Telemedicine or WHIMS: Which solution is superior?

To most people to whom we introduce iKure, WHIMS appears to be telemedicine. Telemedicine has become synonymous with technology in rural healthcare. At times one feels that the whole concept of rural healthcare technology has been overshadowed by the concept of telemedicine. If does have a compelling proposition, but there is immense scope of innovation in delivery models. WHIMS is an attempt at providing an alternate to telemedicine when the costs outweigh the benefits of telemedicine.

The topic of this post asks a question, which approach is better – telemedicine or WHIMS? But the matter of fact is that these solutions can’t be used interchangeably. WHIMS is a low cost collaborative IT platform which enables a rural doctor/health-worker and a city-based specialist doctor to exchange data pertaining to a patient’s health. The model doesn’t demand either of the two sides to be available all the time. The rural doctor places the patient’s data on the cloud server and the city-based doctor accesses it whenever he has time or at a pre-defined time each day or as a response to an SMS sent to his mobile automatically when a case is escalated to him. WHIMS therefore is an extremely flexible collaboration model.

Telemedicine is a better known model which enables a doctor present anywhere in the world to consult a patient in a far-flung remote area through the use to audio-video medium. The consultant can view the patient in front of him and can seek assistance of the doctor present at the rural clinic to examine the patient as per his instructions and can get a feedback instantly. Telemedicine replicates the traditional healthcare model where doctor and patient have to be present simultaneously at a point (physically or virtually). While telemedicine has a huge potential, it puts a constraint on the consultant that he has to be present when the patient is there, or the patient has to be present when the consultant is there in the clinic. Also, telemedicine puts a lot of demand on infrastructure. The network should be able to support a bandwidth that can enable an audio-video communication between the two points. But it can be said that the patient has a lot of assurance because he/she has been ‘seen’ by the doctor and has received an instant consultation from the specialist.

When we designed the hub-and-spoke model for WHIMS, we defined hubs as tertiary, or even secondary, care hospitals and spokes as the rural kiosks which would carry the technology and portable diagnostic bits of the overall network. We also left the scope of a sub-hub, i.e. an intermediary between the hub and the spoke. We imagined the role of telemedicine at the sub-hub level.

Such a scenario can be imagined as the rural clinics serving as the last mile primary care centres which provide generic and specialist consultation using WHIMS. In cases where the consultant needs to have a look at the patient, rather than sending the patient 50-70 Kms. to a tertiary care set-up (hub), we can create an intermediate sub-hub with telemedicine support. So such cases where doctor needs to physically observe the patient, he can request them to visit the sub-hub which would be relatively closer to their villages, say 20 Kms. Upon further consultation, if he feels that the patient needs to travel or if there are any complications, he can ask them to visit the hub hospital, 50-60 Kms. from the village.

As explained above, we see the role of telemedicine as complimentary to WHIMS and both technologies can co-exist in the same network with a common overlap, i.e. patient data. 

Remote Health Monitoring

We have come across data that shows paucity of healthcare professionals and healthcare infrastructure in rural and semi-urban areas of India. We also know that it would take generations for us to remove this disparity. In this kind of scenario, any possible solution should work around constraints and bring in a game-changing proposition.

The constraint here is the scarcity of specialist medical help in rural and remote areas. The healthcare parameters in such areas are extremely poor and the traditional solutions offer little respite. The game-changing proposition we offer is the technology-enabled monitoring system for remote patients.

Wireless Health Incident Monitoring System (WHIMS) is a humble piece of technology which enables a city-based specialist doctor to monitor the health of his patients. A trained health worker or a rural doctor provides the primary care to the patients and records information related to their health in WHIMS’ application. WHIMS can be accessed through internet or through mobiles. Low-cost portable diagnostic devices empower the primary care providers to capture precise health information of the patients and provide it to the consultants. While we do not use any tele-medicine interface, the same can be built into the system.

Remote Health Monitoring has the potential to create a viable scalable healthcare model for rural areas because the scare specialist resources are utilized efficiently. Better care can be delivered to the patients at a fraction of the cost to an urban patient.

While the opportunity is real, we must also realize that this is not the solution in totality. Some percentage of patients will require emergency care and in-patient treatments. In some other cases, high-end diagnostics may be required. Even towns do not have such facilities. Clearly, government’s role in creating such an infrastructure cannot be negated. Public-private partnership (PPP) can also be a model where government supports and encourages private players to create such an infrastructure.

