Express Healthcare (Vol. 16, No. 2) March 2023

Vikas Panibatla CEO, TB

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CONTENTS

Chairman of the Board

ViveckGoenka

Sr.Vice President-BPD

Neil Viegas

Vice President-BPD

Harit Mohanty

Editor

Viveka Roychowdhury*

BUREAUS

Mumbai

Lakshmipriya Nair,Kalyani Sharma

Delhi

Akanki Sharma

DESIGN

Art Director

Pravin Temble

Senior Designer

Rekha Bisht

Senior Artist

Rakesh Sharma

Digital Team

Viraj Mehta (Head of Internet)

Marketing Team

Rajesh Bhatkal

Ambuj Kumar

Ashish Rampure

Debnarayan Dutta

Production Co-ordinator

DhananjayNidre

Scheduling & Coordination

Pushkar Waralikar

CIRCULATION

Mohan Varadkar

PUBLIC HEALTH

COVER STORY

Diagnostic tools can play a crucial role in building the pathway for better health outcomes for women by facilitating early disease detection and empowering them with awareness | P-16

INSURANCE HEALTHCARE IT

P27: INTERVIEW

SIDHARTH SRINIVASAN CEO,Lupin Digital Health

P29: INTERVIEW

33 BENEFITS OF TELEMEDICINE AND OPD COVERAGE UNDER HEALTH INSURANCE

P13: INTERVIEW

VIKAS PANIBATLA CEO, TB Alert India (TBAI)

25 FEMININE HEALTH: ADIAGNOSTIC APPROACH TO A LIFETIME OF WELLNESS

26 CERVICALCANCER IN INDIA: AHIDDEN EPIDEMIC

HEALTHCARE TRENDS

30

ATULCHADHA Business Head – Patient Care Solutions,GE HealthCare REMOTE PATIENT MONITORING SYSTEMS: ROLE AND IMPORTANCE

31 EMPOWERING HEALTHCARE PROVIDERS WITH ADVANCED CRM SOLUTIONS

35 HOWCAN THE MEDICAL COMMUNITY PREPARE PATIENTS TO BECOME HEALTH-RESILIENT IN THE LONELINESS ECONOMY

Express Healthcare® Regd.With RNI No.MAHENG/2007/22045.Postal Regd.No.MCS/162/2022 - 24.Printed and Published byVaidehi Thakar on behalf of The Indian Express (P) Limited and Printed at The Indian Express Press,Plot No.EL-208,TTC Industrial Area,Mahape,Navi Mumbai-400710 and Published at Mafatlal Centre,7th floor,Ramnath Goenka Marg,Nariman Point,Mumbai 400021.

Editor: Viveka Roychowdhury.* (Editorial & Administrative Offices: Mafatlal Centre,7th floor,Ramnath Goenka Marg,Nariman Point,Mumbai 400021)

* Responsible for selection of news under the PRB Act.Copyright © 2017.The Indian Express (P) Ltd.All rights reserved throughout the world. Reproduction in anymanner,electronic or otherwise,in whole or in part,without prior written permission is prohibited.

Living up to the potential of the G20 presidency

Delivering the fifth Ramnath Goenka Memorial Lecture, philanthropist Bill Gates chose to speak on the theme, 'Creating an equal world: The power of innovation'. As Microsoft co-founder Gates scripted the now familiar Silicon Valley basement to billionaire story, becoming the idol for every IT nerd. Now as co-chair of Bill & Melinda Gates Foundation, he is using his wealth to bridge the gaps in key areas, ranging from health, education to climate change.

Like many countries, India has benefitted from funding from The Gates Foundation. Unlike many nations, India has also been crucial to the success of the Foundation. India's expertise to make more affordable medicines and vaccines has allowed the Foundation to stretch its dollar. Gates mentioned India's contributions to affordable HIV medications and low-cost rotavirus vaccines, which have benefitted patients not just in India but across the world. Gates also commended India's tackling of the pandemic, making special mention of the digital public infrastructure platform, which allowed the quick roll out of vaccines developed in India.

Reminding us that three years after the pandemic, most countries’ health systems are still not completely back on track, Gates feels that our country has the potential to develop into a hub of “innovation and ingenuity,” to herald a “new era of global partnership” which can overcome the world’s greatest challenges.

So can India's healthcare sector deliver its part on this potential, building on the COVID lessons and going beyond COVID? While the ACTAccelerator played a pivotal role, it needs to be replicated with major changes to make it more inclusive. In a year when India has G20 presidency, the country is expected to 'strive to build a consensus among member countries on the need for such a permanent institutional platform.' As per a blog on the World Economic Forum website, 'We will deliberate on how its new avatar can have an expanded scope on healthcare, along with much stronger governance and accountability.'

