If Indian government digitizes healthcare, it can deliver healthcare to 1.3 billion people without spending any money. So, Noise and attention need to convert into deployment and business.
For over a decade, a lot of high-octane keynotes and fancy presentations have been made about Indian Healthcare IT. Many startups have also sprung up. The debate has now moved from eHEALTH/EHRs to AI & big data. But the industry is daydreaming about AI & big data without putting the building blocks (EHRs) in place. India needs to make the next decade (2020-2030) as the decade of HCIT to covert the vision into reality and commit to moving 90% of healthcare transactions paperless.
Prof. Rajendra Pratap Gupta Policy Maker and former Advisor to the Union Minister for Health & Family Welfare, Government of India. Rajendra Pratap Gupta (Rajendra) is a public policy expert who has been contributing to policy making for over a decade. He played a key role in drafting the National Health Policy 2017, National Education Policy, Policies for Labour and Employment and the state health policy of Uttar Pradesh. Besides, he serves on several committees of the government and is also, on the global guidelines development group of the WHO and empaneled on the WHO roster of experts for Digital Health. |
DistilNFO had an opportunity to interview Rajendra Gupta for his insights on HCIT in India. We thank him for his valuable inputs.
1. Rajendra, thank you for taking the time out of your busy schedule to talk with us. DistilNFO appreciates it!
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To start with, tell us about yourself, your career journey so far and your current role. What are the key traits that made you successful in your roles?
Rajendra:
I am in healthcare by default and not by design. I wanted to be a civil servant or a Professor to serve society, but my mother (Who was a class 1 government employee) died of stage IV cancer and our family was at the crossroads. When my mother died, we have spent all her money on her cancer treatment and we had no money to do her last rites when she died. So, our family became BPL from APL in a matter of minutes! That was the turning point.
I applied for a job in about 70 companies, and the first company where I got hired was in health. And after that, I thought many times to pursue my original dream, but somehow, the family responsibilities and fast pace of success kept me in the corporate world. But, I did stick to my plan and I quit full-time roles in 2007 exactly 10 years after starting my career and pursued my inner calling of ‘policy-making’ to make this world a better place through the right policies. So, my career spanning more than two decades gave me varied exposure across the USA, Europe, U.K. Middle-East and South East Asia. Also, I got a chance to work across sectors and write policies not just for India but to draft the policy documents globally through WHO, WEF & the United Nations. It has been amazing learning and a journey.
Rajendra: We have to see this from multiple standpoints.
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- Firstly, technology moves faster than policy and regulation. But without a policy and a regulatory framework, you cannot expect clinicians to adopt IT. This has been a big stumbling block. We must build a ‘live regulatory framework’, which fuels innovation and adoption, but not makes it heavy on compliance and is a deterrent for innovation and growth. Also, where incentives with enforcement can work, we must not overdo with penal regulation.
- Secondly, clinicians want evidence and digital health has many ‘islands of excellence’ but not ‘evidence of a scale’ which can convince the clinicians to wholeheartedly adopt IT
- Also, clinicians don’t want to be tied to what they spoke or wrote in the prescription. With digital tools, they will be pinned down for their faults (if any) as all they do will have a digital footprint. This is also a contributor to slow adoption.
- Also, hospitals somehow have a fear, that if they use HCIT, their business will become online and patients will not show up in the hospitals and occupancy levels will reduce and this is wrong but somehow, it has got into the minds of the hospital service providers
- Lastly, there is no defined financial model of who pays for IT and how the clinician gets paid for doing telecalls? Healthcare is already facing a cost – value challenge and IT adds to the cost and who bears the brunt? Finally, reimbursement models are not clear
Till we holistically address the above key issues, HCIT can be pushed for adoption but ‘pull’ from the clinicians will be tough.
Rajendra: Firstly, HCIT has to move beyond scheduling, Clinical decision support, and billing functions. We need to start patient portals and mobile-based patient connect platforms. Practo has done a great job in 180 million records being created in a short period of time. Kerala as a state has done phenomenal work in HCIT. We need to replicate it together as a ‘TEAM’. We need a healthcare information exchange. If the government is delaying, the industry needs to come together and set it up.
Also, I think that the conventional preventive care models are dead and fitness wearables are the future of preventive care; both primary and secondary prevention. Fitness wearables are smart and evolving fast and also, they have form and fashion. With wrist-based fitness bands becoming affordable and capable of doing ECG, we are in for a new care model. I think everyone in the healthcare industry must take note and converge to f-care or w-care ( Fitness Care / Wearable Care ) model. I believe this industry ( Fitness Wearable ) will certainly overtake the diagnostic industry in the next 5 years and the healthcare industry in a decade. Disruption is waiting to happen and we cannot close our eyes.
Rajendra: In my view, the Indian healthcare industry is day-dreaming about AI & big data. We don’t even have the basic EHRs in place. First, let us get EHRs in place, a health information exchange and then, let us talk about AI & big data. Insurance players will drive change and if India moves to universal healthcare, this change can happen faster. I am founding two initiatives and will declare 2020-2030 as the decade for digital health. We have to galvanize all stakeholders to fast-track the adoption of digital tools.
Also, there is an important idea for the government to consider: Look at the most innovative nation- Israel, it is digitizing health records of all its 9 million population and spending about USD 275 million and will monetize this data to earn 600 Billion. Imagine what India can achieve? We are not a 9 million population nation, we have 1.3 billion population! We could make much more! If Israel could make 600 billion USD. Also, if we give financial incentive, we don’t have to spend even 275 million USD to digitize all records, we just have to spend about 100 crores to set up a secure Health Information Exchange (HIE ) in partnership with the private sector! Going by what Israel is doing, by digitizing records of the entire Indian population and monetizing it for research, we can transform the way we look at healthcare quality, boost job creation in healthcare and delivery of care. In fact, if the Indian government digitizes healthcare, it can deliver healthcare to 1.3 billion people without spending any money from its coffers by just monetizing on the population’s healthcare data.