The economic and social disruption caused by the COVID-19 pandemic has been devastating.The pandemic has impacted and exposed the basic problems plaguing health systems across the globe. This is the third virus outbreak of global concern in the last twenty years,after SARS and MERS. Additionally, there have been smaller virus outbreaks like Zika and Ebola during the last decade.
The health system in India has been stressed with a huge spike in demand during the current pandemic. There has been a shortage of hospital beds, ICU infrastructure, doctors, nurses, etc. Given the layout of hospital facilities, it has been a challenge to cordon off a section of the hospital, ICU, radiology departments, etc. to prevent other patients from being infected. Given the high workloads, doctors have found it a challenge to devote adequate time for treating patients,thereby impacting clinical outcomes.
The availability and distribution of life-saving drugs, oxygen, and vaccines have been a challenge. Digitally disadvantaged people have struggled to get timely access to care. Vaccination centers, at both private and government hospitals, have witnessed long queues due to scheduling issues and poor IT infrastructure. Despite the efforts from the government to increase awareness of the current pandemic, there is still a lack of understanding of the gravity of the situation among people.
Infectious diseases will continue to be among the most important healthcare challenges that we will need to address in the foreseeable future.As more people get vaccinated, reducing the acute short-term demands on the healthcare system,organizations need to focus on addressing the long-term strategic improvements required.It is imperative for healthcare providers, governments, and technology companies to translate past experiences into actionable changes, with an objective not just to prevent similar crises in the future, but to also improve the overall healthcare system. Technologies like Artificial Intelligence (AI), Internet of Things (IoT), 5G, and Blockchaincan play a pivotal role in this improvement journey.
Several strategic areas would need focus as we emerge from this pandemic. Some of them are listed below.
Flexible healthcare infrastructure capable of adapting to changes in demand
In addition to increasing the number of hospital beds, doctors and nurses, there is a need to improve the flexibility and productivity of the healthcare system in the country.
- Local strategic partnerships between hospitals, nursing homes, health centers, diagnostic centers, etc., supported adequately by IT systems (cloud-based EHR, HIE,remote monitoring, etc.) to share patient data securely would help in managing some of the demand spikes.
- Home care solutions(including home ICU for medium and low acuity patients) with remote monitoring, supported by AI-based algorithms, coupled with processes to handle emergencies, should be part of the standard portfolio of services offered by hospitals.Patients with chronic disease can be managed in a home care setting unless there is a clinical intervention required.
- Improving productivity – AI-based tools can help in workforce planning, personalized training, aligning staffing dynamically with workload patterns, reducing non-value adding activities, and reducing wasteful movements through layout optimization and process change.Facility utilization can be improved by standardizing clinical pathways and predicting the length of stay of patients.
Reducing infections acquired in a healthcare setting
In addition to the existing sanitization protocols,there is a need for more measures to further reduce the incidence of infections at a healthcare facility.
- Understanding the workflows for various disease profiles during the pandemic can provide insights into the optimal hospital facility design to segregate patients with infectious diseases. In rural India, given the inadequate facilities, vans and buses equipped to diagnose and treat patients with infectious diseases could be explored as an option.
- Outpatient consultation would need to move online (which is already beginning to happen) as a first step before deciding on the next course of action.
- Multiple modes of appointment scheduling (online, voice call center, etc.) and tools to predict no-shows will help in reducing crowding at the healthcare facility. Redesign and automation of processes to ensure a touchless/minimal contact workflow right from appointment scheduling, diagnosis, billing, payment, reporting, and medication dispensation should be explored.
- Deployment of ‘mobile containers’ equipped with scanners (CT, X-ray, etc.) in combination with AI-enabled tele-radiology service, can provide the flexibility required to manage patient flows, increase reach, and open avenues for new business models.
- Virtual connected care supported by AI algorithms is the way forward. This will help minimize the contact between the health worker and the patient. This includes monitoring inpatients virtually from a central nursing station, monitoring patients at home from a command center, ambulatory care,use of robots, etc. A hybrid monitoring approach by combining connected contactless monitoring technology and wearables in conjunction with conventional monitoring devices should be the way forward.
Early warning system and management of infectious diseases
There is a need for an advanced early warning system to alert and manage epidemic-prone diseases. The timely collection and analysis of information on infectious diseases can help trigger prompt public health interventions. Currently, we rely on analysis done by epidemiologists on the collected data, which is rarely done systematically.
- The current system in the country tracks viral infections based on data collected from testing, hospital admissions, and registered deaths. This system needs further streamlining and accountability from all concerned to provide accurate and real-time data. A review of the IT infrastructure supporting this is required.
- Collation and analysis of genomic data from samples collected from different geographical areas across the country can help in understanding better the mutations of the virus and predict the spread.
- Biosensor technology is advancing rapidly. A connected grid of biosensors installed in closed crowded places, like hospitals, train stations, malls, gyms, restaurants, etc. can be used to measure the concentration of viruses and bacteria in the environment in real-time.
AI algorithms analyzing the data from all these multiple sources in real-time can help trigger an early warning to the relevant authorities for further action.
Increased transparency in the distribution of life-saving drugs, oxygen, and vaccines
The use of blockchain technology can help improve the transparency in the supply chain and distribution of life savings drugs, oxygen, vaccines, etc. Digitization of the health system and the policy changes required to make this happen needs to be expedited.
The current pandemic should act as a transformation catalyst to accelerate digitization and the implementation of changes in the healthcare system in India. This needs to be supported with increased government funding, for research towards medical devices used in critical care and medical imaging, life-saving drugs, genomics, and vaccines.Strategic partnerships which enable the creation of localized digital ecosystems of healthcare entities that share data will help in providing the flexibility required to address demand surges. Technology solutions based on AI, IoT, 5G, and Blockchain, will help address the challenges of flexibility, managing the spread of infectious diseases, and will help bring more transparency to the healthcare system.
To manage infectious diseases in the future, a new model of healthcare delivery will need to emerge with more emphasis on prevention,virtual care, and the extensive use of technology.
(Srinivas Prasad is Founder and CEO of Neusights and the views expressed in this article are his own)