Mapping New Frontiers in #DigitalHealth by Aparna Kumaraswamy, @swissnexindia

Healthcare initiatives have taken a quantum leap by incorporating many disruptive applied sciences that search to assist and empower the affected person base by bettering entry to current and novel companies at decrease prices.

A Focus group initiative by swissnex and business consultants, the article was first printed on Nextrends Asia. Its been republished on the HCITExperts Weblog, with the writer’s permission. Digital well being has taken agency root in Public well being companies on account of many elements:

• Democratisation of knowledge by speedy development in telecommunications.
• Elevated consciousness of well being initiatives by most of the people, because of digitisation.
• Aspiration and upward mobility in all fields, together with healthcare.
• Shift in the direction of participative and preventive medication.
• Growing funding and entrepreneurship in digital well being.

Harnessing the info engine

The ubiquity of cellphones and smartphones in India has given rise to a tech savvy era, conscious of healthcare challenges, and keen to analysis and discover all doable well being supplier outcomes. Up to now 10 years, a whole economic system outdoors the purview of institutional healthcare has risen, pushed by disruptive applied sciences, digital outreach and direct to client advertising.

India is especially well-placed to reap the advantages of this new knowledge revolution: it has a big consumer base which is a well-tested marketplace for implementation of new applied sciences and generates large quantities of various knowledge.

An unlimited pool of digital knowledge is now accessible, and knowledge mining is now the brand new gold rush. Nonetheless, knowledge mining can yield blended outcomes at greatest: asking the appropriate questions, sifting by solutions and making insightful observations is one of the simplest ways to derive significant conclusions. This results in higher machine studying (ML) and synthetic intelligence (AI) fashions, and the constructing of dependable studying experiences that translate into product.

From knowledge to merchandise to markets

As soon as a dependable knowledge interpretation course of has been established for an issue space, the place does this result in? Whereas it’s straightforward to be swept away by novelty worth, it’s cheap to imagine that one is extra prone to fail than succeed the primary time. Figuring out most urgent wants, areas that provide buffer house in case of failure and initiatives prone to yield early success are greatest chosen for engagement. Certainly, this pragmatic strategy has led to the primary successes within the Indian digital well being market: on-line pharmacies and doctor aggregator instruments. Enterprises like Practo, Lybrate and 1mg have sensitized the market to healthcare improvements, and offered worth to prospects by growing comfort and reassurance. These enterprises leveraged the success of earlier direct-to-consumer companies like BigBasket, Amazon and Flipkart. These are sometimes the bottom hanging fruit, catering to the broadest buyer base, but additionally have a fragmented market. Nonetheless, success breeds success and these have spearheaded the following wave of digital well being ventures.

The subsequent spherical is undoubtedly tougher. Earlier than speeding into riskier ventures and newer markets, it’s essential to establish potential points, alternative areas and to investigate the startup panorama from totally different features to plot methods enabling success. For this, a spotlight group comprising consultants from diverse fields together with entrepreneurs, coverage consultants, healthcare suppliers and thought leaders was convened.
The main focus group offered significant insights on numerous features of knowledge acquisition, utilization and future tendencies in healthcare.

The information conundrum: Whose knowledge is it anyway?

The muse for all digital initiatives is high quality knowledge. Acquisition of knowledge from hospitals or healthcare suppliers to plot high quality coaching units for strong and dependable outcomes is important to digital product growth. Requirements in India relating to knowledge safety up to now have been lax; nevertheless, healthcare and governmental programs are actually cognizant of affected person/buyer privateness and are adopting stringent requirements like HL7 or HIPAA that makes it obligatory for knowledge to be utterly protected with penalties for non-compliance. That is the fundamental requirement for digital well being information (Storage on-line, offline and inside the nation of knowledge origin). Nonetheless, innovation requires free circulation of knowledge: due to this fact the affected person, who’s the last word proprietor of the info, is now the focus of knowledge acquisition. This has been clearly delineated by three insurance policies – the Srikrishna committee [1], DISHA [2] and the IT act [3].

