Categories
Healthcare Technology

Blockchain in Healthcare

Healthcare today has been adopting new technology like never before. As a result of this we have many significant developments in recent days. Let’s take for instance the adoption of telemedicine by both patients and care providers alike during the Covid 19 pandemic. It is significant to note how quickly the ecosystem moved ahead and adopted the new standards and today we have multiple consultations on telemedicine.

Similarly, the development of the Covid19 vaccine has been possible partially due to the increased collaboration between the scientific community made possible by digital technologies.

Blockchain has become a game changer in the healthcare industry. It is a foundational technology with capabilities that go way beyond the traditional IT stack. With features like immutability, digital identity, encryption and real time updates, Blockchain has many of the features that would help the industry evolve to the next level. 

Last year Priyank Jani and I wrote a paper on Blockchain where we discussed how it could be implemented in the healthcare industry. Here is the link of the paper. 

But before we go forward let me quickly discuss what is Blockchain. 

Blockchain is a continuously growing list of records, called blocks, which are linked and secured using cryptography.  Each block contains, typically, a link to a previous block, a timestamp and transaction data. Transactions have to be approved by all users of the Blockchain to be stored and modifying an older block of data is impossible. Only updating of future records is permissible making the system secure (relatively speaking) and therefore reliable. This also means an entire Blockchain can serve as a secure ledger that records transactions, negating the need for multiple disparate trails of information.

We believe Indian healthcare has most to gain from the adoption of Blockchain technology. For starters, Blockchain allows all types of data to be integrated into the chain. This means one can add not just doctor prescriptions and treatment records but also nutrition information, fitness data, and recordings from medical devices (such as for blood pressure and diabetes patients) by patients themselves. Over time the presence of such longitudinal patient data means caregivers can better interpret disease symptoms and prescribe effective treatment that is customized to work for the patient. Currently, doctors rely on data from treating different patients to prescribe medication. The chances of success for such medication are about 50%. In many cases, doctors wait for feedback from patients to change the medication. With the availability of longitudinal patient data, doctors would know in advance what treatments are more likely to suit a patient in line with his/her health history.

If implemented over a large scale, Blockchain could help significantly lower healthcare costs in India. In addition, it can give multiple parties selective access to patient records ensuring data is not compromised. A survey report by IBM outlines the following healthcare areas benefiting from Blockchain: clinical trial records, patient health records, regulatory compliance, medical device data integration, treatment records, billing and claims, asset management (for hospital assets such as beds/ equipment available), and contract management (for hospitals).

I am really looking forward to the virtual Blockchain summit that is taking place on the 9h of December 2020. I plan to discuss with the various global leaders how Blockchain can be incorporated into the healthcare ecosystem. Do register if you are interested in discussing Blockchain and building a consensus in this area. The link for registration is here- Register | BlockChain in HealthCare

Categories
Public Health

Diabetes levels drop marginally in India as per Novo Nordisk Foundation Study

Diabetes is a cause for greatest concern in India. The reason for that is many fold. But the most prominent among them is that diabetes is the foundation on which many other diseases come into play. As you know, diabetes is a condition and not a disease, and usually starts with the body’s inability to maintain the insulin level in the blood. As you know, diabetes is a condition and not a disease and usually starts with the body’s inability to maintain the sugar levels in the blood.

This could be a result of genetic makeup or also from the pancreas inability to produce insulin. But the most common co factor is stress. In 2018 Novo Nordisk had launched a diabetes impact challenge, in which they wanted to maintain a diabetes index to measure the HPA one c levels in the body.

HbA1C measures the Association of the glucose molecule with the red blood cell. As a red blood cell has a life of 120 days. This measure gives us an average of the sugar levels in the body for 120 days, and it’s a much better, and reliable measure of the sugar levels as compared to fasting, and post prandial blood sugar levels that were used earlier. In its recent finding the Novo Nordisk Foundation which produces this result figured out that from October 2019 to September 2020. The HbA1C levels have marginally dropped in India. Currently they are at 8.48 per cent. They ideally should be below 6.

By, the average HbA1C once he level was recorded at 8.48% for the year from October 2019 to 20. But this collection happened over 30 Indian cities with a vast average respondent rate of 55 years, or which of the 57% were men and 43% were women. Again you can see the testing levels among women are less and this is another area of concern.

The Indian diabetes care index which was also launched in 2018, to improve the diabetes care in the country has been providing a real time view of the average HbA1C levels in India.

According to the Novo Nordisk foundation, there are more than 77 million diabetics in the country. And the country, the total spend on diabetes is around INR 64,000 crores.

The second issue that comes up is that with COVID-19, it is clearly proven that anybody with comorbidity or with underlying conditions like diabetes, was more predisposed to, you know, to health issues. And it is clearly established that diabetes affects a lot of body parts, especially extremities like hands and feet, heart, circulatory system, and your kidneys. Your eyes, and overall suppresses your immune system.

