In times of COVID-19, start-ups have learnt to turn challenges into opportunities. They have resorted to resolve pressing issues related to health services and connecting with patients using digital technologies. DocOnline, is one such start-up that has understood the consumer demand well and has designed some innovative solutions like a chatbot to detect COVID symptoms, back-to-work solutions for corporates and e–PHCs for the government in these difficult times. The founder believes that consumers and markets always reward you in the long run for doing the right thing. Manasije Mishra, MD, DocOnline explains more in an interview with Akanki Sharma
Tell us about the automated chatbot you have launched to help people understand their coronavirus symptoms. How does it function?
We developed the automated chatbot in-house to help people interpret their symptoms. It prompts the patient to answer a series of questions pertaining to their age, gender, symptoms, history of travel, etc., and an internal algorithm helps triage the patients into the appropriate risk category.
If the patient is at high risk, the bot suggests the patient take a free consultation from our DocOnline doctor for further management.
How many free consultations have you offered for COVID-19 till date, and for how long do you plan to keep it going as the number of cases are increasing rapidly? In addition to it, how are you managing your revenue amidst the crisis?
We have provided over 30,000 consultations over the last two months and have consulted over 1,500 patients who were concerned about COVID-19. We plan to keep the helpline completely free till the pandemic is over. Our doctors have also contributed to the StepOne initiative and helped the state government helplines manage the high volume of calls coming in.
The StepOne initiative is a voluntary not-for-profit group of some startup founders to help our country fight the pandemic. It is working with ten state governments to help them run their COVID-19 helplines through technology and volunteer doctors. Six of our qualified and experienced physicians are offering pro bono consultations to triage COVID-19 suspect cases.
We recently secured a fresh round of funding from our Swedish investors. This has helped us support the country amidst the crisis by offering everyone free consultations with qualified and experienced general physicians. At this moment, our focus is not on revenue. Instead, we are focussing on using our technology, infrastructure, doctors and provider relationships to help as many people as possible during this health emergency. I believe that consumers and markets always reward you in the long run for doing the right thing and delivering on your mission. So, revenues will follow in due course.
How many consultations do you offer in a day? Are there people who approach you for diseases other than COVID-19? If yes, give some examples.
Absolutely, we get a wide variety of cases every day. They range from acute diseases like respiratory tract infection, gastrointestinal infection and allergic conditions to chronic diseases like diabetes and hypertension. We
have also managed pregnancy-related problems and other women health issues.
Many patients call us for health advice and counselling. During this time, we have provided advanced training to our doctors on COVID-19, mental illness and disorders, use of clinical protocols and the new telemedicine guidelines.
This is an ongoing effort to ensure that our doctors have access to the latest medical developments, and use evidence-based treatment protocols.
Share details about the e-PHC services that you had announced last year in Uttar Pradesh. What all does it offer to the citizens of the state?
The Government of India, United States Agency for International Development (USAID) and the Government of Uttar Pradesh (UP), entered into a service agreement with DocOnline for a pilot project to set up and manage 10 e-Primary Health Centres (ePHC) in remote ‘aspirational districts’ of UP and two urban centres. The objective of the UP e-PHC pilot is to address the gap in primary healthcare delivery systems through a technology-enabled primary healthcare solution. Our e-PHCs are equipped to provide an end-to-end digital experience. We have trained paramedic staff at each location to coordinate quality health services in the remotest areas of UP.
The e-PHCs offer the following services:
- Registration of patients and initial vitals check-up by an accredited nurse
- Treatment through video consultation with a competent and Medical Council of India (MCI)-registered MBBS doctor through a computer terminal
- Two-bedded day care facility to cater to non-emergency cases
- Labt tests as prescribed by the doctor, processed in the e-PHC by a certified lab technician
- Medicines, as prescribed by the doctor, dispensed by a certified pharmacist
In addition to providing healthcare and maintaining the Electronic Medical Record (EMR) for every registered patient, the DocOnline’s platform incorporates a Health Management Information System (HMIS) which provides detailed analytics about the disease burden and treatments. These analytics provide clinical insights and an accurate view of the ailments afflicting the population, based on which, preventive and corrective healthcare interventions can be planned. An interesting insight emerged that unlike the normal experience in India, women make up 50 per cent of our e-PHC patients. In contrast, as per a study published by the British Medical Journal, in India, almost two-third (63 per cent) of healthcare visits were made by male patients compared to 37 per cent visits by female patients, equivalent to a sex ratio of
1.69. This is significantly greater than the overall sex ratio of the population of 1.09. (https://www.bmj.com/company/newsroom/extensive-gender-discrimination-in-healthcare-access-for-women-in-india/).