The main focus group confused that affected person engagement is the “billion greenback drug”. There are issues if affected person consent may be obtained and if healthcare managements half with knowledge. Nonetheless, there are pioneering programs which can be within the course of of knowledge assortment, collation and integration. These are linked to public knowledge assortment programs: knowledge flows into this when a person accesses these for advantages, banking, insurance coverage and funds. Such knowledge aggregates kind Well being Stacks. One such Well being Stack is nicely underway and is predicted to be operational by 2020. That is additionally anticipated to incorporate inhabitants genetics knowledge, beneficial for figuring out illness predisposition and outcomes. As a corollary, strong insurance policies for knowledge administration are additionally anticipated to evolve at this level. Taken collectively, Well being Stack is predicted to facilitate well being information, analytics and insurance coverage claims [4]. Anonymised knowledge from such sources are anticipated within the close to future and will likely be pivotal to many inventions. Certainly, consultants opine that know-how and authorized points should not huge hurdles, so long as each affected person and physician are agreeable – alternatives do exist.

Based mostly on the present limitations for knowledge acquisition, initiatives available in the market and the present necessities in healthcare, the next areas are recognized as potential development sectors.

Focus space 1: AI, ML resulting in software program as a diagnostic

The introduction of AI and ML purposes, mixed with top quality knowledge and pictures has yielded nice leads to pulmonology [5], radiology [6] and prognosis of breast and cervical most cancers [7, 8]. These early initiatives have led to extra superior purposes like personalized most cancers remedies and modern point-of-care gadgets which have the potential for reasonably priced and well timed healthcare diagnoses [9]. A notable level for the success of those enterprises is that high quality knowledge has been accessible for a very long time, notably within the subject of radiology.

Most cancers diagnoses are catching up too, with AI being leveraged to provide therapy choices by telemedicine [10]. These could also be assumed to be the low hanging fruit of the medical world when it comes to ubiquity of knowledge and market measurement (glucose monitoring for instance) – extra superior purposes would require very excessive volumes of knowledge and appreciable knowledge mining. The speedy focus for India within the eHealth area is thus easy-to-deploy and related applied sciences. This may drive low value improvements that serve populations within the growing world as a substitute of importing applied sciences.

Focus space 2: Partaking the affected person – eHealth instruments for affected person reported trials

India has a big pool of sufferers who’re drug naïve and more and more, tech savvy. Whereas India has all the time been a spotlight of drug trials, elevated scrutiny on drug trials has taken the sheen off scientific trials. As a substitute, the success of digital B2C endeavours has opened up a brand new avenue: affected person reported trials for eHealth instruments. eHealth adoption, notably for medical gadgets is at the moment low. Nonetheless, there may be openness in the direction of utilizing instruments for affected person reported outcomes. This removes the hurdle of knowledge acquisition because the affected person is the info generator and reporter. This additionally offers the affected person higher autonomy over his therapy and permits him to turn into a associate quite than a recipient of healthcare.

Success on this area has been reported for EHR instruments with glorious rural uptake [11], eliminating the misperception that ehealth initiatives have a market solely in city areas. There’s a very optimistic outlook from physicians since these improvements goal sensible issues in care giving. One potential difficulty will be the availability of backup groups of technicians to assist software-intensive purposes and flexibility to native issues. Nonetheless, a well-structured software with clear utilization directions can overcome these points. Peer acceptance is one other hurdle, however a definitive scientific trial can handle this as nicely. Market acceptance is nice, with elevated consciousness and willingness from healthcare programs. Incentives to the sufferers embody simpler entry to telemedicine and quicker doctor response occasions to emergencies.

The consultants on the Focus group emphasised that the Indian healthcare business is more and more open to modern startups in eHealth instruments. Main company hospitals and authorities are engaged on a number of new initiatives to make use of know-how in healthcare, both as monitoring programs or digital well being reporting programs. The eHealth sector is clearly on an upward pattern.

Focus Space 3: Digital Healthcare for the payers-providers-patient axis

Well being protection in India is segmented between authorities well being schemes, non-public insurance coverage and for the overwhelming majority that has no insurance coverage, funded out-of- pocket. Growing lifespan, elevated consciousness and revenue, unmet wants in healthcare, an enormous uninsured inhabitants and growing healthcare prices have created an enormous marketplace for insurance coverage suppliers.

