However, such progress overshadows a bifurcated system, one in which hospital-based care is of international standards, but care outside of hospitals is very haphazard.
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Zachary Jones
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There are huge opportunities in emergency response services, primary care, telemedicine, compliance-focused models, and home healthcare. What is even more exciting is that these functional areas are themselves very much at the crossroads of three healthcare trends that are rapidly developing in the US; India could potentially even break new ground in these areas due to its more favourable regulatory regime which allows for a shorter time to market for new devices and a greater ability to use health-related data. Broadly, these three trends are:
- Move from hospital-based care to outpatient, remote, and home healthcare
- Move from reactive to proactive medicine
- Shift from population-based medicine to personalised medicine
Thankfully, these changes are a win-win for both patients and healthcare providers as they lower costs while improving health outcomes:
Move away from hospital-based care: Hospitals have become victims of their own success; as they have become more popular, space constraints have become more acute. By treating patients outside of their facilities, hospitals can lower costs and become more efficient; their patients also benefit from better health outcomes because they aren’t exposed to hospital borne infections and recover more quickly and fully at home. This is already an established model in the West and something that our company, Portea Medical, is pioneering in India. We estimate that roughly 80 per cent of the care that is currently given in the hospital can be delivered in the home setting with the proper use of technology.
Reactive to proactive medicine: How we consume healthcare today is very inefficient. Patients effectively diagnose themselves and then go to see their doctor for treatment. At this point, issues have often progressed and treatment is more challenging. Remote monitoring technologies now allow healthcare providers to continuously monitor healthcare parameters (e.g. flagging a high BP earlier), predict where they are trending, and proactively intervene. Devices such as FitBit have made self-quantification in the fitness field popular and accessible to the general public; expect a similar focus on quantifying your health in the next few years. According to Dr Eric Topol, a luminary in the nascent field of telemedicine, chronic diseases, the most common causes of hospitalisation, are particularly amendable to technology-based solutions that prevent inpatient care.
Population-based to personalised medicine: Historically, patients have been treated as a group or population when they seek medical attention. When you see the doctor they diagnose and treat you based on what has worked for many millions of people globally. By using data collected by remote monitoring technologies and conclusions drawn from advanced analytics, patients can be treated as individuals, as per a very detailed medical history; this approach makes interventions more effective and negative interactions or incorrect treatments less common. The era of ‘Big Health Data’ is just around the corner in the US and not that far away in India: according to the Journal of Personalized Medicine, globally the quantum of health-related data is doubling every two years.
Portea Medical, a home healthcare company which I co-founded in 2012, is very much at the focal point of these trends. We have been instrumental in shifting care away from hospitals (with their support) and into people’s homes by providing home visits from doctors, nurses, physiotherapists, and home health aides. Portea is also working to bring truly personalised medicine to India by using some of the latest technologies in combination with our innovative healthcare delivery platform.
The five-year view: A complete shake up of the industry
While the three previously mentioned changes will revolutionise healthcare over the next couple of years, they are largely business as usual, because healthcare delivery will remain clinician driven and clinician dependent; however, over the medium term, the face of healthcare will change markedly, because the clinician’s role in the delivery of healthcare, which has been more or less constant for thousands of years, will be reinvented.
Broadly, this will happen in three distinct ways:
Healthcare workers using computers to better diagnose patients: As highlighted by thinkers such as Tyler Cowen, computers are interesting machines; they tend to be exceptionally good at completing ‘rule based’ tasks like playing chess (for example, IBM’s Deep Blue defeated Chess Grand Master Gary Kasparov in 1997) and harnessing enormous amounts of information (for example, IBM’s Watson won the Quiz Show Jeopardy! in 2011). These skill sets are particularly conducive to work in medicine, because diagnosis of illnesses is ‘rule-based’ and requires a clinician to remember and be able to draw upon large amounts of learned information.
Venture capital investor, Vinod Khosla, has argued that computers will eventually do 80 per cent of the work currently done by doctors, all while heightening their abilities. In fact, one of his portfolio companies, Lifecom demonstrated that medically trained personnel that were not doctors, working in conjunction with a diagnostic engine (computer) were 91 per cent accurate in their diagnoses without using diagnostic tests or advanced exams. In the Indian context this creates a significant opportunity for healthcare to become more accessible to a much larger segment of the population by ‘upskilling’ nurses and paramedics’ skill sets, all while unburdening doctors from many routine tasks.
The anytime consult and the great levelling of quality of care: Soon, patients will no longer have to work around doctors’ schedules. In the US, companies such as Doctor on Demand, already allow you to talk to doctors instantly for up to 15 minutes for $40 (Rs 2,400). However, these services are moving beyond just your common ‘cough and cold’ type questions; specialists, particularly those that focus on less-interventional specialities (e.g., dermatology) now offer remote consultations. By 2020, expect ‘virtual doctors’ practices to develop. This is important in the Indian context because it will help the highest quality clinicians treat patients in small towns, creating a more uniform quality of care throughout India.
Consumer-focused healthcare: Over the next five years, powerful diagnostic tools will be in the hands of individual consumers, giving them the ability to take control of their health. I believe this to be one of the most important developments in healthcare, because doctors will likely be forced to engage with patients as equal stakeholders. There is really nothing more futuristic sounding than the Qualcomm Tr icorder X-Prize (named after the device on Star Trek that could instantly diagnose a patient). To win the $10 million prize, teams will have to create a device which ‘will be capable of capturing key health metrics and diagnosing a set of 15 diseases.’ The device is intended for individual consumers.
Healthcare innovation in India is in its early innings, however, we believe that India has a real opportunity to build a non-hospital-based healthcare delivery system that incorporates the best of what Western countries have achieved over the past 120 years as well as the most recent advances in remote medical technologies. These are exciting times for healthcare.