Dr. Ramesh Byrapaneni
July 24, 2019
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Innovative startups poised to get a boost with the National Health Stack

Innovative startups poised to get a boost with the National Health Stack

A powerful digital revolution is set to transform healthcare with the help of data and technology. Developed countries are already moving to provide patients access to care records online, embracing telemedicine and home-based care for the aged. Yet, galvanizing this health interface faces many barriers - economic, technological, regulatory, behavioral, socio-cultural and organizational.

The past week saw a story go viral - Shannon Dingle, an American mother of six, and a rape victim, created and carried her health resume to a hospital, and the surprised doctors were enthused by its relevance in healthcare today. The doctors’ delight also validates the premise, and efforts to leverage a patient’s Electronic Health Record using technology in countries across the world.

A powerful digital revolution is set to transform healthcare with the help of data and technology. Developed countries are already moving to provide patients access to care records online, embracing telemedicine and home-based care for the aged. Yet, galvanizing this health interface faces many barriers - economic, technological, regulatory, behavioral, socio-cultural and organizational. The UN Population Fund (UNFPA) is also striving to help countries collect, analyze and use health data for effective decision-making. But privacy and confidentiality concerns, a lack of motivation, low health literacy, health and disease-related disabilities, and even administrative burdens are making this digital transformation a distant dream in many countries.

Globally, aged and low-income populations have limited access to computers, low computer literacy, limitations in data entry, validation, and information display methods. This digital divide is holding them back from accessing their own health records.

Issues with digitizing healthcare data

Healthcare data the world over are currently not being leveraged completely to gain actionable insights into possible population health measures or even to help high-risk patient groups of chronic diseases. Electronic healthcare data was episodic, and held in silos, with no opportunity to ensure continuity of care as adoption was low, with integration or even sharing of data difficult as technology precluded interoperability. The data collected is heterogeneous and has a lot of inaccurate values, missed timestamps, and thus impossible to leverage. But countries around the world are rallying around and working to manage and overcome such issues, in a bid to leverage data and focus on better healthcare for their populations.

What ails the current health system in India? And in other parts of the world?

In the recent report on Healthcare Access and Quality Index by the Gates Foundation, we find India at the 145th position among 195 countries, behind Sri Lanka and Bangladesh. The standard of healthcare services in India might seem impressive if one were to look at how life expectancy has increased from 40 years (in 1960) to 69 years (in 2017). Yet, the system is still beset with problems. India’s rural masses are a neglected lot – with inadequate medical personnel, and social inequalities percolating into the quality of healthcare received. There are scant medical research and an inadequate outlay of funds towards health initiatives. About 75 percent of India’s population living outside a city has access to only 31.5 percent of hospitals and 16 percent hospital beds. India has almost completely neglected preventive, rehabilitative and public health measures.

How other countries are grappling with issues?

Let’s look at what is happening with a global leader in healthcare like Singapore, and countries like China, Saudi Arabia, USA, Canada, etc. According to a recent survey by Royal Philips, Singapore is collecting and digitizing healthcare data avidly, and applying AI technology to analyze it to improve the accuracy and efficiency of administrative tasks such as staffing and patient scheduling (37 percent) rather than for diagnosis (28 percent), flagging patient anomalies (26 percent) and facilitating remote patient monitoring (25 percent). The focus is not so much on treatment and diagnosis as yet. 

a. Use of digital technology in healthcare around the globe (Source: Future Health Index Report 2019 by Philips)

The report further reveals that emerging countries like China, Saudi Arabia, India, and Singapore are leading the way in the use of technology in healthcare. However, only 28 percent of Singaporeans have access to their own digital health record, and 20 percent are clueless if they do or not. About 48 percent have never shared their health data with any health professional. What’s more, China and Saudi Arabia have higher rates of telehealth adoption by healthcare professionals at 89 percent and 75 percent respectively, compared to 68 percent in Singapore, 61 percent in Australia and 66 percent in India.

