Confronted with a population that’s overwhelming and highly diverse (1.2 billion), India is faced with a constant need to find enterprising and innovative ways to leverage its limited healthcare infrastructure to reach out to more and more people. The lack of infrastructure is a big deterrent in providing care for citizens outside the cities. One wonders, therefore, if decentralization can really help to solve this problem.

In an effort to find answers to such questions, a group of healthcare leaders came together recently at the Philips Healthcare Conclave held at the Taj Vivanta, Bangalore. The panel discussion featured industry leaders and experts such as Mr. Arvind Sivaramakrishnan- CIO, Apollo Hospital Enterprise Ltd., Dr. Ashwin Naik- Co- founder & Director, Vaatsalya Healthcare, Dr. Rishi Bhatnagar- Global Head, Digital Enterprise Services at Mahindra, Mr. Ravi Ramaswamy – Sr. Director, Philips Healthcare and Mr. Ritesh Baglani at Helion Ventures.

Presented with the opportunity to moderate the panel, I was able to procure a few answers to the question before us all. And of course, to leverage digital would not only help the nation but also prove to be an added incentive to my portfolio.

The problem in India as stated in earlier posts is that most of its citizens hail from the country’s villages and hinterlands. There are only little less than 6,50,000 villages in the country and most of them have a population of less than 1000. Obviously, understanding that traditional methods may not help, there is a pressing need to uncover new methodologies to solve this problem. And the panel discussion sought to do just that.

It kicked off defining what is decentralization and what is digital before delving into the core issue of why decentralization is required in the healthcare sector.

Arvind set the stage by helping us understand why all functions cannot be decentralized- while access to care can, but decentralization of delivery is not quite possible. A valid point considering that it requires expertise, training and capability- something that cannot be replicated very easily. As a science that both doctors and hospitals have spent time mastering, care delivery via hospitals is more dependable than resorting to solutions from untrained and ill-informed quacks or godmen. Ritesh too, corroborated the stand taken by Arvind on decentralized access and centralized delivery sighting the example of start ups like Life Cell that are using this model and leveraging digital to the fullest.

RT@drvikram Decentralization of #Healthcare in #DigitalIndia

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One of the interesting aspects of a panel discussion is that one is faced with multiple views on the same topic that helps put one’s opinions and the subject itself in perspective. Ashwin Naik for instance, made a strong case for the need to understand that innovation isn’t just about creating a better ECG system but to discover a better way to monitor overall health. Start-ups, he opined had a significant role to play in the process of decentralization, and expressed that he foresaw a future without hospitals where care was delivered home, especially in cases of monitoring and could also be tracked on a digital backbone.

The discussion was carried forward by Mr. Ravi Ramaswamy who spoke about the care continuum and how Philips had invested in certain areas like remote ICU and home health monitoring systems to foster a system of decentralization. Interestingly, he also explained how the digital ecosystem had place for alternate therapies such as Unanni and Ayurveda as well and urged the attendees to look at something like ECG as a diagnostic tool.

However, he did warn against compromising on quality and the consequences thereof as seen in the baby warmer tragedy in the north of the country. Clearly, decentralization is beneficial but not without a few challenges.

In order to understand decentralization, it becomes important to fully comprehend the case of centralization. A good example of this was presented by Rishi with the setting up of 108 ambulance numbers in Hyderabad- a model that is now being replicated in other parts of the country as well. However, there were other challenges he pointed out such as inoperability, connectivity, security and the lack of clarity regarding who bears responsibility on remote monitoring. Clearly, there is a necessity to take a stark look at the challenges in the system in order to find ways to overcome or work around it all.

While several differing views on the topic were put forth by each of the panelists, they were all in agreement when it came to the mindset of the consumer which they felt required to change. The fact is, that most people still feel secure waiting in long queues to consult a senior doctor or visit a time-pressed head surgeon for a minor cut or injury. A pilot involving senior citizens on monitoring devices actually led to increase in the number of calls to the doctors with concerned patients checking regularly if the monitoring devices were working. Just a little proof of the attitude that needs to change.

All-in-all, the discussion was a fruitful one and brought to light both the benefits as well as areas of concern with regards to decentralization. The overall consensus summarized was,

1. Decentralization is the only way forward. Delivered on a digital backbone, it is an urgent need and requires immediate implementation.
2. Decentralization in accessibility is great. However, care delivery should still be centralized.
3. Hospitals may see their roles changing, focusing more on critical care, while the monitoring and follow-ups can be done through remote technologies.
4. There are a few challenges that need to be addressed like that of quality, connectivity, interoperability and policies that provide clarity on accountability.
5. Quality is a big concern and there are already changes in the ecosystem where technology providers like Philips Healthcare have made investments through the PIC. A good example is the remote ICU.
6. Start ups have already started working in this direction. Life Cell being a good case in point.
7. Mindset of the patients and the patient parties needs to change for the technological changes to be implemented well.

It was an enriching event and I did enjoy being part of the panel. Do connect with me on Twitter on @drvikram. I’d love to hear your perspective on the topic as well.