Rajesh Bhushan, Union Health Secretary reiterated this agenda during the 1st G20 Health Working Group (HWG) meeting under India's Presidency in January, when he highlighted India’s aim to achieve convergence in discussions across various multilateral fora engaged in health cooperation, as chair of the G20 Presidency. We await the action plan to make this happen, over the next three HWG meetings due in Goa, Hyderabad and Gandhinagar, and the Health Ministerial

Meeting, hoping that a year will be sufficient to put in place a framework that prevents the next pandemic as well as ensures our health systems are more resilient.

India needs to continue to look inward. The COVID pandemic exposed the huge gaps in India’s public health systems. State governments are responsible for the health in their jurisdictions, and there is huge variability on health parameters.

A recent study (Venkateswaran, S., Mishra, M., Iyer, N., (2022). The Political Journey of Healthcare in Select Indian States (CSEP Working Paper 42). New Delhi: Centre for Social and Economic Progress) examines the political trajectory of health in five Indian states. While acknowledging that many aspects influence health progress, including fiscal health, governance, institutional capacity, the authors make the point that the political priority accorded to health by a state’s leadership remains a key driver.

Included in the recent monthly newsletter of the Lancet Citizens' Commission on Reimagining India’s Health System, the study concludes with four insights. One, political ideology plays a role in driving attention to health, but political legitimacy can be linked with healthcare to drive attention in the absence of an ideological driver. Interestingly, the authors point out that external stakeholders can create an environment where legitimacy is linked with healthcare.

Two, sensitising politicians to electorally rewarding policies elsewhere, and relevant to the state’s development journey, can motivate them to act. Three, state capacity is a key variable in the confidence to undertake reforms and the choice of reforms. Four, both the Central government and external stakeholders such as civil society can contribute to agenda setting at the state level.

The study assumes more importance this year, with nine states due for elections. Will the leaders of these states pay more attention to making health systems more resilient? Will civil society and other stakeholders ensure that health becomes a rallying point? And more importantly, will the politicians follow through with appropriate action post elections? And if they don’t, will they be held accountable?

VIVEKA ROYCHOWDHURY Editor viveka.r@expressindia.com viveka.roy3@gmail.com

India also needs to continue to look inward and fix the gaps in our public health systems

PUBLIC HEALTH

There are multiple deeply entrenched barriers impending India’s fight against TB

Each year,World Tuberculosis (TB) Day is takes place on March 24 to raise public awareness about the health,social and economic consequences of TB,and to step up efforts to end the global TB epidemic. Vikas Panibatla ,CEO,TB Alert India (TBAI) in an interaction with Viveka Roychowdhury highlights the initiatives taken by TBAI to help India in its fight against TB

Do you think India will be a 'Tuberculosis Free India’ by 2025?

Under the present government, the elimination of TB by 2025 was announced. It is 5 years ahead of the global deadline of 2030. At the same, the National Strategic Plan (NSP) 2017-2025 framed by the Government of India, built on four major pillars of Detect-Treat-Prevent and Build, augmenting its efforts towards achieving the elimination goal.

Through new initiatives of community engagement, all molecular testing modalities and providing TB preventive treatment to the household contacts of Pulmonary TB patients are helping the unreached with immediate, correct TB testing and treatment services. While the country has earmarked the increased case notification, the COVID-19 pandemic and its impact on healthcare delivery had reversed the years of progress and TB in the specific context.

The majority of people who live in rural areas are most affected by it due to perceived community stigma and cultural hurdles for testing and treatment. Also, there is a major infrastructural gap in rural healthcare facilities.

While India achieved 83.7 per cent of new TB case notifications against estimated in 2019 but this dropped to 60.2 per cent in 2020 and 71.3 per cent in 2021 during the pandemic. Response of TB program to come on track is tremendous post-pandemic, while a target to achieve TB elimination by 2025, we all have to ensure at least eradicate by 2030.

What are the major obstacles observed by TBAI in India’s fight against TB to maintain sustained TB eradication efforts, as localised COVID waves seem the healthcare system on tender hooks? There are multiple deeply entrenched barriers impending India’s fight against TB. There is also a persistent lack of awareness about the cause, risk factors, treatment, and prevention of pulmonary TB. It is most evident among people living in rural areas where raising awareness is crucial to reduce disease transmission.

As more than 40 per cent of the people in the country preferred to avail services from the private health sector, various TB program has amalgamated their efforts for meaningful engagement of

private providers for TB in the country. This was made instrumental with the help of the Joint Effort for Elimination of TB (JEET) project initiated by TBAI, but sustaining the impact after project closure must be strengthened through constant efforts. Therefore, to tackle the TB in pandemic, a system-driven, and integrated health intervention is of paramount importance to engage the private health sector for sustained impact.

