Been Busy

It has been a while since an update and the reason has been unprecedented work (from my day job). I promise to be back as soon as possible. Please bear with me.

When doctors become employees, what do patients do?

We’ve all seen it happen. The friendly neighborhood doctor who had a great practice is suddenly less available. He suddenly seems to be associated with one (or many) of the corporate hospital chains springing up around town. He now has a ‘roving practice’ where he is available at different locations throughout the day – sometimes as many as four locations in the same day. Certain days of the week, he is with one specialist hospital in one part of town. Certain others, he is dedicated to another hospital elsewhere. While he begins to visibly thrive, his once loyal patient base needs to follow him wherever he goes.

A slow but steady ill has been seeping through the healthcare industry in India. Increasingly, more and more doctors are ditching their private practice to become employees of corporate hospital chains. The economics of the decision are fairly sound. Why spend money they can ill-afford at the beginning of their careers on setting up a private practice - painfully waiting to grow a clientele, depending on the vagaries of patients for a steady income and maintaining a staff and equipment at their own costs – when a corporate hospital chain offers them steady employment, good remuneration, a readymade set of patients, marketing and sales machinery to generate leads etc? Clearly one option is far superior to the other.

However, that is but one side of the story. For patients, healthcare is suddenly a precious commodity – to be traded for money. When Corporate entities begin to determine how patients are treated, personalized treatment goes completely out of the window. The corporate entity is only interested in making profits, the sooner the better. So patients who enter these places are treated pretty much the way Henry Ford revolutionized the automobile industry – like an assembly line.

Think about it. Patients, even prospective ones need to schedule an appointment. They are then given a 15 minute consultation by the allocated physician. Post this they face a barrage of ‘recommended’ tests; preferably at the hospital where the physician has a tie-up. Reports from elsewhere will simply be dis-regarded. Another consultation after an appointment and treatment begins. The consulting physician refers the patient to a specialist physician depending on the nature of the diagnosis. The specialist needs another appointment and may entail further tests. Finally the problem is diagnosed. Treatment can then begin.

The trouble scarcely ends there. After this comes choice of hospital, choice of accommodation, choice of diet, choice of medication – all of which are determined by the consulting physician. Typically, these are all at one of the associated hospitals. Not that anyone is blaming the physicians of having an ulterior motive. They simply need to meet their monthly quotas. Unless they do so, they won’t get the ‘performance bonus’ component of their remuneration, which can be substantial. The hospital rakes in the moolah, the physician meets her/his quota and the economy grows at a frenetic pace. For everyone except the patient, that is.

This is a far cry from the days when the physician took time and energy to understand the patient. Over time, they actually became trusted healthcare advisors. Keeping the specific information about the patients, their families and even their affordability, the physician would recommend the best course of action. Tests were not a mandate. In a lot of cases, they were skipped in preference of careful examination. Time spent was not a criterion for consultation fee; outcome typically was.

However all that is nothing more than a distant memory nowadays. The Corporate Hospitals, Insurance Companies, ‘Consulting Physicians’ and their ilk have changed the very dynamics of the industry. And definitely not for the better! When doctors become employees, the corporate guidelines take precedence over the Hippocratic oath. Mammon becomes more powerful than patient health. Care decisions; formerly taken by the doctors themselves, are not centrally made by committees which may or may not have patient outcomes as the primary goal. Treatment options, once personalized and customized to individual patient lifestyles and financial status, may become more cookie-cutter in approach with a one-size-fits-all mentality. Sure, physicians and doctors may still play the role of an advocate. However, it is safe to say that they will have to keep the health of the corporate entity – meaning money-making potential – paramount in their practice.

All is not bad though. Being a part of a corporate healthcare facility may give the physician better and more easy access to specialists and expensive equipment. They also have access to quality and reliable healthcare reports. Facilities, otherwise unavailable become more accessible. Their patients can thus benefit from better care. But all of this comes at a premium. Money becomes the primary consideration.

