Sunday, August 20, 2017

India: At The Doorstep of Healthcare Revolution

Healthcare Revolution 
 
If you go down memory lane and revisit the Rajiv Gandhi era of 1985, you should able to remember the fragile and non-existent telecom system of India.  I know a vast majority of the internet population will not be able to understand as they are born in the age of cell phones. They are fortunate enough to see landlines in museums and lift a receiver to play with rather than  to call someone.
During this time getting a landline was like a dream come true if you don’t belong to the crème de la crème.  Then Rajiv planted the seeds of the telecom revolution with the help of a telecom engineer, inventor, entrepreneur, policymaker and most importantly a visionary. I am sure you must have understood that I am talking about Sam Pitroda.  (https://en.wikipedia.org/wiki/Sam_Pitroda) Without going into politics, this is not a political article, I will say that every successive government followed the open market policy, and India witnessed multiple revolutions which have practically changed the face of the Agriculture based economy. Telecom, followed by the Computer, followed by the internet and many more revolutions put India on the world map as a country with an emerging market.
Today this country is at the doorstep of another revolution. This is one of the most important revolutions because it touches human lives. If you analyze and compare the Indian healthcare system with that of any developed country then you will realize that it is one of the most disorganized sectors.  This sector is contains all illnesses and any change in it will certainly be welcomed by the masses.  This sector is plagued with high prices, low quality, excessive delays, low expense on research, and above all corrupt practices.
However, if you are little close to reality, you can notice an undercurrent of change ready to sweep this sector and weed out malpractices.  Majority of these changes are self-driven, entrepreneur based, and not sponsored by the government. This situation is impressive to a certain extent because self-driven systems face less resistance as compared to government sponsored. Now let us analyze some of the subtle, yet significant change, which you can notice while using the system as an end user, a patient, or relative of a patient.
1.      In the year 2015 I was actively monitoring the health of my Father-in-law, and during this time a Patna ( B-Grade City in India) based laboratory gave me access to all of his lab results, which I  reviewed  in  California . In my mind this is the primary purpose of patient portal and a key component of Electronic health records (EHR). I agree that the laboratory may not have a robust system in place to take care of privacy concerns (Also known as HIPAA Laws in the United States:  Health Insurance Portability and Accountability -1996 ACT). But then again, “Rome was not built in a day”.
2.      Few years ago, I talked about mail order pharmacy, the majority of my friends discarded the idea by saying it won’t work in India as it is a highly dis-organized.  Today multiple mail order pharmacies are operating in the country with services such as 1mg.com, netmeds.com etc.
3.      Today if you need appointment with a general physician or with a specialist, you need not go to his clinic to book an appointment. Instead you will turn to practo.com or some other similar web-site to book an appointment instantly.
All achievements I listed above are relatively simple and entrepreneur driven. However the road ahead is very interesting. When I say interesting, I didn’t mean long and tiring. This revolution will sweep the country faster than we imagine. It will be faster because this is the internet era and information travels at the speed of light, if not faster.
One thing which will favor the healthcare revolution in India is the existing system followed in the western world. We have a working model and we need to learn from this existing system, analyze it correctly, and pick the best practices while discarding some of the ineffective processes.
I will go back to the Telecom revolution as my example. When India embarked on telecom journey it certainly learnt from western countries. However they took this journey ahead than their western counterpart. Today’s Indian telecom sector is equally flexible, cheap, and quality conscious than any other developed country.
I do see the same kind of synergy happening in the healthcare.  Once the government will start planning to regularize health industry, all the necessary framework is already present. India doesn’t need to design the framework, rather only adopt the framework and tailor it to suit the need of the country.  Let me give some examples which may be able to substantiate my theory of synergy.
1.      Recently America underwent a massive change of a diagnosis Code called ICD-10 migration from ICD-9.  ICD stands for International Classification of Diseases. This change occurred in every hospital, private doctor offices, Pharmacies, and claim processing centers. This was a huge effort involving tens of thousands of IT and Business hours and dollars. India can directly go to ICD-10 and skip the painful process of migrating from ICD-9 to ICD-10.  To this effect, I did see a plan from the Government of India detailing the implementation of ICD-10.
2.      United States went to multiple phases of Electronic Health record implementation which they labeled as MU1, MU2 and MU3.  MU stands for “Meaningful use”.  India doesn’t need to go through this evolution of MU1 to MU3.  They can directly move to MU3 or somewhere in between MU2 and Mu3
3.       Similarly India can derive many best practices from the healthcare insurance industry such as claim processing and other business processes.
I am not trying to paint a rosy picture here. I am only saying that with the help of the internet, program implementation and rollout are becoming increasingly fast. We are at an intersection and a little push from the Government will get the ball rolling and revolution will move towards maturity from its current nascent phase.