In the unprecedented pandemic time, civil society organisations/NGOs should come forward to supplement the national program, especially leveraging the support from local communities, and the private sector, building empowered TB champions for peer group patient support, etc. Perceived community stigma with cultural barriers to testing and treatment has been an issue with mass at large, with people preferring care by unqualified practitioners and ignoring or self-treating symptoms. There are also infrastructural deficits mainly in line with healthcare (medical facilities and ancillary infrastructure) and the inclusion of private-public

After devastating impact on India’s healthcare system due to COVID-19,experts expected more funding in the 2023 budget

PUBLIC HEALTH

partnerships for TB eradication in India.

There is a link between malnutrition and poor diets to TB incidence. How can this be handled at a policy level in a resource-constrained country like India?

We are a resource-constraint country, but the government of India has taken various initiatives to the eradication of TB. For eg. Nikshay Poshan Yojana, gives a Direct Bank Transfer of Rs 500 every month till the patient completes the treatment, for nutrition supplementation. Recently, the government also came up with a new initiative “Niksahy Mithra”, that enables people to adopt TB patients to provide support for their nutrition and medical needs. These two are the major initiatives by the government

that address the stigma and motivate TB patients to complete their journey on a successful note. This aspect is better taken at the policy level. Proper nutrition counseling and demonstrations at the facility level while giving the medicines and at follow-up visits will be very helpful in reiterating the need for proper nutrition. We also need to prioritise the beneficiary group who are the most vulnerable in Indian society so that it can have a long-term impact on nutritional intervention.

Does the recent budget allocate enough funding to control TB?

After the devastating impact on India’s healthcare system due to COVID-19, experts expected more funding in the 2023 budget. India aspires to eliminate TB by 2025 through its national

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policies and programs. Though it is a welcoming initiative, more work needs to be done to tackle TB by the government through strategic partnership and collaboration with various stakeholders. More than 50 per cent of TB patients rely on private hospitals for treatment, therefore they need to be engaged with government policymakers. The operation of the health sector in both the public and commercial sectors urgently needs to be drastically improved. All TB patients must be effectively followed up on and kept under observation. Also, all TB patients require proper social, emotional, and nutritional assistance. Without concerted funding to control TB, the End TB strategy in India would only be a distant dream.

What are the initiatives from TBAI to reduce the burden of TB patients in India? How effective have they been over the past few years?

TBAI is operating in Andhra Pradesh, Delhi, Haryana, Punjab, Rajasthan and Telangana providing TB education sessions, testing, treatment care and support services in achieving National TB Elimination Program (NTEP).

TBAI has been instrumental in bringing community ownership to stigma free TB services. TBAI has trained more than 4000 members from local Community Structures such as women's self-help groups, youth groups, labor unions, and panchayat raj institution members for local action and reached more than 2.4 million people from different vulnerable communities such as industrial workers, tribal groups and urban slum dwellers with TB education sessions. Out of more than 26500 facilitated TB symptomatic individuals, 2800 are diagnosed with TB and initiated on treatment.

In rural healthcare providers, 1635 informal providers trained and engaged in the project from 9 districts of Telangana and established a strong referral mechanism with NTEP services. As a result, 37775 individuals with TB-like symptoms were referred and of them, 36976 tested for TB at NTEP facilities. 6141 All Forms TB patients diagnosed, notified under the public sector through Nikshay. This project has addressed the key aspects of delay in TB testing and doctor shopping, and of course out of pocket expenses by the TB patients’ families from July 2018 to Dec 2021.

TBAI has contributed to 144911 new TB patients’ notifications to the government TB program and achieved a success rate of 85.5 per cent in treatment outcomes. In

“Programmatic Management of TB Preventive Therapy”, also called Latent TB Infection program funded by GFATM, more than 3 lakh HHCs screened for TB symptoms and around 150000 eligible HHCs were initiated on TB preventive therapy. TBAI has an impactful contribution in creating awareness, improving health-seeking behavior, building the capacities of local communities and health care providers, and pilot testing of newer initiatives to generate evidence for scale-up are the key thematic areas of TBAI.

TB patients and family members have to also battle social stigma, and this plays a major role in dropping off the treatment regime, leading to MDR TB. TBAI’s contribution in effective TB awareness and treatment for vulnerable communities?

There is a social stigma and prejudice around TB which has a serious tailback pushing the patients onto greater risk. Therefore, more local actions have been put in by TBAI. We conducted various capacity-building sessions for community representatives such as PRI members, ward members, slum association members, and local community structure members. To make people aware of TB, community connect sessions were held among TB staff and community representatives. We have also identified and trained more than 300 TB Champions to provide psychosocial and peer group counseling to TB patients while sharing the challenges they have faced and how did they address and overcome them to win over TB. Patient Care Support Groups are formed with the support from NTEP staff at each facility (DMC/TU/PHC) as needed to reiterate the importance of treatment adherence boosting their morale and self-esteem.

What are the strategies that could be employed to ensure access, adherence and adoption of preventive/prophylactic TB measures?

