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COVID-19 pandemic forces relook of the existing healthcare system

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Rajabahadur V Arcot, Independent Industry Analyst/Columnist and Automation Consultant, along with Dr A S Kasthuri, Retired Brigadier – Consultant Physician, Teacher and Mentor, shares insights on how a pandemic has forced people to think and act differently, and how it may turn out to be the harbinger of changes to come

The pandemic COVID-19, which started in China, has rapidly spread across the world causing untold misery. Lives and livelihoods are lost and global economy stands shattered; the world, affected by the pandemic, is experiencing a crisis never witnessed in our living memory. While desperate attempts are being made to mitigate the suffering, for many, the uncertainty hangs over their future. Additionally, the crisis has triggered a debate about the present healthcare delivery system, which is under tremendous pressure. If ongoing discussions among the healthcare providers are any guide, the present patient- and hospital-centric healthcare system is likely to undergo changes. This discourse among the healthcare fraternity has significant relevance to the Indian healthcare delivery system, which, even otherwise, is awfully inadequate and often unaffordable to the vast majority. The pandemic sharply brings into focus the need to strengthen India’s healthcare delivery system, which is under stress, by a viable alternative one. Internet of things (IoT) and wireless communication technologies are likely to play an important role in transforming the healthcare system. IoT is a system of interrelated computing devices and machines provided with unique identifiers and the ability to transfer data over a network without requiring human-to-human or human-to-computer interaction.

Media reports reveal that there is one government doctor for every 10,189 people in India, whereas the World Health Organization (WH) recommends a ratio of 1:1,000, and this means a deficit of 600,000 doctors; with regard to nurses, the shortage is about 2,000,000. Regarding ventilators, media reports also say that the country currently has around 40,000, whereas the requirement may be 80 – 100 times that number. The healthcare allocation in the country’s union budget for year the 2020-21 is below 1.5 per cent of country’s GDP and falls short of target spending of 2.5 per cent of GDP. While the 2017 healthcare policy of the government mandates a minimum of two beds per 1,000 people, the number of hospital beds available in the country for 1,000 people is only 0.7, according to World Bank data. Further, according to reports, India ranks 184th out of 191 in terms of GDP percentage spend on healthcare. These figures give us a grim picture of the challenges the country faces in ensuring the health of the people; COVID-19 is only exasperating the situation.

The spread of COVID-19 has triggered a global debate about the efficacy of the present patient-centric and hospital-centric healthcare that is expensive, and the need to investigate viable but more affordable alternatives. There is a need for more efficient use of the scarce resources without compromising the quality. In this context, the medical fraternity is seriously debating about the pros and cons of the     remotely managed healthcare delivery system which may be possible in cases involving patients with mild illness and no risk factors.

Last month, WHO had issued an interim guidance “Home care for patients with COVID-19 presenting with mild symptoms and management of their contacts” that says, “as hospitalisation may not be possible because of the burden on the healthcare system,” patients “with mild illness and no risk factors may need to be isolated in non-traditional facilities, such as repurposed hotels ….….or managed at home.” It goes on to state that “a communication link with healthcare provider or public health personnel, or both, should be established for the duration of the home care period.” Remote Patient Monitoring (RPM) system, using Internet of Things (IoT) capabilities will gather patients’ physiological parameters and transmit the data to healthcare providers. Remotely managed healthcare implies more efficient use of human and other resources, safety of the patients and clinicians, limiting the spread of the infection, and similar others. IoT comes with connectivity, and data gathering and transmission capabilities.

Pandemic and healthcare-system challenges

Due to the spread of the pandemic, in addition to systemic issues, healthcare professionals themselves are under severe stress. There are worrisome reports about the transmission of the disease to healthcare professionals from COVID-19 patients under treatment, with some of them even succumbing to it. The number of such cases is on the increase.

