I had the extreme pleasure of interviewing Dr Dass the other day to go into a little more detail on her post and her ideas on the mHealth situation in India. We had a very enjoyable Skype call and I asked Dr Dass several questions which she answered graciously and eloquently. Please view the following video to see this exclusive interview:
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Video transcript (by transcriptionstar)
Joan: Hello. I’m Joan Justice from HealthWorks Collective and I have with me Dr. Ruchi Dass from India. Dr. Dass is an expert on mHealth. Dr. Dass, tell us a little about your background and give us if you would your definition of Mobile Health?
Ruchi: Hi Joan. Thanks for having me. And I’m actually appreciating all of your efforts these days reading out your Health Collective everyday so good effort keep it up.
So my name is Dr. Ruchi Dass. I’m a physician by education and lost there to public health long time back. When I was doing diploma so with some of the basic NGOs in India, I realized when you have to reach out to millions of people. You need to harness technology, so hence was the interest in healthcare IT eHealth and mHealth. So what I’m known for is mHealth, but what I’m doing is in healthcare IT.
I’m also the CEO of HealthCursor the Consulting Group which is the only niche consulting group based out of Asia. We have industries, people and provider adopt to low cost solutions, bring them to scale and get them working in Asia Pacific markets so that’s it in all what we do. My mobile Health definition is pretty simple.
And mobile Health is not about healthcare in mobile reforms, and I think that’s the misconception people feel about. Its healthcare which is mobile which is wireless, which is anytime, anywhere, wherever you need it, however you need it by whatever you have at home be it your mobile phone, be it your set top box via television, radio, iPod and think of it and you can get it anywhere so that’s the kind of world of healthcare that we’re talking about, and that’s my definition at mobile health.
Joan: Thank you for that. In your post you mentioned that empowering rural India is one of primary concerns, and you mentioned the need for broadband penetration and financial commitment. Currently what percentage of the Indian population has access to standard healthcare and then what percentage of the population has access to some form of telehealth?
Ruchi: Empowering rural patients, empowering rural India you must have heard this phrase like a million times, but what does it actually means. In India 70% of population lives in rural areas where one-third of the healthcare facilities are, so we’re talking about a steep doctor to patient ratio which is one-to-one [Indiscernible] [0:02:35] which goes even cheaper when you moved to villages, so it is very, very imperative to empower these people with the right kind of information with basic healthcare access and with empowerment so that they can afford healthcare.
Today at this point in time I can — we need more than 700,000 beds for 1 million population and we have not even reached half of it, so why we’re talking telemedicine today is because we know that if we keep building hospitals, if we keep bringing more doctors that’s never going to [indiscernible] [0:03:09] divide. What we have to do is create [indiscernible] [0:03:12] model so that wherever you’re based you can walk into a telecenter facility that is connected to a secondary healthcare facility and in turn to a tertiary healthcare center and you can get your advise sitting at your home without thinking about how to reach there, how to get access to this benefit.
Talking about statistic as you said how much of it is covered already. We have 20,000 primary healthcare centers in India and all of them 300 are already connected through a telecommunication link to 243 super specialty hospitals that is on the government side. On the private side, Apollo Hospitals, Fortis Group [Indiscernible] [0:03:51] and Narayana Hrudayalaya all of these hospitals are building their independent nodes to provide telemedicine to the far flung areas.
And I can say that while 25 to 30% of Indian population already have access to basic standard healthcare, the remaining 70% of it will soon get access to healthcare through the telemedicine so that we are bringing it to the country.
Joan: Thank you. Electronic health records are now being adopted by the United States hospitals but it is the challenge we’re having problems with hospitals talking to each other. Each system seems to have its own platform and they’re not compatible with each other. I can imagine that it’s the same in India. Can you comment on this?
Ruchi: So Electronic medical records are seen in a different light in India. A) When hospital share with other hospitals that is considered to be loss of business for them, so they don’t do it. Back there in 2006 there were more incentive models. They will now mature reimbursement models, so hospitals probably had to pick they’re not willing to do it. They’re still not willing to do it.
And if patient started their selves maintaining sometimes the health records are on different websites so that they can share and also establishment that doctors are not relying on those records because they could be typo errors. There can be other problems and for example your blood group it’s says B positive in your health records, but when the transfusion happened something goes wrong because the doctor is lying on those records. It can be devastating, so in India it’s a little different because people really don’t see a used case or the adoption of EMR.
However, when things like Adhar which is the unique identification concept coming in India I think it will have a lot to do with EMR adoption with interoperability with doing something which is — it would be like a one stop shop for all these people to connect similar fee [0:05:55]. So I think while this is happening on one side, on the other side what government need to do is putting legislations in place so as to how you I looks like what the middle wear should be. Amputation is made to be understood nicely amongst all system players, so that there’s no restrictions to access or what we call an implementation, so that’s the problem.
In U.S. however, there’s a lot of support that comes from the government benefit which we don’t come in India so Obama recently said that anybody who wants to use an iPhone or an iPad will be given more than $24,000 if the comply to what you call a meaningful use so it does not exist in India. But yes there are problems related to standardization. They’re the same as they’re in U.S.
Joan: Yes okay thanks. That’s what I imagined. In your post, you mentioned a Citizen Health Information System. This seems like a major undertaking and what is the first step to be taken here and when will this project start?
Ruchi: CHIS will be a fantastic and a beautiful concept. I think with CHIS coming in, it’s like a plethora [Indiscernible] [0:07:05] opportunities that will actually come into place. The CHIS will not only monitor the concentration of disease in a particular area, but will also keep on updating their electronic medical record based on your biometrics the kind of services they use, the kind of supply that are provided to you by government and so on and so forth, and all happen in just one place.
