Digital transformation persists to be the top priority in every board room across verticals, especially healthcare. Conferring further into in-depth discussions, a panel discussion on ‘Can open source technology be the solution to accelerate digital healthcare in India?’ was held during the virtual 3rd Elets Healthcare Transformation Summit. Edited excerpts from the discussion.
Sharing her in-depth insights on the role of open source technology and assessing whether it can be a solution to accelerate digital healthcare in India, Ruchika Bhargava, Market Delivery Partner, Thoughtworks India moderated the panel discussion. She articulated the destiny of opensource healthcare technology in the diverse Indian healthcare scenario that is emerging and growing. During the session, she delved upon how open source software can help facilities hospitals take that leap forward and how healthcare experts, industry partners, technologists, and even students can contribute to a system for its adoption and spread awareness.
Dr Praveen Gedam, Additional CEO, NHA shared that India is noticing rapid developments in the digital health space. The use and scale-up of digital health keys can revolutionize how residents acquire higher standards of health and services to nurture and safeguard their health. Ayushman Bharat Digital Mission (ABDM) is a flagship endeavor of the government to bridge the existing gap among different stakeholders and transform the digital health ecosystem of our country. Since the launch of ABDM, more than 16 crores of Ayushman Bharat health accounts have been created. He further highlighted that the benefit of open source technologies has been instrumental in the adoption of several digital initiatives. It not only brings down the outlay but also facilitates greater innovation through wider collaboration. Users can customize and modify solutions as per their needs. He averred that our nation is poised to leverage digital health solutions for public welfare.
Dr Manju Sengar, Professor, Medical Oncology, Tata Memorial Hospital shed light on open source technologies and the work done for project EKA that showcased the linking of patient health records, irrespective of the type of records such as clinical records, radiology images or others. Being an oncologist treating hematological cancers, she shared that any cancer management is multidisciplinary. The therapy consists of certain investigations to establish the diagnosis, investigations to stage the disease, and then they also have surgery, radiation, chemotherapy towards the end, even palliative care.
She further shared that except for certain hospitals that have all the facilities, most of the time it occurs that patients’ investigations and treatment are done at two different places. And in all this procedure, it’s the responsibility of that patient to carry all his records for giving the doctor’s a snapshot of their treatment or disease so that they could deliver the best care possible. But some patients belong to lower socio-economic status and do not realize the relevance of every investigation which results in repetition of those tests, and sometimes missing crucial information. She added that this led to the idea that instead of having the patient’s responsibility of carrying the records, they can link their health records across the entire treatment lifespan for every patient so that the doctors at the healthcare centers can access that information just by seeking the patient’s consent. That was the whole concept of starting this project EKA.
She further expressed her views on the digitalization of patients’ records which has proven to be helpful. However, she also stated that moving towards digitalization needs the best of the infrastructure, escalated or built up to match that need, rather than just sitting and or not being able to function at all.
She also conveyed the necessity to maintain the doctor-patient relationship.
Suhel Bidani, Lead – Digital, Bill & Melinda Gates Foundation stated there is a clear opportunity to have efficiency gains and cost savings, whether it’s governments, donors, development partners, or even communities just coming together, working on something would help in terms of getting those gains. He shared that the moment we allow the ecosystem to innovate and layer it with numerous services on top of it, we will see far more utility and use cases that will emerge. He averred that it’s a part of learning how we build ecosystems around open sources and this is the process everyone goes through. He stated that he is more optimistic now than in the past on open source systems and their potential.
He stated that there was a need to create market opportunities for these solutions that will come up and to build ecosystems around open-source solutions that exist, or any district public goods.
He further shared his views on the funding of open source technology as it requires funding to address market failures, reduce fragmentations and how to get that funding? There are some elements that we must consider, anything that is implied for the social sector, larger societal purpose, there is a role that government has. He mentioned that the government is accountable for providing fundamental requirements of electricity, water at a certain price point or at least a lower slab base for low usage for it all that needs to come into play in the context of open-source systems or digital public goods. He added that philanthropists furnish longevity that supports the challenges. He averred that the philanthropists want to do something on the digital side of things, especially on touchpoints with the social sector.