Based on their personal experience, Dr Mirco Nacoti and his colleagues of Papa Giovanni XXIII Hospital in the province of Bergamo, the epicentre of COVID-19 outbreak in Italy, have also recommended home care approach for COVID-19 patients with mild symptoms in their article. The article highlights, under pandemic situations, patient-centric and hospital-centric care “is inadequate and must be replaced by community-centric care. Solutions for COVID-19 are required for the entire population, not only for hospitals.” The article goes on to elaborate that lacking adequate number of medical care givers and necessary equipment and overwhelmed by large number of patients to be attended, pandemic patients do not receive the necessary attention and palliative care and the hospitals are not able to maintain the expected standard of care. Often, doctors are forced to choose between attending to the pandemic patients and delivering regular services to other patients, such as child delivery and other emergency services. This adds to the inconvenience of patients and phenomenal stress to caregivers. Some may land them into legal implications. There is also a strong possibility of hospitals facilitating virus transmission to other uninfected patients and thus contributing to the spread of the disease as their ambulances and personnel rapidly become carriers of the virus. There are also reported instances of the frontline medical staff becoming victims to COVID-19.

Home care with surveillance system for patients with mild symptoms

According to the paper, such disasters could be “averted only by massive deployment of outreach services. The paper suggests home care in place of hospitalisation. In order to provide healthcare support to patients, medical fraternity needs tools that help to obtain patients’ disease information; such information helps them to decide on the treatment.

Using clinical grade sensors often referred to as biosensors and biometric sensors that are connected to Remote Patient Monitoring (RPM) systems, it is possible to gather patients’ physiological parameters and analyse them. Biosensors and biomedical sensors often come in the form of wearables or patches. They have built-in transducers with computing capabilities that convert the sensor outputs into electrical signals and transmit the same from the patient’s location to the monitoring systems at the healthcare provider’s location for assessment and recommendations. With the help of analytical software, the patients’ historical physiological parametric data can be analysed to detect or predict improvement or deterioration. At the individual level, such analysis helps initiation of appropriate remedial actions; at the collective level, patients’ data can be examined further to understand the mechanism of this disease by leveraging the power of data analytics and artificial intelligence (AI). However, there is a need to ensure data security and protect the patients’ privacy. RPM facilities the data to be compiled, stored and distributed in a structured and clinically-relevant format, thus making it possible to better interpret the data.

RPM and IoT facilitate remote healthcare  

RPM systems built around IoT and wireless communication technologies such as wi-fi and bluetooth with their processing and connectivity capabilities are emerging as candidates that can serve the need to let the patients stay at their homes and yet receive the appropriate treatment. With the help of these RPMs, clinicians can direct treatment from remote.  Even in the case of hospitalised patients, these systems will minimise the need for personal visits of doctors to the patients’ beds and thus minimise the possibility of their contracting the infection. The added advantage of remote treatment can lead to reduction of healthcare delivery costs.

Healthcare authorities like the Centers for Medicare and Medicaid Services of the US Department of Health and Human Services have recognised the situation. They have issued notifications that permit physicians and other practitioners, home health and hospice providers, and such others, to furnish services using remote communications technology so as to avoid exposure risks to healthcare providers, patients and the community. The writing on the wall is the extensive use of IoT, which, currently, is the synonym of remote communications technology in the healthcare sector. IoT offers a way out to some of the challenges of the healthcare industry and may prove to be a game changer.

Some of the benefits of the remote communications technology-based services are: more efficient use of the scarce human and other resources decreases the possibility of the spread of the infection and thereby enhances the safety of the patients and clinicians; facilitates generation of structured reports and analysis; and improved records and documentation maintenance. IoT with remote communications technology can potentially facilitate clinicians provide healthcare delivery services from remote and, if the situation warrants, shift from patient-centric care to community-centric care and augment the healthcare system in India. Sometimes, challenges force us to think and act differently and COVID-19 may turn out to be the harbinger of changes to come. India is taking some welcome initiatives in this direction. For instance, the Ministry of Health and Family Welfare (MoHF&W) recently issued “Telemedicine Practice Guidelines” allowing Registered Medical Practitioners (RMPs) to treat patients remotely by using telemedicine tools. We can expect more such steps in the days to come as change is the only constant.

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