Smart Cities would need Smart Healthcare

Ailing healthcare is what we have today

What is a smart city if there is no smart healthcare? But latest spectacles of mess emerging from Chikungunya and Dengue menace ravaging Delhi, the capital of India, hardly indicates we are in for even a semblance of smart healthcare. Smartphone is being flaunted as a harbinger of smart healthcare, and truly so, saying where doctors fear to tread, smart phones already are homing birds even in far flung and inaccessible areas of India  and that this handy machine would make distance between super specialists and areas eternally starved of healthcare infrastructure and skilled health workers immaterial. The buzzword is smart healthcare is where Smartphone is.

As big daddy of App, Mark Zuckerberg, in his new great and most ambitious initiative (you can call it Zuckercare also if you will, on the line of Obamacare) has taken upon himself to help scientists to cure, prevent or manage all diseases within ‘our children’s lifetime’, be sure breathtaking health Apps and new tools to make healthcare smart and very smart at that, are in the offing which would certainly transform the global healthcare. Armed with massive smart phone penetration, India stands to gain from this transformation. India can leverage this advantage to make universal quality healthcare a reality. The central government, which is hard pressed to offer universal healthcare, should sit up and start formulating mHealth friendly laws to welcome new age medicine. Universal healthcare with meagre investment- what more India can wish whose public expenditure in health is abysmally low! India must climb up the bus of App driven smart healthcare.

But is Smartphone is a magic wand that would herald smart healthcare in a flourish? Smart healthcare means affordable quality treatment even without high tech infrastructure and specialists at hand. But distance alone is not a hurdle in taking quality healthcare far and wide. For a patient from Bihar in AIIMS, waiting for his turn to come, is as far away from the apex government hospital as when he was in Bihar. An overburdened AIIMS itself look like a patient. When the age of smart healthcare dawns on India, and that must in time, AIIMS like hospital would have to give an impression of being ultra smart.

Smart phones of course have been found to be a very effective tool in making quality healthcare universally available in many countries. India has also set universal healthcare as its avowed aim. In a vast country like India, it can be done only smartly because making high end health infrastructure and specialists available everywhere would entail humungous investment, which is not going to happen any time too soon. So if universal healthcare is really the intent in India, only smart way and innovation would have to be adopted.

But that is easier said than done.

For sure, smart phones have become ubiquitous in the country but it is not the only component that constitutes smart healthcare. Other components, especially human ones, would be needed to be in place to make this handy machine workable in equitably distributing quality healthcare throughout the country. Smartphone applications can really reform the healthcare delivery in a big way if other loose ends are tied.

Smart healthcare also presupposes smart patients. Smart healthcare is one where patients armed with technology, are smarter than doctors. And patients to be smart, people in general would also have to be smart which means they would have to be well informed and thoroughly sensitized about diseases communicable or non communicable, mobiles phones are expected to do.  Are we that kind of people yet? Are we receptive to health campaigns? I am afraid the answer would be a big No. But this fact needs to be known that mobile phones can truly empower patients. Mobile phone tools would make doctors playing second fiddle.

Sample this, Indian Medical Association is trying to hammer home the point from ages that platelet is not much of a help in managing Dengue and rarely needs to be transfused in the patients and keeping patient replenished with water is the real medicine ever since dengue scourge became an endemic in Delhi but of no avail. Just as dengue season begins, platelets are what are uppermost on the mind of people as well as doctors, though for different reasons. Platelets become obsession. The first question that doctors taking the round of hospitals ask dengue patients what the platelet counts are and would gesticulate as if platelet catastrophe is around because platelet transfusion have become a means to make money in the sickroom. Doctors allege that they are goaded to transfuse platelets even when there is no need for it. Which of the two is true, it is far from being smart. But smartest way to cope with vector borne diseases like dengue or chikungunya would be not to let mosquitoes breed at all. It is incumbent more upon the people because house is the most potent place of mosquito breeding. Till Delhi people become such smart as proactively stopping mosquito breeding and wearing such clothes as would not leave skin within mosquito reach, dengue would continue making mess of healthcare in India.

We are in throes of being one of the few smartest economies in the world but smart healthcare is still missing. It should have come well before India began pitching for being whale of an economy.  India is the only country in the world which is trying hard to become third biggest global economy without being healthy. All developed countries first became healthy before being great economies.

Well, the new age healthcare is bound to be smart. Digital age has brought about a radical shift in the way healthcare is delivered. Digital India will be lopsided if it does not entail smart healthcare. In the era of smart healthcare, 24/7 vigil on health should be a norm. Wearable devices like Fitbit nad Misbit would be a measure of being smart and merit as high end wellness accessories in foreseeable future. Fitness apps would be the order of the day. Genome editing, genetic or DNA testing and personalized medicine would become in thing. That stage though is far cry from India but sooner or later that must herald. With the help of mobile apps you can count your calories. There are apps keeping tab on you health markers and reminding you always that you are going berserk with your life style.  Patients and hospitals both would be armed with electronic data of their health parameters, genome and what not.