TBAI strengthened the private provider engagement both for TB care and preventive TB services. As rural India is highly deprived of healthcare infrastructure, a huge base of informal providers like ASHA/AMM/AWM needs to be provided to sensitise the masses to initial/first point of care services. Additionally, meaningful engagement of community-level structures such as women's self-help groups, youth, labor unions, slum

PUBLIC HEALTH

development societies, village organisations, PRI bodies, religious groups, workers unions etc. Therefore, there should be a more synergetic contribution from NTEP and various civil society partner organisations.

There should be more decentralised TB services to

better strategise its efforts for a greater impact. To achieve this, we’ll engage with key stakeholders such as private providers/associations, vulnerable community representatives/bodies, and other health and allied sectors.

We have worked with a

wide range of stakeholders over the past years with national and local governments, multilateral and bilateral agencies, research institutions, universities, civil society organisations, and membership organisations. Strategic partnerships and collaborations are the

cornerstones of progress. Like bringing more synergy between NTEP and the Private healthcare delivery system for an impactful partnership. We’ve envisioned bringing a meaningful engagement between the Panchayati Raj department and the village panchayat

institutions. We will undertake operational research to illustrate good practices to scale up for a wider reach with TB testing and treatment services for hard-to-reach communities.

viveka.r@expressindia.com

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increase access to TB testing and treatment. Build the community response to TB and strengthen peer support. We also need to train TB patients as health volunteers for TB preventive therapy services to household contacts. There is an urgent need of equipping more health staff with uninterrupted delivery by making sufficient stock of testing kits and treatment regimens.

What is the plan for the next 2-3 years for TBAI, in terms of strategic partnerships for patient care and research, etc?

Over the next 2-3 years, TBAI will consolidate the learnings from previous and the current ongoing projects of TB in the country, to understand the leakages, and bottlenecks, and navigate the solutions to

Perceived community stigma with cultural barriers to testing and treatment has been an issue with mass at large,with people preferring care by unqualified practitioners and ignoring or self-treating symptoms

Diagnostic tools can play a crucial role in building the pathway for better health outcomes for women by facilitating early disease detection and empowering them with awareness

ByKalyani Sharma

Women’s health is an ever-evolving field, with new developments in diagnostic testing happening every day. Despite this, women in India often find themselves under-diagnosed and under-treated in comparison to their male counterparts. This is largely due to a lack of awareness and access to quality healthcare services in the country.

Commenting on this, Dr Akshay Tiwari, Consultant Pathologist and Business Head-Central India, Pathkindlabs said, “Blame it on the Indian culture or the patriarchal society, women are not groomed to take care of themselves. They would rather take medicines over the counter without getting the right diagnosis and hope to get well on their own. However, this approach can lead to dire consequences and thus it is most important for the community to change this way of thinking by consciously educating the women, across every strata of the society, about the relevance of timely diagnosis and keeping in good health.”

DrPadmaSrivastava, Consultant Obstetrician & Gynaecologist, Motherhood Hospitals also feels that, “Women often shoulder the responsibility of their professional and personal life and fail to pay attention to their health. They neglect their health while striking a work-life balance. Hence, a majority of women are detected with a plethora of health issues that can steal their peace of mind.Early diagnosis is key to the management of health problems in women. Just like men, it is imperative for women to pay attention to their physical and mental well-being.While women are susceptible to similarhealth issuesas men, there are certain issuesthat impact women exclusively or predominatly. Women often fail to prioritise their health and land themselves in trouble.Gynecological health and disordersaffecting women includemenstruation and menstrual irregularities;urinary tract health, including urinary incontinence andpelvic floor disorders; and such disorders as bacterialvaginosis,vaginitis,

Our women folk must also prioritise their health and be aware of the facilities that are being provided to them by the government and other bodies

Dr Akshay Tiwari Consultant Pathologist and Business Head-Central India, Pathkindlabs

While women are susceptible to similar health issues as men,there are certain issues that impact women exclusively or predominatly

Dr Padma Srivastava Consultant Obstetrician & Gynaecologist, Motherhood Hospitals

To improve women’s health,we need to address issues related to maternal deaths,reproductive health, malnutrition and noncommunicable diseases through quality and affordable health services

Dr Anju Wali Medical Director, PSRI Hospital

Dr Sonam Gupta Sr.Consultant & Head Unit II - Obs & Gynae, Asian Institute of Medical Sciences

uterine fibroids, andvulvodynia. Apart from that, a range of other health issues can be problematic for women.”

The disease burden affecting women is on rise. In addition to all the possible diseases that can afflict a human being, women are considered to be more susceptible to certain disorders such as osteoporosis, menstrual disorders, cancer, and autoimmune diseases. The rise in innovative diagnostics solutions for women’s health gives physicians the ability to provide the right treatment at the right time.

