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Age of the Smart Doctor

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There is no doubt about the fact that doctors who are proficient in computer science do have an edge over others. These professionals can turn several ideas into reality, solve trivial healthcare concerns and will be ready for future digital disruption

At times when managing and integrating vast patient data to lead better healthcare outcomes seems like a herculean task, when understanding the correlation between operational efficiencies and clinical outcomes becomes imperative for hospitals and when effective communication is paramount for a healthy doctor-patient relation; digital technologies act as a panacea for India’s healthcare fraternity. But how much do healthcare professionals truly invest in becoming technically proficient in order to effectively utilise these technologies in their clinical practice?

Lets take a look….

In the last couple of years, I have had several conversations with doctors, nurses and hospital administrators on the relevance of digital technologies in healthcare and how it will impact the future of medicine. Typically, every healthcare professional I have spoken to is convinced that digital technologies have changed the dynamics of healthcare communication and management of diseases as well as added more intelligence to medical decisions and clinical research.

They also believe that digital technologies have the potential to further remodel India’s current healthcare scenario. When asked about the utilisation of these technologies in their clinical practice, healthcare professionals usually respond by citing several examples of how cloud computing, Big data, IOT, artificial intelligences, telemedicine etc., facilitate them to achieve better clinical and healthcare outcomes.

Having said that, there are two major concerns that these professionals raise—one is of the possibility of being replaced by technology or by engineers who can assist healthcare technologies to provide healthcare facilities and the other is the issue of cyber security of patient data.

To this degree, tech experts may remain irresolute on the concern of medical professionals fearing to be replaced by technology, and  to a large extent they are right in their judgement. Man with all his capabilities to expand his intellect has the potential to work around this situation. However, the concern surrounding security of patient data cannot be dismissed. So, what are healthcare professionals doing to mitigate these apprehensions?

The rise of tech doctors

In the US, doctors are increasingly attending coding bootcamps to educate themselves on computer sciences and programming. After which, these doctors are leveraging their combined knowledge of computer science and medicine to tackle healthcare problems.

For instance, doctors from the Yale University and Stanford Children’s Hospital by learning computer coding have developed mobile apps for clinical studies, the results of which are utilised for clinical practice within the respective hospitals. This has facilitated these doctors in achieving better clinical outcomes as well as helped them in gathering valuable information for further research.

Dr Omar Rayward, Opthalmologist-turned-Computer Programmer in his blog writes, “A doctor that is tech-savvy enough to filter the helpful and trustworthy [apps] could help certain groups of people, such as young people with diabetes.”


What is a coding bootcamp?

A coding bootcamp is a technical training programme that teaches parts of programming with the biggest impact and relevance to current market needs. It enables students with very little coding proficiency to focus on the most important aspects of coding and immediately apply their new coding skills to solve real-world problems. Coding bootcamps teach people with little or no technical coding background how to write code, and build applications on a professional level.

Most coding bootcamps in the US last anywhere from 8-12 weeks and are designed for speed and high-impact learning.

Dr Nagarjun Mishra, Co-founder, Chief Officer – Business & Strategy PurpleHealth speaks about the varied avenues open to doctors who have added skills of coding and this has done wonders for healthcare. Citing the example of the achievement of doctor from the US, he explains, “Yale cardiologist E Kevin Hall, for example, one of the best-known doctor-programmers in the health industry, developed an iPhone-based clinical study using Apple’s ResearchKit to gather information about the quality of life of patients who might have cardiomyopathy. Dr Ed Wallitt set up a medical IT consultancy and software development company (PodMedics). He says that doctors actually make great programmers. They are good at modeling complex systems such as the circulatory system, and compartmentalising complex things. This is exactly what coding is about. Dr Pieter Kubben, a neurosurgeon and award-winning software developer for mobile applications and clinical decision support systems says that we cannot remember everything, and we make mistakes. If we would remember 9 out of 10 issues, we do great in high school. However, we may cause disasters in medicine if the last 10th item is crucial.  That is where his coded apps on WHO Surgical Safety Checklist and Improved decision support for subaxial cervical spine injury have helped him and many others in their practice.”