India's Neurosynaptic's ReMeDi platform

Providing the Indian population with access to quality and affordable healthcare has always been a dream project. The healthcare infrastructure in the country is far from adequate. There is just 1 doctor for approximately 1,700 population and less than 40% of the infrastructure is available in rural areas even though over 70% of India resides in rural and remote areas.

Which is why it is heartening to see that a company called Neurosynaptic has come up with a customized tele-medicine healthcare solution for developing economies like India. This is the ReMeDi platform and it is an indigenously developed customized solution created specifically for the Indian context.

Some of the key features of the ReMeDi platform include:

• System designed keeping in view low resource setting and the constraints associated with developing world
• Integrates end to end healthcare ecosystem
• Support Multiple simultaneous consultations
• Remote Clinics, Central Medical Facility, Diagnostic Centres, Hospitals and Pharmacy can be completely networked on enterprise version
• Easy to operate by a Para Medics or even a non medico
• Can operate on internet, intranet, WI-Fi, Data Card

ReMeDi has been validated at some of most prestigious Medical Institutes of India and is compliant with IEC 60601. Manufactured in an ISO 13485 Compliant Unit, it has an in-built mechanism to capture feedback for audit and quality. It works with real-time measurement of vital parameters and the data thus captured is stored on server & Cloud - making it easily accessible.

Highly modular and customizable the system includes such security features as Biometric identification. It is well integrated with existing HMS platforms and can be structured to suit various requirements. The sooner platforms like these are launched in the country, the sooner the dream of ensuring primary healthcare availability to every citizen will become a reality.

Improving Global Health | The Sana Technology Platform

When the brightest minds at MIT get set to work on an Application to enhance the quality of global healthcare, you can be certain that they will come up with a radical solution. And that is precisely what Sana Mobile is!

What is Sana?

The Sana technology platform includes an extensive set of healthcare tools for the collection, transmission, storage, and analysis of medical data. When fully installed and configured, the tools provide an end-to-end system connecting remote healthcare workers to physicians, and managing medical data. It is open-source, cellphone-based and free to implement!

Key Features:

• Multi-user mobile client with programmable workflow that provides decision support, directs remote workers in the collection of data, connection between workers and physicians, and integrates with point of care applications and devices.
• Middleware which provides a secure communication layer for secure, optimized transmission over poor or intermittent networks and allows for connection to a broad range of data storage and web applications.
• Host based data storage in a relational database along with web applications for accessing and managing data.
• Ready to deploy packages.
• All Sana software products are available under an open-source license to increase availability and encourage community contribution.

To try it out:

A compiled version of the Android based mobile client is available for installation by downloading the application on the mobile device from this location.

Links

Source Code is available at the Sana GitHub site

Documentation

Technical details about installation, configuration, and specific components are available on the individual component pages on the Documentation pages.

Sana Users Google Group

Intelehealth | Healthcare App to cater to primary healthcare in Rural India

The statistics were never really inspiring. India has just 1 doctor to cater to approximately 1,700 people. However, even that figure is misleading. While 70% of the country’s population lives in rural areas, less than 40% of the healthcare infrastructure is. This obviously creates several gaps in putting together a cohesive (and inclusive) healthcare program. The chief among which is access to qualified and trained healthcare professionals.

There are indeed health workers available in rural and remote areas. However, these are little more than semi-skilled nursing professionals. They can offer basic first aid and simple administrations. They have neither the qualifications nor the competence to offer tests and consults on things even as simple as diabetes and asthma. As a result, patients either avoid going to primary healthcare facilities – or more commonly – get over the counter medication without prescriptions from pharmacists who function as pseudo-doctors in underserved communities.

The result is an almost-complete breakdown of access to healthcare among communities of people who need it the most. Clearly an untenable proposition and something that hampers the very growth and development of the nation and its manpower resource.

Which is why, it comes as a blessing when students at the Johns Hopkins University created an App that lets rural health workers act as proxy for doctors who are unable to work in the underserved communities themselves. Titled “Intelehealth” the App aims to digitize the way in which primary healthcare is currently delivered across the length and breadth of the country.