Overall, there are a variety of diagnostic tools available for women in India that can be used to identify health issues and start timely treatment. With improved access to quality healthcare services and greater awareness of the importance of early detection and prevention, more women in India are able to take advantage of these services and receive the care they need.

Talking about the role of early screening/diagnosis of women's health issues, Dr Anju Wali, Medical Director, PSRI Hospital said, “To improve women’s health, we need to address issues related to maternal deaths, reproductive health, malnutrition and noncommunicable diseases through quality and affordable health services. A holistic and comprehensive approach beyond reproductive health is needed which encompasses better health for women starting from adolescence, pregnancy throughout their reproductive years and ageing period. Women must be empowered to take charge of their health.”

Dr Sonam Gupta, Sr. Consultant & Head Unit II - Obs & Gynae, Asian Institute of Medical Sciences opines, “The prevalence of women's health issues is particularly concerning. Women are more likely to develop depression, anxiety, and other mental health-related disorders compared to men. They are also more likely to experience chronic pain and autoimmune diseases. In addition, they are at a higher risk of developing certain forms of cancer, such as breast and ovarian cancer. The

Early detection and diagnosis can lead to better treatment outcomes and improved health for women.Screening tests,such as mammograms and Pap smears,can help detect certain issues before they become more serious

need for early diagnosis of women's health issues is paramount. Early detection and diagnosis can lead to better treatment outcomes and improved health for women. Screening tests, such as mammograms and Pap smears, can help detect certain issues before they become more serious. Additionally, regular health check-ups can help identify any changes in women’s health that may require further investigation and treatment.”

Dr Archit Pandit, Director, Surgical Oncology, Sanar International Hospitals, Gurugram said, “Unfortunately, the urban and rural divide still persists owing to limited access to affordable healthcare facility and trained experts. We still have a huge unscreened population in rural areas who are at a great disadvantage and vulnerable to many health relates risks. Women play a significant role in the development of the society, their health concerns should be prioritisedencouraging them and making them aware about the importance of regular preventive health check-ups for early detection of the diseases and positive treatment outcomes.”

Women's health diagnostic industry: Current market size

As per Research and Markets, “Indian women health diagnostics market is growing at a CAGR of approximately 9.5 per cent during the forecast period. Increasing healthcare infrastructure is estimated to be one of the major factors that are driving the growth of the Indian women health diagnostics market. Over the past few years, a tremendous growth in health sectors in India has been witnessed, along with the increased healthcare spending. Rising incomes and easier access to high quality healthcare facilities and increasing awareness towards health and personal hygiene are estimated to be the major factors that are responsible for improving healthcare infrastructure in India, which augments the Indian women health diagnostics market.”

Giving an overview of the

market, ChandraGanjoo, Group Chief Executive Officer, Trivitron Healthcare said, “Throughout 2022-27, the Indian women's health diagnostics market is expected to increase at

a CAGR of almost 9.5 per cent. One of the main reasons influencing the expansion of the Indian women's health diagnostics industry is the country's expanding healthcare infrastructure. In

India, the health sector has seen enormous expansion recently, accompanied by a surge in healthcare spending.”

“As far as the size of the global market for women's

health diagnostics is concerned, it was estimated to be worth $19.2 billion in 2020 and is anticipated to increase to $36.3 billion by 2030, rising at a CAGR of 6.9 per cent from 2021 to 2030. The

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major factor contributing to its rise are sedentary lifestyle, poor diet, lack of awareness, early/late marriages, workplace stress, and others.”

Sharing some numbers, Sachidanand Upadhyay, MD & CEO, Lord's Mark Industries said, “According to the IMARC Group report, the global women's health diagnostics market was valued at $ 21.62 billion in 2021 and is expected to reach $ 35.7 billion by 2027 at an 8.10 percent CAGR between 2022 and 2027. In India, as per the report of Orion Market Research (OMR), the women’s health diagnostics market is projected to grow at a healthy CAGR during 2019–2025.”

“The health consciousness and awareness of the benefits of early diagnosis are on the rise, and this trend is boosting the demand for point-of-care women’s healthcare diagnostics across the world. The awareness of preventive wellness among women is also growing in India”, he added.

Dr Sunita Dube, a Renowned Radiologist and Founder, MedscapeIndia, Aryan hospital also shares, “The market may see rapid growth owing to the increasing incidence of chronic and lifestyle-related disorders. There will be a surge in imaging and diagnostic centers, and the increased adoption of point-ofcare and rapid diagnostic tests along with collaborations and partnerships by players. The increasing burden of various diseases will lead to a greater demand for proper diagnosis devices and tests for the diseases and thus driving the growth of the women’s health diagnostics market.”