The reason for this could be a higher patient demand in these countries. Countries like the USA and Canada have mandated the digitization of medical records to avoid preventable medical errors and other adverse events during acute care and after discharge. These statistics only elucidate the distance every country has to cover on their journey to total digitization for seamless healthcare.

c. Benefits with digital transformation in healthcare (Source: Future Health Index Report 2019 by Philips)

What can India do?

India is moving towards universal health coverage and embracing digital technologies to fix system-level challenges in providing access to essential health services to all its citizens. Digitized or electronic health records will be mandated at least where the government or insurance companies pay for healthcare services through Ayushman Bharat, CGHS, ESI and insurance with a standardized disease or diagnostic code. This move can also help ensure quality care under these programs as clinical outcomes are recorded and tracked. An EHR (Electronic Health Record) could follow the fragmented journey of a patient through different multi-specialty clinics and care centers. Collecting data is not enough unless all the systems are interoperable and healthcare professionals are computer-literate and willing to share data without violating any security protocol.

Is National Health Stack the answer?

To help India move decisively along the path to digitize healthcare, NITI Aayog has released the blueprint for National Health Stack (NHS) for comments and consultation. NHS is a digital framework that covers healthcare across private and public sectors, aiming to improve the accessibility, quality, and affordability of healthcare across India.

Like India Stack, Health Stack will also create a unique, virtual health ID which links to a strong foundational ID of every user while protecting privacy. It’s set to boost medical research and enable population health management through a national health analytics platform leveraging Big Data and AI with Machine Learning. The different layers of this framework will seamlessly link to national health electronic registries, and provide a platform for various health verticals and even help monitor insurance policies, coverage, and claims. The Health Stack will also offer other components like digital health IDs, health data dictionaries, supply chain management for drugs, payment gateways and more. The benefits expected from the futuristic NHS include a lowered cost of health protection, elimination of fraudulent claims, a cashless experience for the poor and wellness across the population.

Rights of access to sensitive data

The draft emphasizes that digital health data cannot be accessed, used or disclosed to any person for a commercial purpose, and cannot under any circumstances be accessed, used or disclosed to insurance companies, employers, human resource consultants and pharmaceutical companies, or any other entity as may be specified by the Central Government. But multiple stakeholders can be permitted to access a user’s medical history. The NHS envisages the intermediation of ‘health data fiduciaries’ between entities that generate health data, and entities that want to consume that data, in order to provide better services to the user.

Users will need to be educated on the necessity and importance of exercising their right to consent. Allowing access to their health with the right people is of utmost importance if they want innovative new cures to a disease or preventive measures to stop its spread.

Effects of NHS on healthcare product companies

The plan will ensure that all 1.3 billion Indians will have digital health records by 2022. Population health measures like the National Nutrition Mission, telemedicine, and other interventions will reach everyone as the healthcare system moves to people-centric care and interoperability.

The India Stack promises to be an entire ecosystem of operations and services, products and institutional design. Now is the time to plan for innovative products that complement their capabilities. The NHS document also suggests that data can help market players build relevant and innovative services on the platform to fill gaps in service. NITI Aayog is expecting the industry to be involved in building this digital health system, owned and operated by the Government, and accessible to anyone who wants to build on the data using open API software. This expectation will apply to all medical device makers, telemedicine service providers, professional care service providers, and digital healthcare systems providers.

Time to ideate on healthcare

An opportunity worth exploring for any product company, it requires a product team to familiarise itself thoroughly with the details laid out in the NHS document.

IT startups, investors and catalysts are all excited to be a part of this transformative change and to see that India’s healthcare is completely re-imagined. If you are an entrepreneur burning the midnight oil, working towards a transformative product that could revolutionize India’s booming healthcare industry, this is the right time to take stock of the transformative changes across the healthcare eco-system wrought by the NHS. Leverage the huge treatment database to offer sophisticated AI-based solutions, and interoperable apps to offer better solutions to existing problems, and to even offer medical solutions, wherever possible.