Not just in the US, but even doctors from the National Health System, UK, Singapore and many European nations have been upgrading themselves with the knowledge of computer sciences and digital technologies to integrate them into their medical practice. And guess what, they have achieved remarkable results. Moreover in the west, you will find several healthcare digital start-ups set up by doctors which serves as an added advantage for these practitioners to connect to their patients as well as leverage various  opportunities that can help them provide healthcare like never before.

These medical experts believe that there is a huge gap between medicine and information technology which can be bridged by an integrated knowledge of medicine and computer science. Some of the doctors are of the opinion that there exist a lot of patient algorithms that a doctor can see in the medical books that can easily be converted into computer codes.

The Indian story

In India, the scenario is slightly different. All healthcare professionals acknowledge that digital technologies add value to their daily functions. They also concede that the lines between medicine and digital technologies are slowly blurring, but there are many at variances to the fact that they would be needing to upgrade their technical know-how in computer science as these lines continue to blur further.

Why do I say so?

During my research on this subject, I spoke to some general practitioners, diabetologists, and gastroenterologists who see at least 50 patients in a day. I talked about the issues they faced during the time of demonetisation last year. All the doctors shared the challenges they faced due to lack of cash and some also told me how they have overcome this problem by way of not charging a fee to their patients during that period.

So, nice of these doctors to have done quiet a bit of social service. When I asked them, whether they opted for an online money transfer option or resorted to mobile wallets for their payments from patients following this crisis, sadly; only five doctors  had chosen this option. When asked them the reason behind this, they raised concerns around how do they manage or keep track of all the online transactions on a daily basis. Some even asked me what if the Internet connection fails due to which an misunderstanding crops up between their patients and them.

A web developer friend (who does not wish to be named) confirmed that their concerns are genuine, but a serious lack of understanding is where the problem lies. Lack of the understanding of technical know-how of  digital technologies prevent these doctors from leveraging its umpteen benefits.

This web developer has been working with hospitals and private practitioners to develop websites and mobile apps for them. Sharing this experience he informs, “I have often faced this challenge in explaining technical aspects of electronic health record systems. Also, I have tried to convince few of the doctors for whom I have designed Electronic Health Record systems and websites to learn the basics of computer programming so that they could solve some simple technical issues at their end without having to involve an engineer to do so. This would save them cost of maintenance as well as save time. But, they question the logic behind this concept. At times, this creates a mismatch in understanding what exactly the doctor wants, needs and what we can offer”.

Well in future, the situation is not going to be as bad as it may seem currently. I was fortunate to meet and interact with some medical professionals, especially doctors who believe that an amalgamation of medicine and computer science can do wonders and so have set on to the path to acquire knowledge of computer programming.


Cultivating smart doctors for India

Dr Mradul Kaushik, Director Operations and Planning, BLK Super Speciality Hospital, New Delhi opines, “Needless to note, for modern doctors it is extremely vital to have good understanding and knowledge of computer science. This becomes especially true for specialists in the field of oncology, radiology, haematology, neurology and cardiology. A good understanding of this stream is hugely useful and this is also apparent in the way in which some specialities have sprung up across institutions. World’s leading John Hopkins University has dedicated centres like Centre for Computational Biology, Centre for Computational Genomics, Institute for Computational Medicine designed to undertake R&D in these areas, and therefore highlighting the criticality of convergence of the two streams. With use of computer algorithms, data mining, text processing and modelling, we can gather clinical research, healthcare databases, patient records and genomics data which is very useful to us.”

“Technology is now seeping into every facet of life and healthcare is no exception. With developments in robotic surgery, artificial intelligence and IoT, healthcare is poised to enter its next era. The medical fraternity can benefit immensely by actively participating in this technological change,” states Nivesh Khandelwal, CEO and Founder, LetsMD, an health-tech start-up that connects doctors with patients. As example he speaks of Dr Praneet Kumar, who was earlier the CEO of BLK Hospital, who has developed a health app, called Health Mir.

Referring to the present scenario, Khandelwal says, “Currently doctors originate an idea, which are not in sync with the technological possibility of the same. Active engagement by doctors with an understanding of the underlying technology can help the entire ecosystem innovate more efficiently than currently being done.”