I have written about diabetes and its implications on health, many times earlier, including these articles which you can refer to help you get a better understanding of what can be done.

What does this mean for you?

1)      Monitor-  I think 55 is a bit too late to check what your sugar levels are. The most important thing is to start monitoring it from the mid-30’s onwards. If India has risen to 71 million diabetics overnight. It is primarily because the awareness has increased. And the constant checking is possible.

2)      Detect- Get a blood sugar monitor machine. I think it’s very important, a very good investment, along with a Blood Pressure machine. I think these are solid investments that you should make, whether you have an HDTV or the latest Apple gadget. It doesn’t matter but these schedules can really save your life.

3)      Reduce Stress- Diabetes is related to stress to great extent, higher stress higher sugar levels, and higher and lower the body’s ability to deal with the sugar let’s see where is it that is causing stress for you and how you can mitigate it, you might do yoga and meditation to manage the stress, but the ultimate aim should be eliminate the source of stress.

4)      Watch out for added sugar- Last but not the least, which is sugar intake added sugar is the biggest reason why insulin intolerance is happening in the body. So, it is important to figure out if there is added sugar that you are eating which you are not aware of, which could have been causing this problem.

5)      Exercise if your medicine- Workout in the open for 150 minutes a week. This could be a simple walk or cycling or swimming.

As always, it is important for you to stay healthy. Stay safe. Own your health. You have to do it; nobody else will take care of.

Sources: https://www.biospectrumindia.com/news/79/17555/average-hba1c-level-registers-marginal-improvement-in-india.html

Categories
Digital Health Healthcare Technology Public Health

Population Health Management through Digital Tools

Dr Pallabi Roy

Does the Public Health Industry need a Digital Makeover?

Have you heard of buzzwords like ‘Tech Trends’?

Blockchain, Machine Learning, Artificial Intelligence, and the Internet of Things?

As a Healthcare Professional, you might have heard of these digital tools.

Aren’t sure about what they mean? You’re not alone!

We often ignore the technical aspects of a project.

We deal only with the core Biological Sciences.

But this approach needs some amount of tweaking. With the heavy penetration of digital tools in Healthcare, we must embrace the digital era. There is no going back to Pre COVID-19 times!

Isn’t population health management a well-known concept in the Public Health domain?

Yes, it is, but digitization is changing the face of this sector. 

Public health challenges like tuberculosis, HIV, malaria, and other communicable diseases still exist. India’s healthcare industry is going through a transitional stage. The disparity between the rich and the poor is becoming more clear. This gap creates poor health outcomes and using digital tools, we can bridge this.

Why should healthcare professionals bother about these tools?

It’s because they are going to be the harbingers of change!

The Finance Minister allocated Rs 69,000 crore for the healthcare sector. The 2020-21 Union Budget looked better than last year. This is another spectrum where digital tools can come in. FinTech can help divide funds according to the needs of our country.

80% of our fund allocation can elevate health promotion and disease prevention. Using digital tools, we can deliver these healthcare services to the rural parts of India. The public health workforce is working hard and adopting these measures. How can you leverage these tools for research and evidence-based treatment protocols?

Technology has made it easier to reach out. This holds true not only for remote areas but also for an international ecosystem. Doctors can use this approachable network as a reference. Digital tools are facilitating knowledge and implementation, in new-age India.

The Government of India has come up with training and guidelines for telemedicine. Tele-Consultations in specializations like Ophthalmology, Radiology, Mental Healthcare, and Obstetrics-Gynaecology have created waves. ASHA workers (Accredited Social Health Activists) are warming up to digital tools. These include virtual training and EMRs (Electronic Medical Records). We are observing a gradual improvement in primary levels of population health management.

Mother and Child Care programs are improving since e-governance is possible. There are online registries that get updated every week by these healthcare facilitators.

We use them for tracking data like child mortality rates and cases of tuberculosis. Cases of COVID-19 are being monitored through similar means.

National Digital Health Mission has an agenda that we cannot sideline. Our government is centralizing healthcare. This gives us time to catch up with tech trends. It gives us time to understand these digital tools and make the most of them in our clinical practices.

Which are some digital tools that you have used for population health management?

About the Author

Dr Pallabi Roy is a dentist and works as a marketing professional, podcaster and an influencer in the area of digital health. She can be reached on Linkedin- https://in.linkedin.com/in/pallabiroy27

Categories
Healthcare Delivery

Why patient experience would be the key in the post covid world?

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.

Categories
Public Health

Post Covid19 will healthcare become a poll issue in India?

Recently, Dr Devi Shetty, the founder of Narayana Hrudayalaya, authored an article in the Times of India Sunday Edition where he said that healthcare will become a poll issue in the future. Given the historically low percentage of budget allocated to public health in India, can Covid19 realistically push the government to prioritise this area?

