eHealth in India: Advancing on all levels

By Armin Scheuer
02:32 PM

Hyderabad’s airport is a symbol of India’s economic success: organized, modern, efficient. The city is host to this year’s eIndia, the country’s largest ICT event – with a dedicated track on eHealth. The question is, what are the opportunities for eHealth in India? I am here to find out.

Listening to the keynote speeches delivered at eIndia, I am confused. Sangita Reddy, Executive Director of Apollo Hospital Group, for example, shares her experiences of developing and implementing a cloud-based hospital IT system that connects everybody with whom the hospital interacts – patients, suppliers, doctors, pharmacies and primary care, even a group hospital on Mauritius. Dr. Karanvir Singh, CIO of Dehli-based Sir Ganga Ram Hospital, says that their doctors already complete 50% of all medical records digitally –incentivized by the convenience of automatic discharge summaries and a dashboard for data analysis.

Is this India? I ask myself. The country that ranks 134 out of 158 in the Global Human Development Index?

Yes, it is.

In healthcare, as in all other aspects of society, India is divided. Five hundred million people, that is 42% of the total population, live below the global poverty line (BPL) on less than 1.25 USD per day*. For them, the fact that 80% of the Indian healthcare sector is in private hands means “no access”. For India’s upper and middle classes, who account for roughly the same number of people who make up the population of the European Union, it means “world-class healthcare”. It is they who SIEMENS are addressing with their full-page diagnostic imaging advertisement in an onboard flight magazine. And it is they for whom eHealth is made. It is a fact I need to accept in order to free my mind for India’s digital healthcare revolution.

eHealth: A revolution in the making

Because a revolution it is. At least in the eyes of J Satyanarayana, Special Chief Secretary of the Department of Health and Family Welfare of the Andra Pradesh government. With regard to eHealth adoption he says, “We are talking nothing less than transformation, radical and dramatic change – revolutionary, almost.”

India’s private healthcare sector is marketing itself not just to domestic patients, but to patients all over the world. Around 450,000 foreign patients visit the country per year for medical treatment. Cardiology is a major specialty, as well as hip replacements. Hospitals are turning to accreditation agencies to standardize their protocols and obtain the required approvals on safety and quality of care. The likes of Apollo are using eHealth to raise efficiency, reduce medical errors and improve disease management. Their challenges are similar to those of hospitals overseas. But their solutions are not. Apollo did not purchase an out-of-the-box solution from an international vendor; they worked closely with one to develop their own patient-centric IT system, with EMRs that cover the entire continuum of care.

“EMRs from overseas are too expensive and the medical benefits have not been proven yet,” Sangita Reddy says, a fact also highlighted earlier by Mr. Satyanarayana: “EMRs must work in Indian conditions. Are they lightweight and affordable and how much infrastructure do they need?” he asked.

Companies involved in the Indian market should be aware of these “Indian conditions”, developing and implementing their solutions in line with local requirements and capabilities. With international health IT companies such as Tieto or iSOFT operating large developing centers in Bangalore and Pune, the know-how is already available in the country. Reddy is confident that “these smart brains” will now start looking at Indian health IT, too – giving the country’s eHealth revolution its own distinctive flavor.

Solving problems or creating opportunities?

This distinctive flavor is shown by the context in which eHealth is being discussed at eIndia. Given that 50% of the Indian population is below 25 years of age, eHealth does not need to solve the challenges of an aging society, its chronic disease wave or burgeoning healthcare costs. eHealth is here to ensure quality of care and help serve those patients who pay for their healthcare out of their own pocket; Indian healthcare is not insurance-driven. eHealth must create new revenue opportunities: it is more about patient relationship management and less about administration.

“We should be able to send an SMS to our patients at the beginning of the monsoon season, suggesting they increase vitamin intake to avoid fever,” Reddy says. Another delegate explained that their aim was to serve a patient from “womb to grave”. This is the kind of thinking that prevails in India’s private healthcare sector. This is where many of the business opportunities are. But there might be more to come.

India’s six hundred million mobile phone users represent a huge market for healthcare information and research services. The country’s open universities are developing online medical training, ranging from cardiology to acupuncture and even rural medicine. And, finally, with steady economic growth, the government is looking into ways of addressing the catastrophic health situation of the BPLs. In the state of Andra Pradesh, for example, a cash-less insurance scheme was introduced for BPL families called Aarogyasri, allowing them to access healthcare in over 1,000 hospitals, clinics and medical services providers in both government and private facilities. The scheme is believed to have saved more than 450,000 lives since its inception in 2007.

I now understand that, as far as eHealth is concerned, solutions for the country’s booming urban middle class cannot be the same as for the rural poor. European equality thinking does not apply here. Rather, eHealth must address the unique problems at each level of society; at BPL level it will remain a pipe dream for years to come. For now, I am excited to see how eHealth is going to revolutionize India’s private healthcare sector. Sangita Reddy expects that in a couple of years we will be looking at India and saying: “They are very smart in the way they handle their healthcare,” and the country will be able to provide healthcare to everybody. Given the declining, but still massive poverty displayed on the streets of India, this is hard to imagine. But fifteen years ago, when I first visited India, an airport like Hyderabad’s was also beyond imagination.