Insurance coverage is primarily Danger sharing between Insurance coverage, Hospitals and Sufferers. Alignment of pursuits between stakeholders – payer, supplier and affected person – is a problem though alternative areas exist. The ache factors for payers embody the dearth of transparency in payouts and unevenness in medical prices/companies from suppliers whereas the suppliers’ grouse is administrative prices, experiences and documentation, delays in reimbursement and potential litigation. Nonetheless, each have affected person welfare as their finish aim, and therefore current many alternative areas to extend worth to the shopper.

Final result vs. Process as the standard index for incentivisation

Key companies from insurers are a possible level for digital well being initiatives to make a distinction. This could possibly be both a mechanism to allow simpler disbursement, higher stratification of sufferers to allow decrease premiums or being a key hyperlink to allow participative and preventive medication. The overwhelming majority of present insurance coverage schemes concentrate on procedural prices, which can not assure affected person wellness. In different phrases, consultants opine that outcomes and never procedures needs to be rewarded. Nonetheless, the Focus group famous that consequence willpower remains to be a gray space: outcomes for Stage 2 vs. Stage 4 are very totally different for a similar most cancers. Likewise, variability elements (geographies, genetics, financial standing and affected person compliance) that have an effect on outcomes of even simply manageable situations needs to be thought-about throughout validation research. Final result monitoring and costing can’t be monolithic on this situation.

Additionally it is steered by consultants that market validation for improvements ought to zone on which situations reply positively to the innovation mannequin (i.e. Most cancers vs. Diabetes vs. Cardiac care). Clearly one measurement can not match all. As well as, it’s higher to establish the exact stage of startup engagement as a single unit and drive a consumer case research for the actual block quite than the complete chain for higher readability and speedy insights.

Assessing threat urge for food and uptake capability

One other potential checkpoint is the healthcare supplier’s scale and means to implement innovation uptake. Healthcare in India has each authorities and personal institutions: of those, non-public suppliers could also be categorized into small, medium and enormous enterprises. Incentivising elements driving higher uptake of a brand new know-how could also be greatest suited to massive Enterprise Hospitals quite than Authorities organisations. A trickle down impact is clear – governmental organisations have mass outreach applications that may be accessed for late stage rollouts. Lastly, it’s also essential to establish companions or enterprises that share the startup’s imaginative and prescient – alignment and threat urge for food of the potential associate decides concept uptake. That is essential since conventional healthcare suppliers are threat averse and are prone to take up fashions which have succeeded elsewhere. Merchandise which can be both within the deployment part or have very robust incentives can solely be pushed on this case.

Focus space 4: In the long run, nothing succeeds like success

Monetary success, i.e. monetisation of the product, is what sustains a startup and helps it rollout superior assist merchandise. On condition that the market could be very unstable with frequent know-how disruptions and competitors, startups are actually in a do-or-die mode. The Focus group consultants observe that start-ups discover it problematic to monetise from suppliers, particularly for insurance coverage merchandise, except they’ll particularly hyperlink the affected person’s fee with service offered by the know-how/product. Oblique strategies of affect are unlikely to be accepted. A transparent roadmap in the direction of reward must be formulated since failure to translate an innovation right into a monetary success spells doom for additional endeavours.

Increasing on this side, it’s apparent that B2C ventures have had the perfect run up to now within the digital well being market. Whereas sure merchandise clearly fall into the B2C purview (affected person reporting instruments, on-line pharma and consultancies, doctor aggregators), merchandise coping with insurance coverage are greatest focused at main payers who then move on the advantages to sufferers, which makes it a B2B2C mannequin. Positioning startups and their merchandise strategically permits early best-fit associate choice, higher funding in some circumstances and general product uptake.

The Key Takeaways

For these causes, the main focus group assembly at Swissnex with Business consultants has highlighted three broad areas of growth in eHealth initiatives: B2C initiatives, Software program as a diagnostic, and affected person monitoring instruments in eHealth. All three have totally different scales and have the potential to affect healthcare on the macro and micro ranges of affected person care. These are the following dawn sectors, with development and market seize potential.


  1. Knowledge Safety Committee Report
  2. DISHA – ACT – Draft:
  3. Private Knowledge Safety


Aparna Kumaraswamy
Aparna Kumaraswamy

Mission Supervisor, HealthTech,
Swissnex India, Consultate Normal of Switzerland

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