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The Health Connection

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At the Philips Innovation Campus in Bangalore, you may be pardoned for believing that the engineers are experimenting with science fiction. Consider this: the ubiquitous wearable devices and fitness trackers such as Philips DirectLife or FitBit, that help monitor the number of calories you burn, will, in their new avatar, be sending messages about your health, daily to a data centre. What’s more, they will be communicating with all other machines in your house and outside. So while you drive the car, a sensor tracks your blood pressure and scans your retina constantly and sends this information in to the cloud servers off the premise of the hospital database, operated by Philips, GE and Siemens and maintained by service providers like Cognizant, Infosys and Wipro. If there are variations in the heartbeat, then a message is triggered by the network in the car to the house. But that is only in case of an emergency. Then when you arrive home, the app of the wearable device connects to your smartphone via Bluetooth or wi-fi. It will tell the air purifier to cleanse the air to make breathing easy and then it will instruct the coffee machine to make your favourite coffee. Sit down on the sofa to relax and the lights in your house will know what ambient light is best suited for the situation. Then before you make dinner you open the app and input your eating habits for the day. Meanwhile, all this data from your app will be collected at a data centre, which with your consent will be shared with your personal physician or the hospital that your insurance company has tied up with.
 
All this is likely to become a reality pretty soon. Welcome to a world of connected medicine where different medical devices will be communicating with each other helping monitor your health. Now with the government allowing FDI participation in the manufacturing of medical devices, the direct benefit is for the large established MNCs here in India. Needless to say, medicine as we know it, is soon going to change and companies such as Philips and GE Healthcare are looking at spending Rs 600 crore each, according to sources, on research and development to grow in this sector. However, it is left to be seen whether the cost of care will come down if the device, hardware and the software are made in India. Recently the National Pharmaceutical Pricing Authority had written to several firms on importing devices, such as stents and marking prices up. But at least the intent from the R&D side of large companies, is to make healthcare affordable through services and commoditised hardware. 
 
“This is an effort to create proactive health through inter-connected devices. It is also the first step towards the Internet of Things,” says Srinivas Prasad, CEO, PhilipsInnovation Campus.
 
The Internet of Things (IoT) is a term coined by technology consulting companies and refers to a situation where every machine will either speak to each other or will allow access to the Internet. Prasad believes that in the medical devices world it is the consumer wearable technology that will be hogging the lime light in the race towards the IoT.  
 
“Class two and three devices such as ultrasound and photon therapy machines will take some time before they can communicate with each other, although technically they can communicate with each other today,” he adds.
 


In the medical world, IoT can also include industrial Internet, where all diagnostic machines will be communicating with a central server. This data can then be used for remote monitoring of patients. According to a Gartner report there will be 26 billion units forming the ecosystem for IoT in 2020 as compared to 0.9 billion in 2009 – a 30-fold increase. Further, according to McKinsey, the wearable medical device market is currently $4 billion in size in India and is expected to grow to $7.8 billion by 2020. A report by McKinsey also adds that a growing and aging population is driving higher disease prevalence and the need for associated medical devices in India. For example, the patient pool for congestive heart disease in India will grow from 45 million patients in 2010 to 60 million patients by 2015. It adds that since the insurance market in India is rapidly growing, with 45 per cent of India’s population expected to have some form of insurance by 2020, up from 25 per cent today, devices will play a major role in capturing medical data of customers.
 
Connected Devices
GE Healthcare is already betting big on connected health in remote areas. There are 70,000 Public Health Centres in India and none of them are connected to hospitals. “They need to be adopted by the larger hospitals if healthcare has to be delivered. The technology is already there,” says Mohandas Pai, Chairman, Manipal Global Education and also a private investor.
 
GE Healthcare is piloting an Android-based ultrasound tablet device, developed in Bangalore, in rural Bangladesh for real time capture of foetal information. Philips completed a pilot test in northern Karnataka in 2013 of a similar device. These tablets can scan continuously for half a day on a single charge and are connected to hospitals systems via 3G and wi-fi. The images are transferred in to a central cloud and delivered to hospitals. Both these tablets can be fitted with external dopplers or foetal probes to scan images on a real time basis. The information is collected by trained mid-wives and is remotely monitored by doctors in cities.
 
Similarly, a mobile glucometer can be connected to tablets and the information can be sent back to the city hospital’s gynaecological expert.  Philips and GE are also devising ECG machines that are getting smaller every year. Philips, for example, is working on a 10-inch long and 2-inch wide ECG machine which is connected to a tablet to capture information. The reports are also instantly emailed to the patient’s tablet in PDF formats.
 
“Technology is no longer a barrier to delivering care, it is about how the business model will evolve with all the stakeholders in the medical eco-system,” says Vikram Damodaran, Director, Healthcare Innovations, GE Healthcare. GE is globally pioneering the ecosystem of talking machines or the industrial Internet. It is creating a robot system to sort and sterilise surgical tools. All this data coming from machines will be collected and analysed for predictive maintenance on behalf of hospitals and care centres.
 
Companies like AltenCalsoft Labs are building android-based glucometres for India and are pitching it to pharma companies. The glucometre connects to the app via Bluetooth and sends all the information to the hospital. “These products have a great potential to bring healthcare costs down in emerging markets like India. Now only a regulation and ecosystem should come in place to understand how data will be shared and protected,” says Somenath Nag, Director- ISV and Enterprise Solutions, AltenCalsoft Labs in Bangalore.
 


