Waking up with cold sweats for a week in April during the pandemic, Ms Bharati Kumar knew she needed a doctor. She made an appointment on a digital healthcare website and spoke on video to a doctor, who sent someone to collect her blood samples and prescribed anti-anxiety pills and exercise.
Ms Bharati, 50, called the experience “weird and futuristic but easy”.
Telemedicine could become more common as India gears up to digitalise its crucial but neglected health sector.
As the pandemic lays bare unfit state hospitals, severe doctor shortages and gaps in hospital access, the Indian government has turned to digital technology and private players to treat these chronic afflictions.
The Covid-19 crisis has sped up a national digital health programme launched in January. In March, the government released guidelines for telemedicine. This month, in his Independence Day speech, Prime Minister Narendra Modi announced a national health identification for citizens. Fledgling start-ups are gearing up to grow big and fast.
“The government’s articulation makes (digital healthcare) mainstream. It will draw more private investment and make healthcare more inclusive,” said Mr Prashant Tandon, co-founder of 1mg Technologies, a healthcare app.
In a country where only 1 per cent of GDP is spent on public healthcare, and one government doctor attends to more than 11,000 people on average, companies say digital health is the only way to reach more people. But Indians who most need remote healthcare – the elderly, the uneducated and rural poor – are also the hardest to reach digitally. Companies face questions of how they will scale, provide quality diagnosis and secure health data.
Tech developers from iSPIRT, a private tech lobby group of the biggest Indian private tech players, are now building the digital infrastructure – a “national health stack” – that start-ups can build on. The programme is overseen by government think-tank Niti Aayog and the National Health Authority, a state body tasked with delivering universal healthcare.
The health stack will have registries of certified doctors and testing labs, electronic health records of patients, gateways to make and claim payments and, eventually, “health analytics”.
The Indian government sees it as a harbour to launch a thousand e-healthcare start-ups, but the sea ahead is choppy. More than one million chemists, almost 60,000 hospitals and over 800,000 doctors will have to be brought online, and their patient data collected digitally and standardised.
“I’ve seen hospitals with 200 to 300 beds in small towns that don’t have a single computer. Getting them to adopt digital health is a tall ask,” said Mr Rajat Garg, co-founder of myUpchar.com, a digital healthcare firm that works in rural India.
In a country where only 1 per cent of GDP is spent on public healthcare, and one government doctor attends to more than 11,000 people on average, companies say digital health is the only way to reach more people. But Indians who most need remote healthcare – the elderly, the uneducated and rural poor – are also the hardest to reach digitally.
HOSPITALS WITH NO COMPUTERS
I’ve seen hospitals with 200 to 300 beds in small towns that don’t have a single computer. Getting them to adopt digital health is a tall ask.
MR RAJAT GARG, co-founder of myUpchar.com, a digital healthcare firm that works in rural India.
Mr Lalitesh Katragadda, an entrepreneur helping to build the national health stack, admitted it will be a long haul. The first wave will be teleconsultation. “Once the infrastructure to get patient consent becomes better, telemedicine will take about three years to mature. Then it may be e-pharmacies, and then, in 10 to 15 years, the sci-fi stuff can start.”
The sci-fi stuff includes creating personal histories of “biomarkers”, or measurable medical signs like blood pressure and pulse rates, from birth to death; using artificial intelligence for India – and ethnicity-specific medical analysis; and genetic and enzyme breakdown for targeted diagnoses.
Hurdles abound. Mr Katragadda illustrated one: “IDs used and data collected today have to be recoverable five to seven decades later.”
Mr Garg offered another: Standards of accepted medical terms are all in English, while Indians treat and express illnesses in hundreds of languages.
Healthcare tech consultant Pramod Jacob said: “The current architecture is being designed under Covid in a hurry… The major focus is on claims and billing, without due focus on clinical data collected in a way that medical professionals can use it.” Dr Jacob said that scans of medical reports and photos of handwritten prescriptions may help process insurance claims but would not aid clinical analysis.
When Ms Bharati visited a physician in person in June, he told her she had just recovered from malaria. He took her off the anti-anxiety pills, calling them unnecessary.
Jaipur-based pathologist Rohit Jain, who sought a court ban on Covid-19 testing by e-healthcare firms, said: “Do doctor-patient ethical principles apply to these third parties? They are e-commerce entities… It is illegal for them to collect medical samples and issue test reports on their letterheads, but they all do it.”
India has gone online nearly overnight before, for online payments, when the government effectively removed 85 per cent of currency notes in 2018. The pandemic may be to e-healthcare what demonetisation was to digital payments. But there are more clinics, chemists and labs than banks and they are more unorganised.
Health data is also more layered and sensitive. The government insists that, in the digital health system, the data is owned by only the patient. But in the absence of a data protection law in India, there is little accountability for privacy violations.
The pandemic has forced many Indians like Ms Bharati to experience the fragility of the country’s healthcare system. They would hope that any prescription would first do no harm.