How many e-PHCs are active till date and in which districts? Further, how many people have benefitted through these?
A total of 10 e-PHCs were launched in October 2019 by DocOnline, and are now operational in Gorakhpur, Siddhartanagar, Balrampur, Shrawasti, Bahraich, Varanasi, Chandauli, Sonbhadra, Fatehpur and Chitrakoot.
Each e-PHC caters to an average population of 40,000 to 50,000, who lack any access to healthcare due to remote locations, poor transport connectivity, shortage of qualified doctors and an overall lack of awareness. This is the first integrated telemedicine project in the PPP mode offering a bouquet of primary health services, all under the same roof. In the last few months, over 30,000 patients have been treated at the e-PHCs.
Are you also serving any governmental institutions or corporates? If yes, share details on the same.
We have a growing customer base of nearly 200 quality corporate relationships with 400,000 employees. We provide employees access to a quality primary care ecosystem that includes doctor consultations, delivery of medicine and diagnostic tests. We organise preventive healthcare camps and enable engagement opportunities with corporate employees by arranging health-related events. We also provide on-site doctors and paramedics. We have recently put together a “back to work” programme for corporates as they start to reopen their offices. This includes help with SOPs for cleaning, social distancing and precautions for food handling. We also provide COVID-19 risk assessment and certification, guidance on vaccination and other preventive programmes.
An emerging issue is the importance of immunity during this health emergency. People with good immune systems are likely to do much better if they do get infected by COVID-19. We are providing guidance on the appropriate tests and follow up actions needed to boost immunity. We have also been hosting virtual townhalls for our large corporate customers so that we can inform employees and answer the many questions and doubts they have.
How many in-house doctors are there, and tell us about your partnership with Okira. What does it aim for?
We have 25 in-house doctors who are engaged full-time with DocOnline. We adhere to a rigorous onboarding and credentialing process to ensure a uniform quality of medical consultations.
As the physicians providing the teleconsultation service are employed by DocOnline, we are responsible for ensuring the quality and safety of the service. There are effective systems in place for achieving clinical governance of the service in accordance with the best practice. This includes:
Onboarding process: Thorough assessment of the qualifications, experience and clinical acumen of the doctors in multiple interviews to ensure the highest quality staff. While the average experience of doctors is close to eight years, as a bare minimum, we need a quality MBBS qualification and a minimum clinical experience of three years.
HR checks: Background checking of all qualifications and medical registrations by HR
Training: The doctors will receive rigorous training on topics such as DocOnline processes, systems, local telemedicine regulations, tele-triaging and prescription guidelines.
Periodic audits: Random medical audits by Chief Medical Director to ensure delivery of quality care.
While we work well with a number of partners, due to unforeseen circumstances, we couldn’t take our plans forward with Okira. Recently, we have signed up some large partners and are also speaking to a number of potential partners, but currently, due to non-disclosure agreements, we are unable to discuss these names.
Do you have users pan-India? If yes, how many and how many do you intend to target in future? Apart from it, what’s your plan for business expansion across the world?
Yes, we have users all over India. The best thing about digital primary care is that quality medical services can be made available anywhere in India at a reasonable cost. Our vision is to “create a healthier India for everyone” and we are totally committed to making this a reality. We have a physical presence in nine states for our institutional programmes. We currently have about half-a-million customers in urban India and serve a similar number in rural India. I would like to see rapid growth and we are working with a number of large partners to make this a reality. My aspiration is to provide access to quality healthcare to another million customers this year and five million in three years.
We are currently focussing all our energy on solving the healthcare problems in India. We are a large complex country and primary healthcare is neglected by the rich, the middle class and the poor in both urban and rural India. This is a vast canvas and offers plenty of growth opportunity. Once we make a significant impact in India, we will look at expanding the model to other countries. India’s neglect of primary care is not unique and a number of emerging markets in Africa and Asia face similar health challenges.