Responding to the panel on the digitization of Government healthcare programs and the necessary use of Open-Source technology, Sunita Nadhamuni, Head of Social Innovation at Dell Technologies and Lead for Digital LifeCare alluded to the overall government spend on health, with the majority going towards critical needs such as infrastructure, facilities, and other developments. She highlighted that Open-Source Technology can be useful in bridging investment gaps. While talking about Dell Technologies’ experience of working with the government on non-communicable diseases (NCDs) initiative, Sunita said, “These programs carry several modules, there is a lack of data sharing in a coherent manner. However, with unified systems like Ayushman Bharat, we are finally addressing this fragmentation. We see the need for systematic integration and how Open-Source is assisting us in addressing it.”
Describing the role of technology in a national health program, Sunita talked about the Ministry of Health and Family Welfare’s launch of Ayushman Bharat-health and wellness centers, done with a goal of transitioning from a segmented approach to a comprehensive one that could operate on a larger scale. This approach made health service delivery available at a superior scale, including population-based screening and management of five NCDs, namely hypertension, diabetes, and three common cancers. “However, this program came with its own set of challenges, including lack of human resources, unreliable capacity of health workers, multiple health priorities, and poor utilization of public health facilities. These problems called for a reliable solution, and that is when technology emerged as an enabler for addressing these problems” added Sunita Nadhamuni.
She went on to talk about the active work Dell Technologies has been undertaking in the healthcare space since 2013. “We started working with Karuna Trust (a non-profit organization) to look at how we can make healthcare delivery more comprehensive through technology. Guided by our social impact strategy and our Moonshot Goal of Transforming Lives, we are pledging to advance health initiatives that will touch 1 billion lives globally by 2030,” she said. Referring to her practical experience of working with the government, she added that OpenSource is absolutely the way to go, especially considering the scale of the problem at hand. “We need to cater to the diversity of the country and strategize closer engagement. We need more apps which extend this unifying platform approach through open API interfaces, which allow innovation and enable problem-solving at a large scale,” she asserted.
Sharing her thoughts on the advanced technologies that can be of assistance in public health, Sunita provided an example of primary health centers where doctors are reluctant to manually enter data. To solve this, she called for equipping them with simple mobile apps which can be beneficial on some pressing days where they have multiple patients. “Another application of technology to enhance effectiveness could be with training. Our system still relies on age-old methods like master training and cascade training which are also very crucial, but these durations can be brought down and streamlined with the use of technology. I also see a huge scope for improvement in digitizing health registries for health workers, doctors and several stakeholders which still use the manual method. The inter-village movement of Auxiliary Nurse Midwives (ANMs) for instance is often entered later than the actual time of incident which makes tracking tough and lacks any source of truth. Using technology can help us address this. With blockchain, we can make the process verifiable and develop traceable credentials,” she explained while shedding light on data anonymization. Nadhamuni concluded with the thought that everyone is headed towards the direction of Open-Source Technology. “Our collaboration with Ayushman Bharat will continue to be driven by this technology”, stated Sunita.
Prof. Ganesh Ramakrishnan, Institute Chair, Professor, Department of CSE, IIT Bombay disseminated his thoughts on how Indian academic institutions are contributing to open-source software. He began by saying that there are three types of technology interventions, it could be complementary, supplementary, or substitutional. The Ayushman Bharat Digital Mission has tried to revolutionize the entire method of digital health which is substantial. Indian academia probably doesn’t have the strength to do anything substitutional today but it is good for complementary interventions. The other thing that academia can do is supplementary. And to distinguish complementary and supplementary slightly, complimentary work can be explained by the work IIT Bombay tried to do with project Bahmni that offered lots of points, which could extend it with each transcription, and optical character recognition. On the other hand, supplementary would be forming a lower footprint, EMR EHR systems.
He stated that there is a need to recognize technology interventions along all these lines and identify the strengths. And so he said, Indian academia can be a strength today more than complementary and supplementary than creating an overhaul in terms of substitution. It may not be required in the healthcare space, particularly given in the recent initiative by ABDM.
He added that there’s a consultation on new measures which are very much transpiring with ABDM. Academia plays a significant role in the process where the criterion is defined and managed.
Ayushman Bharat Digital Mission has assembled the plug points which are openly concerted so that academia can play a satisfactory role in handholding and training on the same. It is moreover linked to the entire substitutional paradigm whose priority could be more on training, teaching, and understanding. We need to determine technology interventions along all these lines and identify our strengths. It can play a crucial role in defining and evolving standards where humans and machines could interact. He further expressed that academia is a hotbed of interdisciplinary research and explanation that thrives and complements the industry healthcare ecosystem in other countries.
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