However, speaking from a connected world perspective, Indian hospitals still have a long way to go. First and foremost, they need to connect their patient medical records and only after that can they focus on machine-to- machine and consumer to hospital connections. “Today it is only device to mobile device communication that is spoken about the world over, however the Internet of Things is going to grow very rapidly and a citizen lifecycle tracking system will emerge in the medical field,” says Nag.
 
According to Siemens India, the demands of hospitals are changing. Given the rapid growth in data volumes and the growing need for interdisciplinary cooperation, data exchange and networking solutions are becoming more and more important. Siemens has developed a concept to help hospitals manage information in a range of formats and from a range of sources – images, laboratory results or physicians’ reports – and make it available across all institutions and sectors. With Unified Information Management, Siemens combines archiving and networking solutions depending on specific customer requirements. The solution is so scalable and flexible that it can connect, for instance, hospitals, physicians and patients, potentially leading up to fully digital care processes.
 
While such hospital networks are also built by Philips and GE, it is their leap of faith on mobile phones and tablets which can change healthcare in India. “These devices enable two things; an increase in reach which will enable an increase in healthcare outcomes,” says Damodaran of GE.
 
Hospitals & Connected Devices
Even though current day doctors have all taken to iPads to jot down patient information, hospitals are still not spending much on technology to create a connected eco-system. Consider this: on an average an Indian hospital spends only 0.85 per cent of its revenues on IT. For Indian hospitals today, connecting the hospital information management and electronic medical records to the cloud is the first big step and some hospitals are working towards it.
 
Take for instance, Bangalore-based Narayana Hrudalaya which is integrating 22 of its hospitals into the private cloud. The hospital is increasing from a 5,000 bed hospital to 30,000 bed hospital and is thinking of integrating everything from the vendor management system to the hospital information management system into the cloud. “I cannot give you the exact investment but we saved at least Rs 30 crore by not building an IT infrastructure in each hospital,” says Srikanth Raman, CIO, Narayana Hrudalaya. He adds that his task was to make sure that right from the entry of the patient to the heart procedure all the information was seamlessly captured. “Our next bet is on big data and mobility as it will tell us about whatever is happening in all our hospitals on the go,” says Raman.
 
Narayana Hrudalaya outsourced its entire private cloud to HCL Infosystems in 2012. Many of these large hospitals have operations in tier-2 and tier-3 cities where it is critical for technology to link to an expert’s second opinion. Bangalore-based Manipal Hospital which has 14 hospitals is creating short-term and long-term plans for the roll out of technology. “Five years ago the term CIO was a new term in Indian hospitals. We are now creating a road map that can make us a world class hospital in technology usage,” says Nandakishore Dhomne, CIO at Manipal Hospitals. He adds that doctors who work in intensive care units, from various locations need to interact with each other on a real time basis if they have to provide the best care and technology in isolation cannot help them. Dhomne solved his hospital’s problems by working with Wipro to define the hospital’s business through critical levels and modules. His team listed 1800 problems and solved them in buckets of 25 modules and 58 specialities.
 
Apollo Hospitals, which currently has 27 hospitals, is integrating the hospital information systems of each of its locations into one system. There are experiments to integrate over 50,000 doctors by using devices and tablets. The hospital has invested Rs 30 crore on the same. “We need an information highway and we have started a project that will create a connected hospital. In this journey our first hospital is already paperless,” says Umapathy Panyala, CEO, Apollo Hospital, Bangalore. Indian IT service providers like Wipro, Infosys, HCL and Cognizant (based in the USA) see big business coming from connected devices and hospitals. “Connected medical devices provide healthcare professionals  the ability to share data with other members of healthcare staff or those in the healthcare ecosystem, often in real time, both inside and outside the confines of the medical establishment,” says Sairamkumar Jayaraman, Global Delivery Leader, Life Sciences, Cognizant. He adds that this real-time connectivity has tremendously enhanced the healthcare services and experience for patients and providers, especially in their ability to attend to emergencies in a timely manner. Take for example, a geriatric patient who has all his vital parameters continuously monitored and recorded in a device. The device could then be programmed to alert the patient’s healthcare provider in real time, if any parameter were to move out of the prescribed range. It is possible that the patient may not experience any ill effects, but the provider would be alerted, who, in turn, could contact and alert the patient, and recommend immediate care before the patient is possibly advised to travel to the nearest care facility.
 
In the above example, services would be provided by the medical device manufacturer, mobile device manufacturer, the service/network-provider to enable connectivity, emergency responders, and others. And that is the crux of the matter. The ecosystem, for connected devices, needs to have several stakeholders to come together (see graphic) for it to work. The devices could be sold by pharmaceutical or insurance companies who then will connect the customer to the hospitals. Once a patient consents, the hospitals will tap into the information stored in the cloud and will use analytics services from GE, Philips or Siemens to provide care to the patient. Remember that this is a scenario where everything works including regulation and adoption of technology. At least, one part of the equation is solved for low-cost delivery of services with the government allowing 100 per cent foreign equity participation in the manufacturing of medical devices. Now the infrastructure, broadband and new generation telecom networks, need to be put in place to deliver pre-care and post-care services in rural regions. The science fiction part will become a reality only when healthcare costs drop because of the reach and scale provided by technology. The numbers are on the side of technology for providing the reach; whether the cost of drugs will ever come down is a never ending debate.