E-Health Services and Technology Interventions

E-Health is an ever-evolving field at the juncture of medicine, public health, business and modern technology. eHealth can be described as the delivery of health care services using upcoming electronic information and communication technologies. E-health services are provided in a setting where the health care providers and patients are not directly in contact, and the interaction is mediated through electronic means. It consists of different electronic health data exchange such as:

  1. Telemedicine: Telemedicine, also referred to as telehealth, can be described as the remote delivery of healthcare services including exams and consultations using telecommunication services. It gives healthcare providers the opportunity to evaluate and treat patients without their physical presence.
  2. mHealth (mobile health): mHealth refers to the practice of medicine and welfare supported using mobile smart devices.
  3. Electronic Health Records (EHR): EHR is a systemized collection of patient history stored electronically that can be accessed across multiple formats.
  4. Wearable Sensors: Wearable sensors refer to the health monitors which help in tracking an individual’s body functions like heart rate, sleep quality, and oxygen levels, among others.

The world health organisation defines three key areas of e-Health:

  1. Delivery of health information and records, for both the professionals as well as the consumers.
  2. Using the power of information technology and e-commerce platforms to improve the public health infrastructure.
  3. Use of e-commerce and e-business practices in health management systems.

After the advent of the Covid-19 pandemic across the world, e-health services have become increasingly useful. The onslaught of the pandemic bought upon us an increased need for healthcare services in times when the entire world was on lockdown. The all-time high spread of infections was worsened by lockdowns that restricted movement and access to medical facilities. Such situations led to an increased demand for dispensing healthcare services using the internet and telecommunication services. Many governments across the world have supported the critical imperative of enabling private companies to produce innovative tools which enable authorities to identify suspected patients and carriers, identify their trail and contain any people they may have come in contact with. These technologies involve facial recognition cameras, drones and sensors which enable gauging a person’s body temperature as well as their medical condition.

Experts suggest a massive increase in the global digital health or e-health market both from the demand and supply side. The digital health market is expected to experience a 29.6 per cent compounded annual growth rate from 2019 to 2025. In 2018, the digital health market stood at $ 86.4 billion and is expected to reach approximately over $ 500 billion by 2025. According to Research and Markets, the global digital health market would be worth $ 223.7 billion by 2023. Global Market Insights predicts the digital health market to reach $ 379 billion by 2024 and Transparency Market Research foresees by 2025 the digital health market worth $ 536.6 billion.

Digital health or e-health provides a variety of advantages, such as:

  • Efficiency: Using modern technology within healthcare enables professionals to reduce inefficiency, save time and accurately diagnose and treat diseases.
  • Reduction in cost: More efficient treatments lead to reduction in cost. One potential way is by dodging duplicative assessment through improved communications between healthcare providers and electronic medical records.
  • Empowerment: e-Health services enable both the consumers and healthcare providers to feel more empowered by making available the knowledge base of medical data and health records over the internet.
  • Better relations: e-Health services can enable better relations between the patient and the expert since it provides clear and easier channels of communication.
  • Equity: e-Health is a great concept for reducing the gap between the haves and the have nots. It enables equitable healthcare access irrespective of age, race, gender, ethnicity, geography etc. Digital health also enables access of better healthcare facilities to remote locations.
  • Education: e-Health services are beneficial for educating healthcare professionals of any medical advancements. These services can also be beneficial for consumers to educate themselves about personalised preventative healthcare.
  • Faster decision making: With the advent of decision-making software and increased automation, decision making in medical situations have become much faster and more efficient. Patients need to merely input their symptoms in order to understand their symptoms and possible options of treatment.

As the world begins to recover from the Covid-19 pandemic, there is likely going to be an emphasis on the digitisation of public health services. Most global technology firms are likely to capture the increasing global appetite towards public health. It is anticipated that this space shall become a booming industry for investors with a great return on investments and massive potential for social welfare. Some major trends in digital health in the post COVID19 world are:

  1. Smartphones: With the increasing number of smartphones consumers, these devices can be used to effectively use digital technology to support healthcare facilities, address the growing health concerns and support the use of m-health services.
  2. Big Data: Big data is expected to be a gamechanger in this space by providing a lower rate of medication errors.
  3. Virtual Reality: Virtual Reality has already started making its mark in the digital health world by providing support in treating anxiety, post-traumatic stress and stroke, among others. Virtual Reality is slated to play a major role in complicated surgeries.
  4. Wearables: In the age of smartwatches, fitness bands, sugar monitors etc, wearables are playing an important role in making patients aware of the likelihood of a health emergency. With wearables tracking heart rate, exercise levels, sleep quality etc, these can play a key role in providing up to date monitoring of high-risk patients.
  5. Artificial Intelligence (AI): The power of artificial intelligence can be seen in areas such as precision medicine, medical imaging, drug discovery and genomics. Additionally, the use of chatbots and virtual assistants shall see a sharp increase in the times to come.
  6. Blockchain: Blockchain technology has already been deployed to create digital versions of medical charts.

