Digital health platforms, telemedicine shall be integral to healthcare in post-COVID world: Shobana Kamineni

Shobana Kamineni, Executive Vice Chairman, The Apollo Hospitals Group explains to Viveka Roychowdhury how the Apollo 24|7 app, launched in February, has in some way, been able to bridge the urban-rural gap in terms of healthcare and the role of such telehealth platforms post the pandemic. She believes that telemedicine will not entirely replace the physical healthcare, but it will be a smarter choice for people, helping to take the load from hospitals, while hospitals continue to play an important role in advanced cross functional treatment requirements, advanced diagnostics and surgical interventions. She also gives details on the expansion plans to stay ahead of the curve in terms of customer satisfaction

With a tough Q1FY21 behind us thanks to the COVID-19 pandemic, what are the profitability challenges faced by hospital chains in India and what are the measures taken to mitigate these challenges?

Hospitals all over the world are obviously facing major challenges due to the pandemic. Honestly, challenges pertaining to profit are not the main concern here. The world at large seeks to ensure that adequate healthcare facilities are provided to the public through novel means. Of course, low revenues plague hospitals in the country as the cost of medical equipments seems to increase. Additionally, OPD walk-ins and consultations have come down significantly since the lockdown.

But, the tumultuous  and volatile business environment during this time has given us all a vital lesson of ‘reinventing and evolution’. Providers have realised that round the clock service availability and access to specialists is the primary duty that each provider, must provide, and at Apollo we have fulfilled the same via all our channels. In this aspect it is not fair to evaluate business and profitability in a preplay  “revenue” sense but in a manner in which we can demonstrate the number of lives that have been touched and healed in this pandemic.

I can say that the sector has evolved swiftly and has taken the digital route to ensure that healthcare reaches the patients uninterruptedly. While there was definitely a digital transition taking place before as well, the pandemic has accelerated its adoption by both doctors and patients.

The use of cutting edge technology and data has been central to the functioning of the Apollo ecosystem since its inception. We have always valued technological innovation as paramount to our evolution. With this ideology in mind, Apollo 24/7 was launched to enable users from any part of the country to use trusted Apollo services from their phones, at the click of a button. The platform gives the patients access to more than 7000 quality Apollo doctors, and across 55+ specialties. The platform also provides healthcare services such as seamless medicine delivery at home, diagnostic test booking and doorstep sample collection, digital health records, home healthcare and more. This has especially been beneficial to Tier 2 and Tier 3 cities, as they’re able to access better healthcare facilities from the comfort and safety of their homes.

 Hospitals like AHEL have re-focused on other revenue plays like pharmacies, diagnostics etc. In fact, since patients cannot come to the hospital/doctor/pharmacy, these facilities have gone to the patient through tele-consultations and omni-channel health platforms. Have ventures like Apollo 24|7 made up for the loss of revenue due to the price cap on COVID-19 treatments?

 Indeed, telemedicine has received a never-before impetus since the onset of the pandemic. Even the Indian government has legalised and standardised telemedicine this year by issuing strict guidelines for its practice. Apollo has been always a step ahead in pioneering technology and medical innovation, with this foresight, we had established the first telemedicine setup 20 years back.

With our core philosophy of bringing quality healthcare to every individual we launched Apollo 24/7 in February before the government announced the nationwide lockdown. This has allowed us to continue to provide services to a majority of our patients and deliver healthcare services digitally to people who need it the most. This has also helped us to create access to the best medical specialists without any geographical limitation with ease of booking various services at their fingertips

Apollo 24/7 has helped us continue our mission to provide better healthcare to all, especially during these uncertain times. Apollo 24/7 is the fastest growing health app in the country. During the last six months of operations, we attracted over 15 million Indians to engage with us and over 3.5 million users to register themselves on the app. These users are from 400+ cities across the country. And most importantly, we’ve been able to reach out to areas with poor health infrastructure through the platform. 33 per cent of our registered users are from Tier 2 and 3 cities. These cities also account to 21 per cent of our virtual consultation with Apollo doctors. Hence, in some way, we have been able to bridge the urban-rural gap in terms of healthcare.

Will these newer revenue streams like omni-channel health platforms such as Apollo 24|7 remain a part of the post-pandemic world? Will the vision last beyond the pandemic?

 The health seeking consumer behaviors has changed and we believe will continue to exist even post pandemic as “ the new normal” provides access to primary healthcare services at their fingertips. Also, we are highly certain that digital health platforms and telemedicine shall be an integral part of healthcare in the post-COVID world.

Back in 2019, the Indian telemedicine market was predicted to reach $32 million by 2020 and now it is expected to cross $5.5 billion by 2025. The extended lockdown and quarantine regulations have only acted as a catalyst in the growth of telehealth apps, which has registered a growth of over 178 per cent in the remote consultations. The improved internet connectivity has also enabled people from Tier 2 and 3 areas to easily access tele consultation.