How it works

The current rural health workers have been trained to operate the App. When a patient comes to a primary healthcare center, first their symptoms are noted and photographed. Demographic data is compiled about them and pertinent lifestyle, cultural and dietary information is gathered. This data is sent to qualified Healthcare professionals (usually retired doctors) living in urban areas who go through the information and revert with a diagnosis and recommended course of treatment. When required, a prescriptions is also sent along.

This makes the rural patients more confident that they are getting access to quality care – for a fraction of the price. When they see better outcomes for themselves and others in their community, they are more likely and willing to report health issues to gain care advantages.

Primary benefits

First and foremost Intelehealth fills a need in the market for affordable, quality, reliable healthcare. The fundamental gap it fills is that of access. The peripheral issues it tackles are wide-ranging. Patients in rural or remote areas can now access diagnoses from qualified healthcare professionals without having to travel long distances spending money they can ill-afford to spend. This makes them more likely to access healthcare and not delay symptoms that could result in more dangerous diseases if left untreated.

Larger Benefits

Intelehealth also functions as a epidemiological resource. When the gathered patient data is collected and encrypted, some of it can be anonymized and used in research. This can range from identifying the health profiles of specific areas to tracking the spread of disease over larger geographical regions. This is something that is currently unavailable in the market. The conventional means of data collection, collation and distribution are heavily manpower-reliant and lack of access to qualified and trained healthcare professionals makes it more of an administrative exercise with no healthcare outcomes.

Intelehealth however is much more than a simple tele-medicine App. The lack of bandwidth prevents solutions like that from being deployed. Hence the team worked on a solution that uses low bandwidth. It is currently available as an Android-based solution. Similarly the functionality of the App was geared towards collecting, disseminating and securing diagnoses in the fastest time possible. So bells and whistles typically found in Apps of this nature were also ditched to function well within the low bandwidth

Pilot studies were conducted at two location in West Bengal and the product will soon be launched in other parts of India. The App itself is free for anyone to use. It is currently in Beta mode and will be officially launched by year end. To cater to organizations who want Intelehealth to manage and train health workers, they have a separate program. After India, the target areas include SouthEast Asia and Africa – regions with similar challenges. Here’s more power to the people behind this really useful healthcare App!

Depression is the flavor of the season for healthcare marketing

Until Deepika Padukone stood up at a public forum to speak about her battle with depression, the disease wasn’t even recognized as such. Suddenly, post that historic moment, pharmaceutical companies, individuals and healthcare organizations are falling all over themselves to contribute their mite to the cause of mental health. This is especially significant as October 10^th marks the worldwide recognition of the World Mental Health Day.

There’s nothing wrong with a celebrity being able to endorse a cause. Rather, it is sad that until celebrities attach their name or their money, the cause remains under the radar for most people. Especially in the Indian context, mental health has historically never been viewed as an illness or a disease to be treated. It has been attributed to demonic possession, to “weak-mindedness”, lack of will or even sheer laziness! The cultural mores made speaking openly about it not just taboo but as something embarrassing to be hidden away and dealt with privately.

So it was with a great deal of positivity that I reacted to the news of the Live, Love Laugh Foundation! Not just because of the Deepika factor, but in spite of it! 

The Foundation has an interesting logo and an even better objective – to express, share and champion mental health concerns. The site is power-packed to deliver. Not only can you learn and understand more about mental health, you can also find a therapist, read inspirational stories of other sufferers, access great articles, find answers to common questions and even share your tips and tricks to deal with the illness or its care and management.  Help lines offer telephonic solace to callers and a call for donations promises to do more for the cause as well.

As the foundations gets set to celebrate one meaningful year of its existence, it continues to strive to achieve the following:

• Creating awareness and reducing the stigma around mental health
• Partnering with other non-profits organizations and academic institutions to drive various interventions and
• Supporting research in the area of mental health

These objectives will be delivered through the creations and sustenance of programs like:

• You are not alone
• Together against depression and
• The Nationwide Campaign

Do check out the foundation website and learn more about the steps they have taken. We need more such meaningful initiatives to help the estimated 7% of our population suffering from mental health issues. If more celebrities can lend their fame and resources to such programs, there is indeed hope that we can tackle this sooner. 