Latest trends and recent developments in women's health diagnostic industry

Women’s health concerns are no longer restricted to reproductive health or maternal health. The discussions on women’s health now factor in a number of illnesses and health issues that impact women throughout their lifespan, such as cardiovascular diseases, bone diseases, thyroid disorders, diabetes, ovarian and breast cancer, etc. In this

One of the main reasons influencing the expansion of the Indian women's health diagnostics industry is the country's expanding healthcare infrastructure.In India,the health sector has seen enormous expansion recently, accompanied by a surge in healthcare spending

Chandra Ganjoo Group Chief Executive Officer, Trivitron Healthcare

The need of the hour is to build an enabling ecosystem for inter-governmental agencies, non-government organisations,and diagnostic players to come together to manufacture and distribute various diagnosis test kits in government healthcare centres across India

Sachidanand Upadhyay MD & CEO, Lord's Mark Industries

There will be a surge in imaging and diagnostic centers,and the increased adoption of point-of-care and rapid diagnostic tests along with collaborations and partnerships by players

Dr Sunita Dube ARenowned Radiologist and Founder, MedscapeIndia, Aryan hospital

In India,factors like digitisation, e-commerce platforms creating ease of access,use of social media platforms for initiating conversations on women’s health,and the government taking measures to educate women in rural areas have added to the demand for goods and services paving the way for the growth of women's healthcare sector

Dr Sunita Kapoor Director and Consultant Pathologist,City Xray & Scan Clinic

context, diagnostic services and solutions can play a pivotal role in building the pathway for better healthcare outcomes for women by facilitating early disease detection. Diagnostic solutions, in a way, empower women with knowledge and awareness of various health issues and help them make informed decisions at the right time.

With the invention of new technologies, including digital platforms, telemedicine, and AIenabled diagnostics, the healthcare industry in India has seen tremendous growth in the past few years. These technologies allow for more efficient diagnosis of diseases and lead to faster treatment.

On digitisation of women's diagnostics space, Dr Gautam Wankhede, Director of Medical Affairs, Mylab Discovery Solutions highlights, “In recent years, women healthcare apps such as period, ovulation and pregnancy, etc. and diagnostics have gained considerable momentum apps have gained traction. We will see further growth of such Apps and an increased use of Apps for menopause, other diseases. Digitalisation in health has enabled much-needed attention to women’s health. Advancements in technology will offer new diagnostics for women-centric conditions that include infectious diseases, osteoporosis, and breast cancer. Further, usage of tech can help make solutions more affordable and accessible to women.”

Dr Sunita Kapoor, Director and Consultant Pathologist, City Xray & Scan Clinic while mentioning about the latest trends said, “In India, factors like digitisation, e-commerce platforms creating ease of access, use of social media platforms for initiating conversations on women’s health, and the government taking measures to educate women in rural areas have added to the demand for goods and services flourishing, paving the way for the growth of women's healthcare sector.”

Adaption of personalised medicine and growing focus on non-invasive and minimally invasive diagnostic techniques are

also gaining attention among women. Moreover, there is an increased acceptance and adaption of Point of Care Testing (POCT).

Runam Mehta, CEO, HealthCube stresses on the role of POC diagnostics and mentions about several key areas where POC diagnostics are enabling easy healthcare access for women. She said, “Even a few years back, there were several barriers limiting women’s access to primary healthcare needs. This includes systemic challenges such as a lack of infrastructure for screening and diagnostic capabilities. Additionally, there was a body-part-bybody-part approach to screening which is not only time-consuming but creates other encumbrances as well. As per a report, the tests women need are often unavailable in health systems; also there are information, financial and cultural barriers created by gender inequality in terms of access to testing. Moreover, there is a lack of trust, fear and stigma associated with medical procedures and diagnosis.”

“And this is where point-ofcare diagnostics are emerging as the panacea in the form of access as well as awareness by taking healthcare screening to women at home and work. Dozens of common pathology tests and vital measurements are now possible through simple hand-held diagnostic devices that can be operated by anyone with minimal training. This approach is also ideal for women in tier II and III areas since it resolves the challenge of access. There are several key areas where POC diagnostics are enabling easy healthcare access for women. The parameters include cervical and breast cancer, prevention of maternal mortality, osteoporosis, and menstrual health, etc. Innovations in healthcare are now ensuring access to minimally invasive tests for these conditions. There are several FemTech startups that have come up with solutions in the area of menstrual health – be it creating a community for girls and women to discuss their challenges or delivering solutions”, she added.

Aayush Rai Co-Founder and CEO, Inito

Advent of sophisticated healthcare technologies in diagnostics,has revolutionised the diagnosis and treatment of women’s health conditions

Dr Girija Kishore

Lead- Clinical Governance, LivLong

Aayush Rai, Co-Founder and CEO, Inito added, “With advances in technology, non-invasive point-of-care diagnostic tests has become increasingly popular in the women's health diagnostic industry. These tests are convenient, safe, and cost-effective, and can be performed at home or in a doctor's office. The global point-of-care diagnostics market is projected to grow from $36.37 billion in 2022 to $51.94 billion by 2029, at a CAGR of 5.2 per cent during the period.”