What we call our Citizen Health Information Systems were also provide seamless connectivity amongst the primary healthcare center, secondary healthcare center and tertiary healthcare centers, so there can be healthcare information exchange and you can get best consultation at the right point in time whenever you need it, so this has already been started so and at one point in time what we call as Swabhimaan what we call as Adhar. What we call as CHIS they all will be talking to each other to bring the maximum impact in the society that they can.
So this has been already started. Adhar people are still you know it would be in completing the existing mandate, but the next step is definitely healthcare. So CHIS, Adhar will be interconnected with what they call as RSDY which is Rashtriya Seva Bima Yojana which is a health insurance policy for rural India. All of this will be connected and I think 120 million people are already there on the unique ID project which is then will go to 600 million by the next years so it’s a world of opportunities in India.
Joan: Okay this unique ID project is this the project I have heard about where each individual is going to be supplied with an identity card?
Ruchi: Correct. So this is the project where everyone who is born in India, who is a citizen of Indian even an infant will be provided with a unique identification number that is a 12 digit numbers on which your biometrics will be there. It is on a cloud-based technology so its kind of plug and play, so there will be a whole lot of opportunities to become a project Adhar once its there. It eliminates a lot of things. It eliminates human error, duplication of records and identities and makes things pretty easier to you, to build upon.
Joan: Wonderful, wonderful. And what percentage of the population has it started yet this project and how far along is it? What percent of the population?
Ruchi: Over 3 million people I would say have already, already opted for Adhar cards. It’s actually going very, very strong, and the idea is that in the next two to three years it will cross 600 million mark.
Joan: Wonderful. And you also mentioned the disease surveillance project and how does this work?
Ruchi: So correct, so in India healthcare is a state affair. So every public have funding that we talk about 80% of it comes from the state, and the rest of it 15 to 20% comes from the national health programs. So [Indiscernible] [0:10:05] is an annual concept for each and every state they submit a record saying these are the five major diseases that are leading to morbidity and mortality in the area, and based on that the funding is provided and the programs are being made that has come in the campaign so that they can reach out to the remotest of areas and can provide this information to people.
So the [Indiscernible] [0:10:28] for now is been done on a very manual manner where there’s a representative who goes with so many questions door-to-door and collects this information. But with CHIS and Adhar that’s a unique identification project coming in, this will all become automated. You could actually do it on a mobile phone by yourself sitting at your home or healthcare worker can do it for you on a PDA which is much easier to carry their user interface, and it’s quick and convenient.
Joan: Wonderful. That sounds great. I probably several posts on the use of mobile divides in India for telehealth and I’m sure there are a numerous projects going on, but is there any overall strategy?
Ruchi: Very good question. So in India there are — there’s World Bank very active, [Indiscernible] [0:11:18] India Foundation then there were hospitals like volunteering for mHealth, but all of it, its like, its happening episodic. It’s going to be and it’s not a part of the closer to strategy with there, so there’s a strategy behind it, but for a used case. We’re still lacking a cohesive strategy that has a meaningful reimbursement model, a business model that will keep all the stakeholders in the value chain, incentivised and intact which is lacking today.
But with the five year plan coming in and the department of IT working with Ministry of Healthcare there will be a strategy coming in very soon where we’ll talk about standardization. We’ll talk about legislations and we’ll talk about a cohesive strategy of how to get all of these people on board. One interesting example here is RSBY. Its the only most successful project in India that has gone in the health insurance database [Phonetic] [0:12:12] for rural India where there are players like NGOs, hospitals, SMEs, government of India, public private partnership.
It’s a very big example of this and it has already reached millions of people. We’re probably going to duplicate the same benefit, but not from the PR side, this time for the provider side.
Joan: No okay. Well, keep us informed on that. It sounds wonderful. As India goes forward in the adoption of mobile health for all of its citizens what is your primary concern?
Ruchi: My primary concern is evidence and though there are several things happening in India and its happening in every nook and corner. There’s no centralized database that would tell us of all and what is already been tried and tested and how not to do any expensive mistake so it is very imperative that we keep learning about what we try, what fail, and what we’re trying that’s succeeded so that it becomes you know it comes in the grand schema of things rather than being in at one corner or a points tradition [Phonetic] [0:13:16] error, kind of error thing.
That’s one concern of mine and second is research, so though we’re doing a whole lot of stuff, the initial research which is we did, done about the overall strategy better fit, the business model is a better fit and little research about so as I said India is the land of diversity which clicks and now India might not say consult India so I keep saying this, and all of my speaking assignments that India is not one country.
India is around — India is like 26 countries because there are like 26 states independently managing healthcare of the nation and their priorities are different and what works there is different and the customer behavior and the lifestyle and everything is so, so different that sometimes it becomes a problem to learn from some of these ideas and to implement at any other state, so I personally feel that is my primary person [Phonetic] [0:14:12].
However, I tell you about [Indiscernible] [0:14:17] said also there are limitations to technology and sometimes people feel that technology can replace the doctor which I really don’t agree to. One of my mentor says this and I would say that again a fool with a tool is still a fool, so I think that it makes a lot of sense to empower doctors and patients with the right kind of information and tools, but you really can’t replace the doctor from the value chain.
Joan: Exactly I agree whole-heartedly. Well, thank you so much for your input Dr. Dass and I hope I have the pleasure of speaking with you again.
Ruchi: Thank you. You have a great day. Thanks for having me.
Joan: You too. Thanks.