In India, the digital health market was valued at INR 116.61 billion ($ 1.57 billion) in 2018. The market is estimated to reach INR 485.43 billion ($ 6.53 billion) by 2024, expanding at a compound annual growth rate of approximately 27.41 per cent during the 2019-2024 period. According to India’s e-Health Market Opportunity Report 2021, the e-health market is projected to hit $ 10.6 billion in revenue by 2025. The telemedicine market has the maximum potential within e-health in India and is expected to touch $ 5.4 billion by 2025, growing at a compound annual growth rate of 31 per cent. Emerging as a strong market for wearables, India has sold approximately 2 million units in 2017 and is expected to reach 129 million units by 2030. India's surgical robotics market is estimated to expand at a compounded annual growth rate of 20 per cent between 2017 and 2025 and achieve a size of $ 350 million by 2025. According to a recent report it is estimated that even though e-pharmacy is at a nascent stage in India, it is expected to reach $ 4.2 billion by 2025. The overall larger health tech market in India is slated to reach $ 21.3 billion by 2025 acquiring 3.2 per cent of the global health tech market pie. India is now also home to 133 health tech start-ups that have seen increased demand during the lockdown.

In addition to health tech startups cropping up in India during this time, healthcare services were also offered on social media platforms. During the peak of COVID19, many people received aid by sharing their requirements through WhatsApp, Instagram, Twitter and Facebook. Messages regarding the availability of oxygen cylinders, hospital beds, lifesaving drugs, home-cooked meals and other essential equipment were often seen circulating on social media platforms. It was during this time that many mental health applications and online therapy sessions were introduced to provide people with safe spaces to talk about anxiety, loss, loneliness and other mental health issues bought on by the pandemic. During this time, state governments also released dashboards outlining the contact information for various hospitals and live status updates for hospital beds.

Under the guidance of Prime Minister Narendra Modi, India has made long strides in advancing the digitisation of the economy to harness India’s collective entrepreneurial capabilities. Highlighting the importance and potential of telemedicine in India, Prime Minister Narendra Modi commented, “We are already seeing several consultations without actually going to the clinic or hospital. Again, this is a positive sign. Can we think of business models to help further telemedicine across the world?”

Healthcare services in India remain unevenly distributed. Rural India, in particular, has unreliable access to medical and healthcare services. In the absence of an organised modern healthcare system, traditional practices remained widely prevalent, often posing a fatal risk to patients who tend to be caught unaware of potential diseases and cures. In order to extend the delivery of healthcare services and expand the public healthcare system to all corners of the country, the Ministry of Health and Family Welfare (MoHFW) has undertaken measures to promote digital healthcare with a view to empower citizens through the dissemination of crucial information. Among the first steps taken by the Modi government was establishing the National eHealth Authority (NeHA) in 2015 that would serve as a promotional, regulatory and standards-setting organisation in the health sector. NeHA has a goal to ensure the development and promotion of the eHealth ecosystem in India and enable the organisation, management and provision of effective people-centred health services to all in an efficient, cost-effective and transparent manner.

In view of the risks posed by the lack of penetration of health services, the MoHFW, through a comprehensive nation-wide e-health programme, hopes to address the gap in human resources and ensure efficiency, improve patient safety through access to medical records, reduce healthcare costs, improve training and capacity building, and aid in evidence-based planning and decision making. To this end, the ministry outlined various initiatives in the National Health Policy, 2017 that aim to deploy digital tools to improve the efficiency and outcome of the healthcare system in India.

The first aspect of digitising health services in India is the Interoperable Electronic Health Records (EHRs). EHRs are an online repository of medical records of citizens that facilitate continuity between different healthcare providers, ensure affordability of service, and promote a better decision support system. Standards for EHR have been determined and notified in December 2016. A key element of electronic records is interoperability, or the ability of computer systems to use and exchange information. The guidelines for this were determined and notified by the Ministry of Electronics and Information Technology in August 2018 under which all public and private health facilities have been issued a National Identification Number (NIN). So far, 99 per cent of public health facilities in India have been allocated a NIN.