A Fresh Perspective

“Anyone who stops learning is old, whether at twenty or eighty. Anyone who keeps learning stays young. The greatest thing in life is to keep your mind young.” - Henry Ford

The benefit of being a start-up is that you keep learning all the time. The learning itself becomes the joy and the achievement. The knowledge can come from any direction and from anyone. The important thing is to embrace the new knowledge and the new perspectives.

April brought with itself an opportunity for the iKure team to gain new perspectives from four students of management from XIMB (Xavier Institute of Management Bhubaneswar). Arnab Neogi, Vidhi Sharma, Abhiroop Saha and Abhishek Jobanputra joined us for an 8 week summer internship to help us solve a few business puzzles. Since it’s the first time such a batch of management students has joined iKure, and we intend to follow this practice in the near future as well, so we have called their gang as ‘Cohort One’.

After having spent a good fortnight with them, all we can say is that this bunch is fun-loving, ambitious, hard working, intelligent, curious and eager to learn. We have been gaining a very fresh view on how we operate as a team and as an enterprise and we are sure together we will be able to meet their project objectives.

As we progress through the remaining days of their internship, we will have more stories to share about their successes and key inputs. So keep checking this space!

Limitations in scalability of healthcare delivery model and possible solution

It is very common from anyone who has worked in the IT sector to come across the term ‘scalable’. Basically it points to the capability of the technology components – hardware and software – to ramp up as the business demand goes up. The implicit requirement is that this ramp up is achieved in a relatively short period of time (compared to how things used to ‘scale up’ in the past) and without compromising the performance of the system.

In business also most start-ups are faced with this question by prospective investors and clients. Their ideas are great and workable and some are even profitable very quickly. But then comes the question of scalability and replicability. Here the expectation of the potential investors and clients is that the design of the business model should allow it to grow quickly. But the thing I’m pondering over is that are all business models scalable? Is it right to expect every business to be scalable? What if a particular industry dynamics do not allow scalability? Should I be bothered if it seems that my business model is not as scalable as other business models in other industries?

In the previous post, there was a discussion on various factors that contribute towards creation of an urban healthcare delivery system and on efforts of iKURE towards creation of an ecosystem of partner organizations and experts to finally create a rural healthcare delivery system. You can refer to the post here.

Now the question arises – Is our delivery model scalable? Or for that matter, is even the urban healthcare delivery system scalable?

The basic elements of a care delivery system are healthcare providers, namely doctors and nurses, supportive services like diagnostics, pharmacy and blood bank, care setting which comprises of the physical infrastructure of the clinic/hospital, bed capacity & types and the medical equipments installed in the setup and other ancillary functions like purchase & stores, housekeeping, engineering, med gas etc. Let me also add IT to this list of elements of a care delivery system. So as I discussed in the beginning of this article, scalability is not new to IT and this is a tried and tested model in the sector. But can we stretch or scale up other elements of the care delivery system? How reasonable is it to assume that we can create more health professionals like doctors and nurses in a short time without compromising quality? How economically feasible is it to add more beds and clinics and hospitals infrastructure? How easy is it for anyone to ramp up ancillary functions of a hospital, like stores, housekeeping and engineering?

By very nature, healthcare industry is infrastructure-dependent. Apart from that, there’s this issue of lack of qualified medical professionals. So one would wonder that if one doesn’t have enough staff and support services, what is the point in creating more infrastructure. There’s similar challenge in rural healthcare delivery as well. There are statistics that say there are very few doctors serving India’s massive rural population, compared to relatively better availability of doctors in urban areas. Similarly, there are statistics on paucity of health infrastructure in rural areas and most new infra being developed in cities only. The ROI-driven growth definitely will happen in cities and there are customers who can afford and pay for the healthcare infra built in the cities. In this context, the infrastructure and availability of healthcare professionals in rural areas become bottlenecks in scalability of rural healthcare delivery models.

iKURE’s model is trying to address a different kind of challenge. Whatever healthcare facilities are available in the villages are also not upto the quality standards. So on one hard the villager doesn’t have many options and on the other hand, the only option available to him also is not upto the mark. It’s our endeavour to give a better deal to healthcare seekers in rural areas by creating a collaborative platform where a rural doctor can coordinate care delivery with the assistance of a city-based specialist consultant. With the use of low-cost diagnostics and timely advice from the doctors, we can prevent the health of the patient from deteriorating further and escalate the case to a higher centre of care at the right time. All it takes is a basic infrastructure to be put into place. A small patient-examination room with a computer kept close by can become an iKURE kiosk. The health-worker or the doctor needs to be trained in using iKURE’s software. Communication can happen in English or in regional language.