Dr Arvind Ranganathan – Clinical Specialist and Product Manager, Philips Innovation Campus, a doctor turned technocrat shares the example of how Philips Healthcare with the help of digitally literate doctors has developed a tele ICU system. He goes on saying, “The digital age is catching up with clinicians in a big way. One needs to be savvy of the technology available and power it brings in when used. Knowledge of technology does not include coding alone. One needs to understand technology, the products available, the power it can bring in, the usability of it and also the robustness of it. Doctors are comfortable using software’s like MS Office, charting solutions, EMR’s, mobile apps. A clinician’s mindset is in tune with that of an inventor and computer knowledge definitely opens up a big avenue for them. Doctors with basic coding skills is definitely a plus for building solutions. Similarly, the bigger value add is the clinical relevance that one brings as a clinician that helps the product. The tele ICU product by Philips is built on this module where clinicians have worked closely with engineers to bring in cutting-edge technology at affordable prices. Here, the synergy between the clinicians and their technology skills along with the minds of the engineers have played a significant part in bringing in quality healthcare to the people.”

While multinational companies are aligning with doctors who are technically proficient to develop newer technologies for healthcare, there are a few doctors who have acquired competence in computer coding and are doing great in their careers.

Dr Prem Pillay, Co-founder and Non-executive Director, HealthCode and tech-doctor, says, “Although it is not necessary for doctors to have an equivalent knowledge of computer science with medical science, it would be an advantage for doctors to know how to code. Also, a general knowledge of computer science, artificial intelligence and robotics is useful for the doctors of today to develop the medicine of tomorrow. In my own practice, I learnt how to code very early on and I was coding a variety of different systems, particularly in order to analyse complex biochemical and blood flow changes for critical organs in the ICU.”

He further cites an example of the same saying, “In the late 1990s, we helped the Institute of System Science, NUS, Singapore, develop an electronic brain atlas. This was a successful and commercialised product that did not require you to refer to a paper atlas to perform navigation and interventions in the brain. I was also involved in using virtual reality and augmented reality glasses for surgery and in using robotic microscopes. A lot of these pioneering activities came because of my deep interest in artificial intelligence and computer science. Currently, I am a medical advisor for several companies including Clinify, which has developed an excellent electronic medical record system that is not only paperless but still images, video images of patients, and procedures like MRI can be stored on an iPad and accessed by doctors anywhere. Patient information can also be stored on cloud and, therefore, is retrievable on a smartphone. I also advised the world’s first children’s wearable device called Kiddowear. This device not only enables parents to geolocate their children but also to monitor their general health like nutritional and mood assessment to enable early intervention.”

Dr Kaushik lists down various scenarios in which a technology literate doctor can help hospitals in India look and work better and thereby enhance her career prospects.

  • Each day tonnes of data is generated in a hospital and knowing data mining and developing analytics is critical to make good use of these. A doctor with enhanced computing skills will be far better equipped to deal with this data crunching than one who is not.
  • Such doctors are also fast to adapt to new software solutions including those that cater to better back end systems for data management, better patient-facing electronic medical record access points, and better software for diagnosing and treating patients who come to the hospital.
  • Such doctors are also good to help train the hospital staff on a new software tool
  • Given that many complex cases require multi-disciplinary approach and comprehension, a doctor adept in computer science is better able to read reports and develop analytics in coordination with other specialities

Apart from these, learning coding will enhance doctors to climb the leadership ladder. Explains Dr Kaushik, “A leadership role requires comprehensive understanding of the evolving technologies as well as appreciation of these. Doctors who embrace technologies into their profile faster and understand the nuances of computing will most certainly have better career opportunities as future healthcare systems will rely on high-end computing technologies and it will become incomprehensible to have a hospital without such integration. The faster we embrace computer sciences and adapt to it, the better it is”.

Another important advantage of learning computer science is identifying cyber attacks. WannaCrypt ransomware, the infamous cyber attacks in the recent times impacted around 150 countries globally. It still continues to affect the National Health System in the UK. Experts say, a clear understanding of computer science among medical professionals can help in averting such attacks.

“Knowledge always empowers a person. When doctors learn programming, they will get to understand the technology framework and algorithms better. They can then contribute in troubleshooting problems. It can be their own home PC, phone or tablet, or certain software that they use while consulting patients online,” adds Amit Munjal, Founder, Doctor Insta.