In the post COVID world, we are sure that people will make smarter choices in every aspect of their life. Telemedicine will not entirely replace the physical healthcare, but it will be a smarter choice for people. This means that telemedicine can help take the load from hospitals, but hospitals will always play an important role in advance cross functional treatment requirements, advanced diagnostics and surgical interventions.

Having said that, patients are already opting for telemedicine apps for home based collection of test samples, delivering monthly medicines, and booking appointments. This behavioural change is here to stay. This trend will further accelerate the growth of telemedicine in India. With telemedicine, everyone can access quality healthcare at ease, irrespective of geographical barriers.

Since these are tech-driven initiatives, how can these platforms help in discerning disease trends (like transmission patterns of COVID-19), which could assist public health officials in pre-empting new outbreaks of infections?

COVID-19 is a wake-up call not only for the governments but also for all of us to prepare the world for future pandemics. With the advent of mathematical tools, scientists are now able to better predict epidemics, understand the specificity of each pathogen, and identify potential targets for drug development. There is a need to take advantage of the rapid progress made in the past decades in data processing, analytics, and utilisation. Existing structures such as the MOH-driven global influenza surveillance could be used as examples to develop long-term capabilities in preventing infectious disease pandemics and their deleterious effects.

The use of tech- driven initiatives will make it possible to digitally trace the footprints of an infected person and also get access to trace the travel history, places visited, people met. This information can help to stop the widespread transmission of the virus by identifying the person and taking the necessary medical safety measures. The large datasets of anonymous patient information available from digital health platforms can be used to better existing technologies. This can aid health professionals as well as public health officials in dealing with the pandemic. Harmonising the integration of AI will enable us to enforce its use for infectious pandemics prediction, better understanding of infections, and reduce time for drug discovery.

 Is India ready for a long term and wide-spread deployment of tele-consultation, given the patient confidentiality and data security issues? What are the security features that can assure patients that their data is safe and not shared without their permissions?

 The COVID-19 pandemic has been a case study on the importance of having efficient and reliable data systems. Countries with a robust health data infrastructure have been successfully able to leverage real-time data, which has informed their key strategic and public health responses.

The Indian government launched the Aarogya Setu app to provide real-time updates and contact tracing. Since data security is incorporated by default, it ensures end-to-end encryption. Apropos telemedicine services, remote-care devices and remote patient monitoring are particularly vulnerable when they don’t come with embedded security features to ensure the decoupling of sensitive patient information. In order to scale telemedicine network, data security audits to ensure patient safety are a must.

At Apollo Telehealth, all our platforms are HIPAA compliant and the backend is ISO 27001 certified. Our front end point of presence across geographies is also ISO certified. This ensures that the data security measures adhere to global standards.

 While tele-consultations will improve access and reach, do they address the affordability challenge, especially in tier 2/3/4 towns and villages of India? 

There has been a significant increase in the number of people using online consultation. Like I mentioned, Apollo 24|7 has witnessed tremendous increase in online inquiries from Tier 2 and 3 cities. 33 per cent of our registered users are from Tier 2 and 3 cities. These cities also account to 21 per cent of our virtual consultation with Apollo Doctors.

We believe in customer empowerment and our key responsibility is to make Apollo Expertise available for every user. Charges are led by the doctors and depends on their experience and expertise. For the users there is a large horizon of choice based on experience, specialty and location. We enable one to choose as per their requirement while empowering towards data-based decision making.

Apollo 24|7 has the capability to remember every user and keeps learning about them and their actions. This help towards giving refined choices for the users with time. We have observed with our experiences that a routine consult involves various direct and indirect costs like travel, incidentals and opportunity. These costs multiply in case of the patient requiring an attendant. Apollo 24|7 definitely cuts a lot of extra expenditure like these  for those in Tier 2 and 3 cities and provides them with affordable quality healthcare options at their convenience.

What is the long term vision for Apollo 24|7 beyond the pandemic? 

We will continue to expand our network and reach across the metros and mini metros. In addition, our focus is also to penetrate in Tier III and IV towns and provide the best of healthcare services to every user in India. As for pharmacy delivery, we envisage to serve an order within two hours leveraging our huge physical network of pharmacies. We started with Chennai and Hyderabad in February but with the pandemic push we are now catering across seven cities with a four hours or same day delivery guarantee while in over 900 other cities we cater within the extended delivery promise.

Our tech platforms and data-based decision making is poised to bring in higher order of customer experience and satisfaction.  We are fully prepared for the new normal,  and are confident to stay ahead of the curve in terms of customer satisfaction. However, as the patients shift their healthcare-related dependencies from the physical to the virtual world, quality and trust will in the digital healthcare delivery services will play a critical role, which Apollo has been maintaining for the last 35 years.