Dr Ashwini Bhalerao Gandhi,Consultant Gynecologist, P.D.Hinduja Hospital & MRC

Dr Girija Kishore, Lead- Clinical Governance, LivLong believes that the advent of sophisticated healthcare technologies, such as advanced ultrasound imaging, liquid biopsy-based tests, and the use of Artificial Intelligence (AI) in diagnostics, has revolutionised the diagnosis and treatment of women’s health conditions. He said, “As the rise in chronic and lifestyle-related disorders continues, the expansion of imaging and diagnostic facilities will be further driven, leading to better access to advanced diagnostic procedures for women around the world. In accordance with the latter, the increased use of POCT, diagnostic kits, tele-diagnostics, and rapid diagnostic tests is all expected to contribute to the rapid growth of the women's health diagnostic market. These advances in the diagnosis of women's health conditions will go a long way towards improving the quality of care and outcomes, as well as promoting preventative measures for the prevention and early detection of diseases.”

Dr Arjun Dang CEO, Dr Dangs Lab

On personalised medicine and minimally invasive techniques, Dr Ashwini Bhalerao, Gandhi, Consultant Gynecologist, P.D. Hinduja Hospital & MRC shares, “One of the most significant trends in the women's health diagnostic industry is the increasing use of personalised medicine. Personalised medicine involves tailoring treatments to individual patients based on their genetic makeup, medical history, and lifestyle factors especially during pregnancy, post-menopausal period, etc. This approach is

With advances in technology, non-invasive point-of-care diagnostic tests has become increasingly popular in the women's health diagnostic industry

One of the most significant trends in the women's health diagnostic industry is the increasing use of personalised medicine

In addition to diagnostic testing, there is also a growing focus on preventive care in the women's health diagnostics industry

becoming increasingly important in the field of women's health, where there are significant differences in the way women experience and respond to diseases compared to men. Personalised medicine has the potential to improve the accuracy of diagnoses, reduce unnecessary treatments and improve overall patient outcomes. Another trend in the women's health diagnostic industry is the growing focus on non-invasive and minimally invasive diagnostic techniques. These techniques aim to reduce the discomfort and risks associated with traditional diagnostic methods such as biopsies, which can be painful and carry a risk of infection.”

Also, women's health care is increasingly shifting from a reactive approach to a proactive one, with a focus on preventive care. This includes early detection and screening of medical conditions, as well as offering lifestyle advice and counselling to promote better health.

Dr Arjun Dang, CEO, Dr Dangs Lab mentions, “In addition to diagnostic testing, there is also a growing focus on preventive care in the women's health diagnostics industry. This includes providing women with information and education about reproductive and gynecological health, as well as offering screening and early detection services for various conditions. This is a crucial aspect of women's health, as early detection and treatment can greatly improve outcomes and reduce the risk of complications.”

Dr Wankhede also feels that, “Women are increasingly seeking solutions as per their health conditions. At-home-diagnostics and smart wearables will see an uptick in near future.”

Neetha Joy, Director, ACT For Health see cancer care for women as one of the big emerging areas that has the potential for innovation at scale. She emphasises, “With the incidences of cancer expected to increase in India over the next few years as per the data released by ICMR, it is important to regularly screen women for high-risk and high-incidence cancers like

Improving roads,telecommunication networks,and electricity,can help to improve access to diagnostic tests for women in rural areas.This can make it easier for women to access healthcare services

Dr Jitendra Choudhary Consultant - Intensive Care & Critical Care, Fortis Hiranandani Hospital

Investing in healthcare infrastructure in rural areas,including building and upgrading healthcare facilities,can help to increase access to diagnostic tests for women in these areas

Ameera Shah Promoter and Managing Director, Metropolis Healthcare

breast, cervical, uterine and ovarian cancer. But with the bulk of cancer screening happening in tertiary centres, there is a very heavy burden placed on the limited number of tertiary centres in the country today. It is important to enable a hub and spoke model to decentralise cancer diagnosis so that equitable access to diagnosis is available to all.”

“While training and capacity building of healthcare workers is the most important lever to bring about this change, innovations in affordable medical devices can play a huge role as well. Early screening, pathology and cytology tests can be brought to the peripheries only through the use of such innovative medtech solutions”, she added.

