In January 30 2020, India recorded its first case for Corona Virus popularly known as Covid19. Since then India has seen a series of lockdowns and as we inch towards somewhat of a partial recovery, the question around the state of our healthcare system has become centre stage again.
Since the 1940’s where the Bhore committee gave its recommendations for developing the healthcare structure in India, as a nation we have been playing catch up with demand far exceeding the supply in terms of doctors, diagnostic equipment, hospital beds and medicines.
In addition the wellness programs have been struggling and preventive measures have not been very successful. In this context the corner stone of the healthcare system in India has become the hospital.
What determines a successful healthcare intervention is patient experience. Today with the advent of telehealth and the guidelines given by Medical Council of India, it becomes even more important for hospitals to focus on patient experience and add to the growth of the industry.
What is Patient Experience?
Private hospitals have long tracked patient satisfaction ratings, but they didn’t always carry great significance. While all hospitals want happy patients, most hospitals have been historically plagued with the “doctor knows best” mentality — a mentality where clinical outcomes outweigh “touchy-feely” indicators such as patient satisfaction or overall patient experience.
However, in recent years, some leading institutions in India have begun to focus more heavily on providing an outstanding patient experience. Drivers for this include growing consumerism and transparency for healthcare services and increased interest from both consumers and providers in patient-centred care.
Why Patient Experience is important to Hospitals?
Healthcare consumers increasingly view their experience with a provider as a key consideration for determining if they’ll return to or recommend the provider, largely because it remains one of the few ways consumers can differentiate providers. Over the past few decades, clinical outcomes have improved dramatically, and patients no longer view favourable outcomes as a key differentiator as these are expected. What remains is the patient’s overall experience, which encompasses everything from customer service to patient-centeredness and care coordination among providers. Also given the growth of Tele Health, it would become even more important for hospitals to focus on patient experience in order to create a favourable experience and create the hook that would bring patients and others in the community back to the hospital.
We are working on a report on understanding the current digital levers to manage patient experience. We will be releasing the report soon.
In the last week of April 2020, a septuagenarian in the state of J&K who was a renal dialysis patient for 2 years, was asked to get his next round of dialysis from a private nursing home as the hospital where he normally went for treatment refused the dialysis procedure since the entire hospital was converted into a COVID care center. The nursing home neither had the apt infrastructure nor the skilled personnel to handle any kind of complications that is common during a dialysis. Unfortunately, the patient died in less than a week. Another dialysis patient in Mumbai had to wait for 7 hours for treatment as he was not carrying his covid test result report. Around 1,30,000 patients are on dialysis in India and most of them depend on private dialysis centers.
In another caustic case, last week, a 25 yr old pregnant woman in Delhi, visited 2 of the leading government hospitals in Delhi for antenatal care. Both the hospitals denied her admission as she was not Covid-19 positive. As a result, she visited 6 hospitals and maternity clinics in next 48hrs before giving birth outside AIIMS. Many hospitals and nursing homes are completely shut even if one case comes up in them.
There are a plethora of such cases rising across the country as our healthcare system is under stress from managing the contagion outbreak. This is despite the fact that the Government of India has asked state chief secretaries to ensure that hospitals and clinics do not ask for a Covid test report from every patient who requires medical treatment. This raises red-flags and serious questions on the local authorities and regulatory bodies who have also threatened to cancel the operating license of hospitals and clinics if they turn away any non-Covid patient. Patients also fear the escalated economic cost if their treatment cost is not claimed or reimbursed as not all nursing homes and clinics fall under health insurance policies.
Similar danger mounts on Cancer and TB patients. India has the world’s largest TB load of 25%. In Mumbai, due to COVID, lack of adherence to TB drug regimen has risen to 40% from 15%. A significant decrease in TB notification has been witnessed which indicated that access to a TB center and subsequent diagnosis and reporting has been severely hit. These are dangerous signs which are being ignored. A TB patient can infect 10-15 more, and such patient can become a breeding-ground of new Coronavirus cases as Covid hits hard on low immunity patients. Many senior oncologists have claimed that due to difficulty in travelling during lockdown, many hospitals not providing regular treatment, hospitals shutting down and fear of contracting covid, have resulted in a delayed diagnosis of cancer patients which can push them to an advanced stage of cancer.
There has to be clear and stringent guidelines by MoH to each state health authorities highlighting the delirious effect of not providing critical care to non-Covid cases. State should ensure that no patient is denied treatment for any ailment by a hospital (government or private). Instead of shutting down the entire hospital even for one covid case, a wiser approach of creating zones within the hospital can be implemented. Online, phone consultation and Tele-medicine modules should be made widespread thorough proper communication channels.