An analysis[1] of select 2014 election manifestos indicates that we may be woefully behind on the path to a more comprehensive health plan for citizens.

  • India spends about 1.2% of its GDP on health services and in 2018 this number went up to 1.4%. However, this is still significantly lower than the time and efforts allocated to areas like physical infrastructure development and jobs.
  • Women Led parties had more space dedicated to healthcare in their election manifestos (AIADMK – 6% and TMC – 5%). AAP follows closely with 4%, whereas national parties BJP and Indian National Congress (INC) dedicated around 2.3% and 2.1%, respectively. Interestingly, the AIADMK appears to have been implemented given that Tamilnadu leads on several health parameters, the TMC in West Bengal needs a stronger implementation policy to suitably action on its promise.
  • Most parties tend to pay little attention to preventive health. There is almost no mention of areas like nutrition in election manifestos and while the BJP manifesto does talk about Swachh Bharat, there is no mention of ways to tie that back to measuring health outcomes. The INC manifesto talks about malnutrition and mentions Anaemia and HIV but does not spell out anything concrete in terms of action plans to prevent or tackle the disease.
  • All election manifestos considered for analysis missed addressing non-communicable diseases and the measures to tackle them. Given the high incidence of non-communicable diseases such as diabetes and hypertension in India, this is a glaring miss.
  • Most of the focus on health in manifestos is on building hospitals – more beds and more clinics and so on. But there is no focus on the quality of care provided at these centres or the variety of ailments they can treat. One cannot provide hospitalisation and expect improvement in the state of health without tackling the underlying social and sanitation causes for the ailments.
  • Strangely, while the focus remains on building new facilities, there is no mention of improving existing primary health centres and community health centres that have suffered from decades of neglect. Even in Ayushman Bharat these have not been addressed. While the insurance part of Ayushman Bharat is doing well, the wellness program can be significantly improved.
  • There is no mention of disease surveillance in any manifesto. This is surprising considering most developing countries in the world have some semblance of proactive disease surveillance to curb the spread of disease and manage its citizens’ health.

In summary, even if all that has been promised in the election manifesto is delivered, it would not even make a dent in the state of health in the country.

Why is this so?

Historically India missed the boat in prioritising healthcare reforms recommended by the Bhore committee in 1946 (See box in the next page), particularly the delivery of health at the grass root levels through primary health centres (PHCs).

Further, religious beliefs that tie poor health to karma and a generally fatalistic outlook have ensured hospitals and external care providers are seen as the last resort for patients. Preventive healthcare was largely provided at home. In line with this, the government has not undertaken research connecting the health of its citizens to their productivity. For instance, a study in the UK found that those who smoked were twice as likely to take time off work. Another study found that workers with obesity (BMI over 30) annually took an average of three sick days more than those with normal weight (BMI less than 25), and those with severe obesity (BMI over 35) took six days more. In India, a large population and limited availability of jobs means employment remains a bigger issue than health for the government.

The relatively affordable cost of healthcare so far has also meant citizens have remained negligent about lifestyle diseases. Until recently health insurance wasn’t understood and perhaps without the tax exemption many citizens may not opt for it.

Until the time healthcare is viewed as a discretionary spend, political parties may see no value in contesting elections on the plank of better healthcare for citizens. Citizens themselves need to demand for better health from its government for parties to take the issue seriously. A possible reason why some of the Southern states have overall better health indicators is the relatively high proportion of senior citizen population that resides alone, without support from younger people who tend to live outside the state/ country. This changing demographic of voters may have prompted political parties in the region to place greater emphasis on public health and deliver results.

In addition states like Karnataka and Kerala have prospered from the investments from the princely states. Tamilnadu alone benefitted by keeping public health distinct from Health Services, this is one of the few states that implemented this recommendation from the Bhore Committee recommendations.  

The article is based on the research report “Healthcare and Democracy: Can healthcare become a poll issue in India”.


[1] About the analysis –

  • The following part manifestos were considered for the analysis – Bhartiya Janata Party (BJP), Indian National Congress (INC), All India Anna Dravida Munnetra Kazhagam (AIADMK), Trinamool Congress (TMC) and Aam Aadmi Party (AAP). The rationale was to consider national level parties and those led by women, as it is widely acknowledged that women tend to prioritise health. (We wanted to include the Bahujan Samaj Party (BSP) but we couldn’t find the manifesto in the public domain). AAP was considered in the analysis as it was a recently formed political party that emerged from a citizen movement demanding a corruption free India. All manifestos from 2014 were considered for the analysis.
  • The following parties have not been considered as their manifestos were unclear on the healthcare aspect – JDS Karnataka, Shiv Sena, Shiromani Akai Dal, and Biju Janata Dal. The communist parties are also missing from our analysis. We are planning a follow up report on the analysis of the 2019 manifestos and we plan to include more parties there.