Moreover, Dr Mishra looks at the larger picture on how technically-proficient doctors can improve accessibility of healthcare within the country. “I believe that technology would certainly be a key enabler in not only addressing to this demand supply gap, but also in improving accessibility of specialised care to a larger target audience. Scalability to address to the population of 1.3 billion Indians is only possible through advanced and adaptive technology systems with doctors actively being a part of its creation process”.

Dr Jagdish Chaturvedi, Director, Clinical Innovations and Partnerships Innaccel Technologies,  is another example to the same. He shares his experience saying, “My first device which I developed in 2010 was a portable ear nose throat endoscopy recorder. It included a digital camera and an adapter that could connect to any standard endoscope enabling portable and low cost endoscopy of the ear, nose and throat. I had licensed this technology to a design firm called Icarus in Bengaluru and it was further licensed out to Medtronic. The final version of the device called Entraview now includes a touch screen digital camera with image processing capabilities that has an ear probe to visualise the ear drum. Over 200,000 patients have been screened using this device by health workers as a part of the Shruti iHear programme in Delhi.”

Very well, experts above have propounded on the advantages of learning computing coding such as building apps to monitor patients, tackling clinical problems, navigating electronic medical records, recommending health app to their patients, using innovative technologies to clinical practice, etc. Yet, we cannot ignore the fact that the number of embracing this concept are not many.

Giving a reasoning to this, Dr Mishra says, “In India, however, I do not see a significant number of doctors turning coders anytime soon. Both because of the already strenuous curriculum and limited opportunities for dual knowledge.”

Certainly, Dr Mishra India does not have many doctors who have the added skill of computer coding but as mentioned above by experts, it does make sense to gain this knowledge especially; when mobile apps, electronic health records systems, artificial intelligence and robotics are increasingly being applied to medical practice.

Incorporating computer science in medical education

Including computer science into the medical curriculum will undoubtedly facilitate in rearing the nextgen doctors. Dr Pillay advices to teach courses in coding, artificial intelligence and robotics in medical schools. On similar lines, Dr Aniruddha Malpani, Malpani Infertility Clinic feels that coding should be a part of the medical education curriculum and that healthcare hackathon need to be conducted within medical colleges to cultivate a culture of forward thinking among all medical professional right at the time of their education.

“The problem with medical education today is that all the knowledge that is imparted is very authority- based. They are not encouraged to question the status quo, or think about creating better solutions. In medicine, there’s only one right way of doing things, and doctors aren’t taught critical thinking skills, or how to improve and innovate. This is a great opportunity, and if we put together a group of different people from varied disciplines (especially medicine!), and with different perspectives, they will be able to come up with ingenious out-of-the-box solutions. The hackathon format works well to encourage this cross-pollination of ideas – short enough to draw people out of their daily routines, and long enough for participants to identify the people they want to work with and arrive at a basic wireframe of the solution they want to explore in more detail,” he expounds.

“India has a huge untapped population of intelligent medical students, who haven’t yet been exposed to these powerful tools. Once we give them the chance to wield these tools, we will be able to liberate their curiosity and intellectual ability. Given their understanding of the law of the land and their experience working with resource strapped conditions, they’ll be more likely to come up with far clever solutions than some of the ones we have borrowed blindly from the West. India needs home grown solutions, and that’s the beauty of these hackathons – they are designed with the intent of catalysing locally relevant innovations. The most important thing is that the hackathon format teaches students how to ask the right questions – “Why are things being done a particular way? What if we did things in this way, which is so much better? And how can we actually implement this in a better way?” These are all inter-related questions, some with easy answers, some far more complicated. Some would be great as thought experiments but would never work in real life,” Dr Malpani maintains.

Bringing some good news, Dr Rajiv Yeravdekar, Director, SIHS informs that Symbiosis’ Faculty of Health & Biological Sciences  is already advocating for the same. They are already in talks with the government for incorporating computer science as an important subject in medical education.

For a brighter tomorrow

The digital age has empowered both patients and doctors alike. In times to come, digital transformation will continue to disrupt the field of medicine and medical practice. In order to be braced for future disruptions, the medical fraternity in India will need to upgrade their skills to achieve new levels of understanding, knowledge and abilities in computer science.

If, doctors truly realise the potential of digital technologies and upgrade their existing skills, we can take pride in saying that India is soon going to step into the age of the smart doctor!

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