The wedding of big data with smart phone and other electronic technologies would come handy in delivery of smart healthcare. India, which is at the crossroads of healthcare reforms, will have to put smartest foot forward. In other walks of life digital way of living is quite the in thing in India. Snapdeal, Flip cart, Big basket, Amazon, Mintra et al are already driving our lives. From shopping, ordering food, booking vacations to money transfers, everything is going digital. Software-driven businesses are rampant. The question is can healthcare remain untouched by this transformation. The answer is – no.

What constitutes smart healthcare after all? The first component should be our ability to stall the march of diseases just as they set in. It can be done if India shifts its focus from curative healthcare to preventive healthcare. The need is to not allow the diseases to progress to a point where tertiary hospital remains the only way out. Britain’s National Health Service is doing that very smartly. They tackle 80 percent of diseases in Primary Health Centres alone and successfully eliminate major need of tertiary care for them. Only about 20 percent of patients have to go to tertiary care. This model of health is best suited for India. In fact, NHS mandarins have been offering to replicate that in India too as smart healthcare and they point to deep penetration of smart phones in the country as a great advantage. They contend that emerging concept of mHealth would prove a manna form clouds for Indian healthcare. mHealth is projected as having potential to revolutionize Indian healthcare. So simply put, Samrt phones are dubbed as most efficient way to herald smart healthcare.

A recent study estimates, smart phone users in India on an average spend 3 hours and 18 minutes every day with the handy tool. One third of this time is spent on various types of mobile apps like Facebook and Whatsapp et al. The country has the second largest mobile phone user, approx over 900 million, in the world. Mobile phones have penetrated far and wide even in rural areas where state of art health infrastructure components is nonexistent. India is facing multiple challenges that stare its quest for universal healthcare goal- Health infrastructures have become archaic, population is on surge, there is lack of quality healthcare for all and sundry. Given the huge population to tackle, number of doctors is dismally low.  More, whatever doctors we have, they would simply not move to rural areas from urban areas citing nonexistent living infrastructures. In India, one union government after another has been cracking whip to make doctors available in rural areas but they have come a cropper so far.

So, in this scenario, what is the next best option? Technologies certainly present themselves as one in which smart phone is critical component. With the help of technologies, quality healthcare can reach masses at large with limited investment. E health with its features such as healthcare portals, digitization of healthcare records (Electronic Health Records/EHR) and creation of a centralized IT infrastructure like National Health Portal for healthcare information access has already made strides in India. Its happy blending with mHealth promises greatly for smart healthcare.

Sensitized patients base is a must for smart healthcare. There cannot better tool than smart phone to do it. Awareness campaigns can be done most effectively by using smart phone rout. Many studies of outcomes have shown that SMSes have succeeded where radio, television, hoardings and brochures have come to naught. SMS can come handy in sensitizing large masses about disease symptoms, disease management and precautions. SMSes have been harnessed in case of TB with fair degree of success.

Mobile phones armed with specialized software applications can make distance immaterial to a great extent. Remote Patient monitoring (RPM) is one function that mobile phones can facilitate, makes it a most powerful tool for making healthcare system smart. Mobile phone can be used to track and report vital body parameters to doctors. The mobile applications monitor body parameters and send them to a database where they can be monitored by a physician or a qualified healthcare assistant.

This way rural patient can easily be looked after despite complete lack of healthcare facilities. RPM coupled with electronic health records (EHR) can prove hugely economical too. Mobile based technologies are ‘it’ tool for making quality healthcare available universally because government investment in health is dismally low. The proposition that calls for huge investment would not move in India.

Mobile phones can clinically empower healthcare workers by making them accessible to big data of healthcare and treatment and can fill the gap that absence of doctors create. Vast human resources of alternative medicine can come handy in rural areas via mHealth .

There are many online sources from where they can educate themselves. Mobile telemedicine is proving very successful.  Remote healthcare workers enter patient details and medical records into a healthcare information system. The doctor reviews all the information and uses video conferencing to remotely examine the patient and prescribe necessary medicines. Many mobile telemedicine applications are already is use. Not to talk of India alone, mHealth is a tool of choice in many other developing countries.

Smart healthcare comes sewn with Digital India initiative of the present Union government. First and foremost aim of this initiative should be to make healthcare information available accessible anytime, anywhere with guard against theft of patient data. The government should not delay in making full proof mHealth related public policies and eliminate the bottlenecks due to regressive regulations. Though mHealth was included in the national telecom policy but that is only gathering dust.

Life style diseases have made deep inroads in rural areas. More than 25 million rural people have diabetes and the number is rising rapidly. Premature deaths are happening day in and day out. Such patients need constant monitoring. . Out of pocket expenditure is pushing millions below poverty line.  The fear is these diseases can undermine the emerging economy because productive years are in the grip of these diseases. We cannot have smart economy without smart healthcare.

Mobile phones can come handy in rural areas and avert pre mature deaths. SMART Health India program created by George Institute researchers in India, Australia and UK is a case in point. It is a unique low-cost, high-quality healthcare delivery system that enables both community health workers and doctors to provide state-of-the-art healthcare for common chronic diseases dog cheap. It utilises advanced mobile health technologies that provide the healthcare worker with personalised clinical decision support to guide the Systematic Medical Appraisal Referral and Treatment (SMART) of individual members of the community.


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