Our healthcare infrastructure is one of the weakest in the world with a lack of adequately qualified health care professionals adding to the woes. We certainly can’t afford to inflict more burden on the already fragile healthcare services by denying treatment to those who are in need.
About the author
Dr Sumeet Kad is a Healthcare and Artificial Intelligence Leader, focusing on leveraging technology to create a model for affordable care
One of the perplexing questions that have baffled technologists for long is why the regulators have not approved the use of teleconsultation for doctors. In the past, I have felt the need for Tele-Consultation or Telemedicine, tremendously to improve care in India.
Here are my reasons
As a doctor, I used to see the 8 hours of works heavily imbalanced. I was free for the first 5 hours of the day but loaded towards the evening. The last three hours and especially the weekends would be packed and I would be overworking at that time. If I had to balance that time well, was If I could equally load the patients throughout that 8 window period. But as I would have to meet the patients and they might require someone to bring them to the clinics.
Our health infrastructure, both in terms of people, beds and devices, is based in the cities. Our rural areas are underserved and they need to make the trip tot he cities for any healthcare service. Sometimes even to take a blood test or an X-Ray. While they might need to make the trip to avail of lab facilities, through Tele Medicine, this problem should be solved.
India needs cheap access to care. Most consultations are expensive as they take into account the investments in infrastructure, rent, etc. With Telemedicine, one has to only pay rent for platform and bandwidth charges. The overall cost of consultation should come down.
While I have argues for this for long, the regulations until recently did not allow for telemedicine or teleconsultation.
The breakout of Covid19 has changed everything. With social distancing emerging as the best defense against Covid19 it is obvious that the next step was the guidelines for telemedicine from the Medical Council of India.
On 25th March 2020, the Medical Council of India along with Niti Aayog has released the Telemedicine Practice Guidelines. The document can be found here
In summary, these are the key areas covered by the document.
Guidelines for Telemedicine in India Elements specific to Telemedicine
Appropriateness of Telemedicine
Identification of RMP and the patient
Appropriateness of technology/Mode of Telemedicine
Patient Consent · Patient Evaluation · Patient Management: Health education, counselling and medication Duties and responsibilities of RMP in general
Medical Ethics, Data Privacy & Confidentiality
Documentation and Digital Records of Consultation
Fee for Telemedicine
2) Framework for Telemedicine
Patient to Registered Medical Practitioner
Care Giver to Registered Medical Practitioner
Patient to RMP through Health Worker at a Sub Center or any peripheral center
Registered Medical Practitioner to another RMP / Specialist
3) Guidelines for Technology Platforms enabling Telemedicine
I would recommend that everyone should read these guidelines. It’s a great read for startups and technology providers planning to build these platforms and healthcare providers planning to develop their telemedicine services.
As always questions and clarifications are welcome.
It’s been two weeks since India took a step towards a historic lockdown which effectively put 1/6th of the world’s total population in their home prison. Using the data that is available in the public domain, we have tried to evaluate the last 14 days.
The Effect of “India Lockdown” – India is doing much better
On 25th March, when we updated the Covid19 Projection Model (CPM19) with the latest data, the projected number for India according to our CPM19 was around 31.6K cases. With the lockdown, as on 7th April, the number for 15th stands at 15.6K cases. It’s been 24 days since India reported its 100th case. India seems to be doing much better when compared to other countries on their 24th day after reporting the 100th case. (CPM19 Performance numbers are shared at the end of the article)
Date of (100th Case)
Date24 days later
Total Cases on 24th Day
Daily Avg Growth%
In the next seven days most of the countries doubled their cases with the exception of Korea and the US. If we take that trend we should be around the 11k mark. When we take the worst case scenario by extrapolating the US trend we could be at around 16K cases.
Date of (100th Case)
Date 31 days later
Total Cases after 7 days
India seems to be well placed even after a month of declaring 100 cases. Besides, even with higher testing our positive % results have not been that high. This has already been discussed in a previous article.
The India Story – Case Drivers
There are eight states that contribute to around 76% of the total cases detected in India so far.
Amongst these states the positive news is that two states have started showing a downward trend in the lockdown. Two other states seemed to have flattened the trend. The problem is the remaining 4 states that are showing an upward trend even during the lockdown. We take a look at these states individually
Maharashtra – Maharashtra is a prime driver of cases in India. It’s doubling the cases at the fastest pace amongst all states. Even if we look at the daily growth rate of cases, it shows a very clear upward trend.