5 myths about Advertising and Creativity in the Pharma/Healthcare world

When it comes to Marketing or Advertising, it is safe to say that most Pharma and Healthcare marketers are a confused lot. For one, they don't understand the industry as it deals with products in the outside world (non-pharma/ healthcare!). For another, they have crippling regulations which cramp whatever little they can say and do. Except in the US and New Zealand, most pharma marketing is restricted from Print or Television almost everywhere in the world. So it is no wonder that several myths abound.

In this blog we will take a look at 5 myths about Advertising and Creativity in the Pharma/Healthcare world.

Myth 1 - Healthcare/Pharma marketing is different from Consumer Marketing

While it may be true that Pharma/Healthcare marketing is highly regulated, the fact remains that brands are still selling to consumers. As such, the rules that govern business in other sphere also apply here - albeit with some restrictions. More importantly, healthcare decision makers, like the rest of us, are subject to the laws and flaws of human behavior. Their decisions are primarily influenced by non-rational biases. If they choose to, advertisers and brands can influence and leverage this to create a massive opportunity.

Myth 2 - Healthcare brands sell themselves

Nowhere else is the 'Build it and they will come'mentality more rife than in the healthcare marketing industry. Health is undoubtedly one of the most searched rerms on the internet. This however does not automatically mean that consumers will easily find your brand message online. You need to take concrete steps to create awareness, promote interest and call for action. This is where marketing can help you. No matter how great the solution you can offer or the app you have designed - if it can't be found, it won't get popular.

Myth 3 - Healthcare brands don't require creativity

Most healthcare marketers firmly believe that clinical evidence is what powers their sales activities. However, most consumers buy brands that strike an emotional chord with them. No amount of rational, scientific or clinical explanation can win over customers if there is no compelling story that emotionally resonates with them. Case in point is the Pain relief category. While healthcare marketers are currently focused on the relief of pain as the primary factor and attempt to sway consumers with claims and counterclaims of fastest-acting formulations, consumers are heavily invest in pain in an emotional way. When a dear one is suffering, their family members too feel the pain. When the pain is alleviated, the family members heave a sigh of relief. this is the compelling emotional territory that is up for grabs! Small wonder then that the brands who have actually managed to crack compelling campaigns are based on powerful, emotion-laded brand reminders.

Myth 4 - Global (HQ) will take care of my brand marketing

Most Pharma/Healthcare Companies are multi-national entities. Typically, they tend to centralize branding at the HQ or at Regional HQs in order to deliver on the goal of branding - consistency and uniformity across all communication. This is especially true when it comes to the development and implementation of brand identity elements, as it rightly should be. Advertising on the other hand is built on creativity which has an altogether different goal - that of being different and able to stand out in the minds of the consumer. Add to this local cultures, habits, interests, themes, memes and thee like and it becomes evident that locally-produced campaigns will be able to emotionally engage the local consumer better. The sooner marketers at all levels of the MNC organizations realize this, the better. Hopefully that will spell the death of the plain-vanilla concepts structured to mean nothing to anyone globally.

Myth 5 - Pharma/Healthcare Companies discourage creativity

Most Pharma and Healthcare Marketers prefer to err on the side of caution. The primary reason is that they prefer to toe the line when it comes to making claims rather than battle legal and regulatory departments over complaints. However creativity thrives on taking risks. Given that it is subjective, difficult to define and doesn't test well, Pharma/Healthcare markerters are understandably nervous. The products they market are built on the basis of rigorous formulation and testing after all! But it is about a mindset change. Once the marketers are able to distance themselves from the clinical mindset and focus on the consumer benefit (rather than product features) they will begin to see the value of creative marketing.

So there! This is a humble attempt to break some of these myths. Let me know in the comments if you have come across any other similar myths and hopefully we can bust those as well!