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फ्रंट लाइन लेख / Front Line Article

Building Healthcare Ecosystem around a Digital Nervous System

Fast Tracked adoption of technology in healthcare post Covid19

Arun Kumbhat

In 2003, when SARS  (Severe Acute Respiratory Syndrome) was first reported, the origins of the virus were a mystery. Scientists suspected it may have come from bats, but it wasn’t until 2012, when the second major coronavirus (Middle East Respiratory Syndrome – MERS) outbreak was spreading across borders, that researchers confirmed its provenance. At the time of their discovery, they warned us of the outbreak potential of coronaviruses, urging the global community “to learn from our past to help us prepare.”1

The Bitter Lessons of COVID 19

Be that as it may, when COVID 19 did happen earlier this year, most of the world’s public health guardians were caught unprepared, even if not unawares.

On March 12, 2020, the WHO declared COVD19 a Pandemic and was hard pressed to contain the panic and the subsequent lockdowns – both physical and economic – that it has resulted in.

The lack of resilience in both, Global economic and healthcare systems has clearly been exposed, regardless of which part of the development spectrum one looks at.  The world definitely can’t afford more instances of these.

Also, it would be safe to say that COVID 19 may be the first of the kind of global threats, but it certainly will not be the last. Human Coronavirus are a group of viruses that can change small parts of their genetic code and mutate during their life cycle. That is even if we restrict the discussion to just Corona viruses.

That would be patently unwise, considering that there are stockpiles of Nuclear, Chemical and Biological Warfare Agents assiduously built by nations over the years. We must also consider the possibilities of Industrial Disasters like Chernobyl and Bhopal that can present mammoth public health challenges to several generations and need better detection, response and oversight capabilities than we have been capable of, so far.

Not to forget that, in addition to communicable diseases, the rampant growth of Chronic Non-Communicable disease burdens across the world have already been bedeviling public health systems for long now.

‘Co-morbidities’, as we refer to these, have been responsible for a greater number of the fatalities in the Covid19 Pandemic.

Where do we go from here?

The Guardians of public health must therefore scramble to ensure that we are not caught napping the next time around. Much has therefore been said and done, as the crisis continues to evolve. Some 10 Candidate Vaccines and several new drug candidates – both biological and molecular, dozens of old ones being repurposed – are in various stages of research and approval around the world. We are even risking the integrity of our regulatory mechanisms in a frantic search for a cure and getting it out into the market.

There is then also, the frantic activity in the Diagnostics space as we realize that Testing, Tracking and isolation are the only strategy we have available, until such drugs and vaccines are commercialized.

Additionally, Patient generated data or Data from Point of Care Devices can play a vital role in situations where distancing and remote management are essential, to prevent the overwhelm of the health delivery systems.

Add to this cauldron, the long evolving trends of convergence between drugs devices and software which are coming into sharper focus thanks to the incidence of COVID19.

Remaining clear of the heat and controversies related to the issue, it is evident that detection, containment and characterization are key steps to dealing with future events of similar nature.

Countries like South Korea, Taiwan, Singapore that could rely on Data and superior Digital Information Eco Systems were not only able to nip the spread of the Virus very early but also avert its community transmission through judicious Track, Trace and Treat initiatives.

The time for Knee Jerk reactions is long past and it is time to think in a new contextual framework which might more appropriately be called Health Security.

Clearly Data is the Key!

We shall therefore, for the purposes of this discussion, restrict our discussion to technologies related to the governance of such challenges using data.

Current disease surveillance systems are built around identification and quantification of threats which are already well known to public health system. These are based on looking for conformity. Early detection will however, need to be based on looking out for Non-conforming data points and Speedy, diligent drill-down investigation of these. This could save days, weeks or months on response times and translate into lives saved. The Mutation of the Human Corona Virus discussed above is a case in point. Epidemiological surveillance Capability is what is needed going forward.

Extensive use of Artificial Intelligence and Machine learning technologies can make this process comprehensive and efficient. However, these capabilities are meaningless if the data flowing form healthcare facilities in inadequate, poor in quality or historic in nature.

There is also then, the issue of Adoption and compliance to ensure data quality, sufficiency and currency.

Most governance systems are daunted by the apparent level of investment and cost-of-change that installing such systems would require, in their reckoning. This is not necessarily true.

Digital Technologies that have evolved in less than the past decade, have revolutionized how data is collected, shared and used. It has made the use of data Platform and Device agnostic, democratic, intuitive and thus able to leverage publicly available infrastructure to dramatically reduce deployment and adoption costs while making a quantum improvement in maintainability, user experience and reliability. Above all it has made Semantic Interoperability a reality, in order that longitudinal personal health records become possible, as medicine is required to become more and more personalized, portable and safe.

From a governance perspective, this would mean ensuring availability of data that is analyzable and effectively available for epidemiological and clinical research, thus imparting predictive and pre-emptive capabilities to public health management. Health information exchange must heed this need for speed to make nimble responses possible.

The ubiquitous accessibility of Netflix, Facebook, WhatsApp and other such services is a testimony to the transformative power of digital technologies. How many of us recall having had to take classes or installing expensive hardware to start using Netflix or Facebook or WhatsApp?

That Healthcare can successfully leverage these innovations, is being validated by India’s innovative National Digital Health Blueprint2. The fast-tracked National Digital Health Mission3   (NDHM) is leapfrogging India to Digitally Enabled Universal Healthcare just as mobile telephony lifted her out of the communications quicksand of the 1980s.

The Digital Integration and transformation of the healthcare ecosystem also has the potential to bring a harvest of solutions to long standing issues that plague the healthcare space. The Internet of Things (IoT) has great integrative powers to harness patient generated and point of care device data into Personal Health Records in Real time thus strengthening the continuum of care beyond healthcare facilities, while improving outcomes through superior monitoring and compliance of care.

The quantum improvement that Digital Health can make on the systemic capability in responding to healthcare emergencies through improved Triage, Transport Decisions, Disaster Management, Tele Radiology and accessing expertise, will have a direct bearing to lives that can be saved and restoring quality to these lives.

The integration of disparate supply chain and governance solutions in place today can easily increase accessibility and affordability of drugs and related information. The ability to integrate information from Drug Research, Drug development, Clinical Trials, Approvals, Manufacturing and Regulatory Supervision, Treatment Guidelines, Prescriptions and sales, Post market surveillance can ensure quality and safety and visibility of drugs and devices to all stakeholders. Addressing Intractable problems like the overuse of Antibiotics is a case in point.

There are important debates that will arise from these evolutionary processes and transitions.

Technology based aggregators like Practo, 1mg, Jio, NetMeda, KiviHealth etc. have been attracting big investors and perceived as a threat to brick and mortar healthcare businesses who may question the equity of the situation.

There is also then, a swirl of questions around liberty, privacy and security issues. Clearly the imperatives of health emergencies would need us to make realistic allowances to let us live healthy and productive lives.

It really no longer remains a question of building a digitally enabled healthcare system, but a need to move towards a healthcare ecosystem built around a digital ‘nervous system’; to ensure that healthcare spends ensure equitable and accessible healthcare to one and all.

Also, achieving a ‘process balance’ between Preventive or Primary, Secondary and Tertiary healthcare delivery facilities. The Overwhelm that Tertiary Healthcare facilities and health workers have been subjected to in the current pandemic is a serious cause for concern.

The sustainability of Universal Healthcare while delivering better health outcomes to the citizen hinges on such a balance, for both, the provider and the beneficiary.

Digital Health promises to help strike this balance.

(Subject Matter Expert, Access Health Digital, +91 9810050478)









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