Furthermore, a Hospital Information System (HIS) is being implemented for computerised registration and capturing of patients’ EHRs. The HIS improves efficiency and leads to better delivery of services to patients. These digital repositories are also accessible to individual patients themselves on a single online personal medical record storage platform. This centralised platform improves accessibility and sharing of personal health data, making it easier for patients to track their medical histories and share with physicians at ease.

The MoHFW has also implemented a framework for the National Health Stack (NHS) that has recommended a National Digital Health Blueprint. The blueprint details a pathway for the holistic adoption of digital technologies based on global best practices. Key features of the blueprint include a federated architecture of five layers: Unique Health ID (UHID), privacy and consent management, national portability, EHR, applicable standards and regulations, health analytics and above all, multiple access channels like a call centre, Digital Health India portal and MyHealth App.

Indeed, India's experience with the tremendously successful Aarogya Setu app is a testament to the growing public ease with e-health services. Developed in a record 21 days, the Aarogya Setu app quickly became the most downloaded Covid-19 tracking app in the world. However, the app continued to serve the Indian people in another crucial matter: checking for the availability of and registering for Covid-19 vaccines. India’s vaccine rollout, aided in large part by the Aarogya Setu app, has been internationally acclaimed. The evidence of its success is apparent in the number of people India has managed to vaccinate. As of 5 January 2022, we have administered nearly 1.5 billion vaccines with the drive just opening to children below 18 years of age.

Telemedicine is a key component of digital healthcare especially as telephone (and smartphone) subscribers in India grow at a rapid pace. More Indians will have easier access to healthcare facilities on the phone than in person. The Covid-19 pandemic also served to enhance the adoption of telemedicine as country-wide lockdowns made access to non-Covid patients difficult and unsafe. A survey by Indian health-tech company Practo revealed that India witnessed a 67 per cent decline in in-person doctor visits and a 500 per cent growth in online medical consultations just between 1 March 2020 and 31 May 2020. Befittingly, the government released the Telemedicine Practice Guidelines (TPG) in March 2020 prescribing rules regarding physician-patient relationships, issues of liability and negligence, evaluation, management and treatment, informed consent, continuity of care, among others.

To facilitate greater adoption of telemedicine, the government has undertaken the implementation of the National Telemedicine Network (NTN) that provides telemedicine services to the country’s most remote areas by upgrading existing government healthcare facilities in all states. This service aims to overcome existing challenges like the lack of specialists and inaccessibility of doctors in rural areas by using information technology in delivering healthcare services. The government of India also manages the eSanjeevani portal, a doctor-to-patient telemedicine system under Ayushman Bharat Scheme. Through eSanjeevani OPD (Outpatient Delivery), an individual may seek medical advice and medication through audio and video.

A number of new portals and websites have also been introduced to promote better penetration of health services and related information. The MoHFW has launched a website to monitor Health and Wellness Centers (HWCs) under the Ayushman Bharat Scheme. HWCs deliver comprehensive primary healthcare by upgrading existing health facilities like Sub Health Centres (SHCs) and Primary Health Centres (PHCs) or aiding in relevant infrastructure development. To improve the quality of care in labour rooms and maternity operation theatres, a dashboard called LAQSHYA has also been launched the data for which is updated by states. An application that prevents, controls and screens for Non-Communicable Diseases (NCDs) is also maintained by the MoHFW.

Other ministry initiatives include a programme that makes information calls about safe motherhood and natal care to beneficiaries, a website dedicated to mental health awareness, an emergency medical response website and a website that facilitates the collection, collation, transmission, analysis and feedback of India’s vaccine safe data from the country’s peripheries. The National Health Portal (NHP) is perhaps the most popular undertaking that aims to improve health literacy, improve access to health services, decrease the burden of diseases through awareness and serve as a single point of access for consolidated healthcare-related information for Indian citizens.

The pandemic has presented both India and the world with a myriad of opportunities towards boosting technological advancements in the healthcare sector. India’s advancements in this sector with a strong push from the government has proven well to the country’s advancements. Given India’s vast diversity and population size, the sector presents tremendous opportunities and scope in the future. Extending the idea of the old age saying of ‘Health is Wealth’, we can safely say that technology will be a great investment.

This article was originally published in the February 2022 edition of Kurukshetra Magazine, a premier government publication on rural development.