Tamil Nadu – Tamil Nadu had one big spurt during the lockdown which has really increased its numbers. But overall the state has managed to reverse its growth trend and now seems to be slowing down the trend.
Delhi – Delhi seems to have been impacted adversely because of the religious event and has seen two peaks in the lockdown period. Last few days Delhi seems to be reversing the upward trend
Telengana – Like Maharashtra Telengana is also showing multiple peaks since the lockdown which has resulted in an upward trend line for the state
Kerala – Kerala was the first state that reported Covid19 cases. Kerala was also affected by a huge expat gulf population coming back. But during the lockdown Kerala has actually slowed down and is now showing a downward trend.
Rajasthan – Rajasthan seemed to be managing well until the religious event in Delhi started affecting the number and changed its trend to an upward trend.
Uttar Pradesh – Uttar Pradesh seems to be slowing down after the religious bomb.
Andhra Pradesh – This state had one day when the number grew by more than 2.5 times and post that it seems to be correcting its trend.
The Bad News
Besides these eight states, Gujarat, Haryana, West Bengal and Jammu & Kashmir are the states with more than 100 cases and they are showing an upward trend.
6 out 10 most populous states (UP, Maharashtra, MP, Rajasthan, WB, TN) in India are still showing a growing trend. The combined population of these 6 states is 582 million which is more than the population of the US, Italy, France and Spain combined.
The Good News
Madhya Pradesh and Karnataka are the two states with more than 100 cases that are showing some signs of a slowdown. Though there is a super spreader in Madhya Pradesh who can still wreak havoc.
We have avoided looking at the pre-lockdown period because the real growth in the discovered cases has happened during the lockdown. This may work to India’s advantage as the growth spurt has happened during the lockdown period. In other countries this happened before the lockdown. The time taken for the lockdown to have an effect, the base had increased so much that even a small percentage increase meant a significant strain on the health services.
In conclusion even though India has been doing much better than some of the other countries during the same period, we are still sitting on a timebomb. India may be better off not removing the lockdown completely. A better strategy would be to start opening states where trends seem to be in control in the lockdown.
CPM19 Model Performance
As on 8th April the Model is performing well. With the exception of India, the model has correctly predicted for the other countries. For India, it is currently predicting higher numbers due to the spike in cases due to “The religious event in Delhi”. We are hoping that spike is an aberration rather than the norm and are pleased to be predicting a higher number for India.
About the Author
Sanjeev Prakash is an Analytics and Marketing professional with more than 12 years of experience in Analytics, Data Management, Sales, Brand Management, Corporate Communications, Market Research and Customer Relationship Management. Sanjeev has an MBA from IMT Ghaziabad and a degree in economics.
Collaborators – Parinay Pande
(Views expressed in this article are the author’s personal views and need not represent the views of Healthcare India)
Man is a social animal and given this day and age, we have been used to getting around across geographies and interacting regularly with other people. But with the current lockdown this is an area that is directly impacted.
While people in lockdown in India have done the right thing to protect them from Covid 19 but their mental health is definitely suffering. Anxiety, depression, Insomnia among others have become common. In this situation, Mental Health Helplines are the best way out.
Lets Talk, a Mental Health Support Helpline is a free volunteer supported project initiated by a group of collaborators to help people cope with emotional impact of Covid-19 pandemic.
It aims to help those facing dramatic psychological conditions such as panic attacks, anxiety / stress and those suffering mentally and emotionally due to quarantine / isolation /lockdown.
Lets Talk helpline number is 844 844 9428 and has a team of 120+ volunteers who are supporting this initiative, including Psychologists from across the country.
The project has been powered by different International and National Partners in the space of Mental Health, Helpline Support, Social Organizations and Outreach Support. Partners already on boarded include Global Dignity, Arogya World India Trust, Life Surfers, Suicide Prevention India Foundation, Oust Labs, Hope Network, Global Shapers Community, Ria and Manah wellness.
The team behind Lets Talk commented on this initiative
“We are grateful to the volunteers who have come forward to help and support the community at this critical juncture. We believe that mental health impact of this pandemic is going to be significant and will have long lasting impact.
At Lets Talk, we are continuously looking at multiple outreach channels, who could collaborate with us in our initiative to help all those who are worried about the uncertainty of events, a deep sense of meaningless at the moment, missing our loved ones and some of us, our freedom.
At this difficult time, we can’t help you to be in a different place, but we can help you be in a different mind space. So, Lets Talk.”