From a scalability point-of-view, we have a key challenge in terms of taking technology to the rural clinics. As a software company, we specialize in the application which meets the requirement. But investments are also required in the digital infrastructure to be put at the kiosk. All this has to be done without increasing the cost of the treatment to the patient otherwise the whole exercise will lose its purpose. In the Salboni project of iKURE, the CSR partner JSW Steel takes care of these costs and even provides branded medicines at no cost. This model is easily replicable if there are corporates whose vision is to see a healthier community in the areas in which they operate. State governments can also leverage this low-cost technology by bringing its health centres under the ambit of such a project.

As a company iKURE has been able to generate sufficient interest and it’s a matter of time when we fulfill our vision. The need really is to associate with partners who are committed to the cause and who understand that scalability in a healthcare delivery system cannot be achieved overnight. The community has to be taken into confidence and their involvement is essential. Investments in infrastructure have to be made with a greater focus on SROI (Social Return on Investment) and monetizing the investments through alternative activities which can be aligned to education, livelihood, financial support, women empowerment, e-governance and many more. Innovation is the key.

Technology-enabled healthcare delivery to under-served market

For the last about 2 years that iKURE has been working on technology solutions for healthcare delivery, we have straddled 2 very different customer segments – rural and urban. And it has surprised us that opportunities for advances in rural healthcare delivery exist through the use of a humble technology platform.

Why I used the term ‘under-served market’ in the title is because I wanted to highlight that rural people also pay out of pocket for their healthcare needs. Their ability to get quality healthcare is limited by Access and Affordability. Most good hospitals are built in urban centres and there also you will witness a huge difference in healthcare facilities available in metros and towns/cities. From my own healthcare experience I have realized that it takes many factors to create a quality healthcare system – Doctors, Nurses, Technicians, Engineers, Billers, Security, Waste Management, Medical Suppliers, Equipment suppliers and maintenance, IT etc. and many other supportive institutions like municipality, banks, electricity dept. among many others. And add to this the problem of high rate of attrition in medical and non-medical staff. So let’s admit that it’s not economically feasible to replicate an urban healthcare delivery system for rural setups in the near future. But rural masses deserve the same standards, yet access is limited because they need to travel a lot to avail of the services of hospitals in the urban setup. Affordability is another issue because one another aspect of the urban healthcare system or a hospital is that it is capital intensive and most of the costs are passed on to the patients. For city-based patients it is within reach because per-capita income level in metros/cities is much higher than those for towns and villages.

In such kind of circumstances, the easiest we can do is to enable patient in a village to seek health services from a city-based consultant without having to travel to the city and at a fraction of a cost of what it would be for a city-based patient. At iKure we leverage this through a hub-and-spoke model. For more information on this, please read the post ‘Health for remotest of areas – the iKure way’.

From our field experiments, we have come to a working model which is supported by Corporate Social Responsibility funds. So while the technology creates Access, the Affordability is taken care of by the CSR grant which subsidizes the treatment costs. It’s heartening to see how such partnerships create difference in the lives of our countrymen.

The scope of this model to radically change the rural healthcare delivery process is immense. Our concept is basically to create a technology platform to enable a rural doctor/health worker to collaborate with a city-based specialist doctor to deliver care to the village-based patient. In this process, we are able to uplift the confidence and credibility of the village-based doctor and significantly improve his decision-making abilities regarding his patients’ treatment. Our health partner also spends their resources in training these health workers/doctors to bring them up to the common communication level with the city-based doctor. The CSR partner funds the medicines, consultations and other health costs for the target community. But as a group, it is our endeavour to make the whole model self-sustaining by letting the community take ownership of the whole system.

As we make progress, we would like to explore opportunities where a fairly good number of spokes or village health centres/clinics are technology-enabled and these are connected to a series of specialized centres to provide quality healthcare to a larger set of population. Many more innovators can leverage this network, for example insurers, pharmaceutical companies, low-cost diagnostic device manufacturers, research institutions etc. As I said in the beginning of this post, there are a number of factors which contribute to make an urban healthcare delivery system. We are in the process of creating an ecosystem of partners and experts who will together create a rural healthcare delivery system which will materialize our vision of delivering quality healthcare services to rural people at a price point affordable to them.

If you share our vision, or you are an innovator passionate about this sector, please contact us at contactus@ikure.in