetite.

Traditionally, healthcare providers (doctors and hospitals/clinics) have been at the center of healthcare. This has resulted in an access issue because good doctors prefer to stay in urban centers. This in turn results in quality issues in rural areas.

The emerging thinking in healthcare places the patient at the center, at least in primary and secondary care scenarios. The skills of the doctors must be brought to the patients in rural areas by some how collapsing the distance between the doctor and the patients. This is what telemedicine does.

In the case of secondary and tertiary care, patients may have to be handed over from one doctor to another for specialist treatment. In this case, all relevant clinical information about the patient must transfer seam lessly along with the patient. This is the vision of the National Digital Health Ecosystem.

Finally, emerging technologies such as artificial intelligence are making a significant impact by shifting healthcare from illness management to wellness management (which focuses on keeping people healthy). Specifically, machine learning enables risk stratification of a population, thus facilitating interventions to keep them healthy.

Clinic-In-A-Box
The contours of telemedicine have broadly become clear in recent years. Startups are working on creating compact, portable point-of-care diagnostic devices such as ECG, blood pressure meter, electronic stethoscope, pulse oximeter, spirometer and many more devices. that are wireless enabled. These devices wirelessly connect to tablets or mobile phones which in turn use 3G / 4G networks to transmit clinical parameters to doctors located elsewhere.

"In the case of secondary and tertiary care, patients may have to be handed over from one doctor to another for specialist treatment"

A typical scenario involves a rural entrepreneur carrying a case with a set of diagnostic instruments (the ‘Clinic-in-a-box') to the patient's bedside. He establishes a video call using his tablet/smart phone with a doctor located in a far away clinic. The doctor examines the patient, after which he instructs the entrepreneur to measure certain clinical parameters, which the entrepreneur does with the instruments he carries in the case. These measurements are transmitted to the doctor over a 3G / 4G network. The doctor completes his diagnosis and prescribes a course of treatment. The entrepreneur collects a fee for the service, a percentage of which is allocated to the doctor / clinic.

National Digital Health Ecosystem
Unlike telemedicine, the idea behind the National Digital Health Ecosystem (NDHE) is both nascent and abstract. The core idea is as follows:

During the last decade, digital payment infrastructure in India evolved in leaps and bounds. Millions of Indians have adopted digital payment mechanisms such as Paytm, Google Pay, BHIM, UPI and other payment merchants. This leads one to wonder if a similar accelerated evolution is possible in the healthcare space. And if so, what shape will it take?

The National Digital Health Mission of the Ministry of Health and Family Welfare believes that such an accelerated evolution is possible, and proceeds to define the building blocks for this evolution. At the heart of this vision is digitized clinical information about individual patients (called Personal Health Records) which can be seamlessly exchanged between hospitals and doctors. You can think of clinical information as the healthcare equivalent of payment information in the financial services space.

The NDHE is enabled by a set of building blocks such as Personal Health Identifier, Personal Health Record, Health Clouds, Health Master Directories, Health Information Exchange, Anonymizer, Consent Manager and several other factors. Once these building blocks are established, it becomes possible for entrepreneurs to build healthcare applications on top of this framework to address a variety of needs such as emergency care, wellness management, public health, medical education, health analytics and a lot of other healthcare  Issues.

                                                                              

AI in Healthcare
While the NDHE keeps the individual patient at its core, health administrators are realizing more and more the benefits of aggregating the health information of a group of individuals with similar health conditions, specifically chronic conditions such as diabetes and hypertension. Aggregated data can be analyzed using digital technologies leading to new insights that reduce hospitalization.

Digital technologies are a new set of technologies that have come of age in the last few years, such as artificial intelligence, virtual reality, internet of things, chatbots and related technologies. Of these, artificial intelligence, specifically machine learning holds out a lot of promise.

Consider The Following Scenario:
From the NDHE implementation we extract clinical information about all chronic diabetic individuals in Hyderabad, including those with kidney failure. We then use machine learning techniques to detect common patterns across all kidney failure patients. Once these patterns are learnt, the system can proceed to stratify the diabetic population into those at risk of kidney failure over the next 1/5/10 years. Healthcare providers can then initiate steps to encourage this segment of the population to stay healthy and track their progress.

The above illustrations are only a small sample of what is possible. The complete set of possibilities is only limited by imagination. As the White Queen said in Through the Looking Glass, you can believe in "as many as six impossible things before breakfast" and they could all come true in Indian Healthcare!

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