Sandeep Vyas, Founder, Mild Cares' GynoCup says that one area that has garnered attention in recent years is menstrual health and there is a need for better diagnostic tools to address menstrual disorders. He shares that, “Menstruation is a critical aspect of women's health and wellness, and the menstrual health sector of the women's health diagnostic industry has seen significant growth in recent years. Menstrual disorders are one of the most common health concerns affecting women. Disorders such as polycystic ovary syndrome (PCOS), endometriosis, and uterine fibroids can cause pain and discomfort, as well as impact a woman's overall health and quality of life. In the past, diagnosis of menstrual disorders relied heavily on a combination of medical history, physical exams, and ultrasound tests. However, advances in technology have led to the development of new diagnostic tools that can provide more accurate and efficient results. One such tool is the menstrual cup, which has seen a rise in popularity in recent years. While menstrual cups are primarily used for period protection, they can also be used to monitor menstrual flow and identify potential issues. Changes in menstrual flow, such as heavier or lighter bleeding, can indicate a problem and prompt further diagnostic testing. Additionally, menstrual cups can collect

One area that has garnered attention in recent years is menstrual health and there is a need for better diagnostic tools to address menstrual disorders

Sandeep Vyas Founder, Mild Cares' GynoCup

Carefully thought out health research is essential to achieving outstanding health outcomes

Kiriti Acharjee Co-Founder, HealthFab

samples of menstrual blood, which can be analysed for abnor malities or infections.”

Government initiatives and need of the hour

The Indian government has taken various initiatives to promote early diagnosis of women's health issues in India including initiatives like implementing the National Health Mission (NHM), setting up National Institutes of Public Health (NIPH), launching the Pradhan Mantri Surakshit Matritva Abhiyan (PMSMA), Janani Shishu Suraksha Karyakram (JSSK) and others.

In addition to these initiatives, Ganjoo shares some the additional steps to promote early diagnosis of women's health issues by Indian government consisting of increasing funding for rural and remote health infrastructure, including diagnostic facilities, Women's health issues and early detection training for healthcare professionals, including community health workers, encouraging women to undergo routine health examinations and providing incentives for early detection of health problems, raising women's awareness of the significance of early diagnosis and the screening options currently available and promoting research on women's health issues in order to better comprehend the prevalence, risk factors, and treatment options for various diseases.

While sharing some of the suggestions on what government can do further, Kiriti Acharjee, co-founder, HealthFab says that, “Carefully thought out health research is essential to achieving outstanding health outcomes. For better health outcomes, health research initiatives in India must align with public health priorities. Government-funded and independent research funding agencies, like the National Institutes of Health (NIH) in the United States, must take the lead in the development of evidence for policy. We won't be able to distribute resources effectively without precise data. To enhance health outcomes and equity, comprehensive evaluations of all the key public health programmes

and policies are required.”

“As a crucial tool for ensuring everyone's health, primary healthcare must be improved. If the government wants to provide universal primary health care through public-private partnerships in India, it may need to adopt the National Health Service (NHS) model from the UK (PPP). The vast majority's greatest need should be addressed first, because primary healthcare, if done well, will significantly reduce the need for secondary and tertiary care.The government should simultaneously develop a strategy for enhancing the urban poor's state of health through the use of effective, efficient, and long-lasting strategic intervention techniques. Reforms must be implemented in line with the WHO framework for enhancing health systems, which consists of the following six distinct "building blocks": (i) service delivery; (ii) health workforce; (iii) information; (iv) medical products and technologies; (v) financing; and (vi) leadership and governance”,

he added.

Bridging the rural-urban divide

◆ Increase investments in rural healthcare infrastructure: Investing in rural healthcare infrastructure is essential to bridge the gap between rural and urban access to diagnostic tests. This includes providing more medical professionals, equipment, and technology to rural areas so they can provide quality and comprehensive care.

Dr Jitendra Choudhary, Consultant - Intensive Care & Critical Care, Fortis Hiranandani Hospital stresses that the rural-urban divide in access to diagnostic tests for women is a significant challenge, but there are ways to bridge this divide and improve access to healthcare services for women in rural areas. One being improving roads, telecommunication networks, and electricity that can help to improve access to diagnostic tests for women in rural areas. This can make it easier for women to access healthcare services.”

including women, under its health care, preventive healthcare, and screening network. The need of the hour is to build an enabling ecosystem for intergovernmental agencies, nongovernment organisations, and diagnosticplayers to come together to manufacture and distribute various diagnosis test kits in government healthcare centres across India at affordable rates to build a robust earlystage healthcare intervention framework. This is critical for bridging the rural-urban divide in healthcare delivery as well."

Ameera Shah, Promoter and Managing Director, Metropolis Healthcare also beleives that “ Investing in healthcare infrastructure in rural areas, including building and upgrading healthcare facilities, can help to increase access to diagnostic tests for women in these areas. Improving transportation and connectivity in rural areas, for example by building roads and bridges, can make it easier for women to access diagnostic tests in urban areas.”

◆ Expand public-private partnerships in rural areas: Publicprivate partnerships between the government and private companies can have a significant impact in improving the access to healthcare for rural communities. Some of these partnerships could focus on providing affordable diagnostic services for women in India.

Commenting on this, Upadhyay said, “The government is expanding the presence of Ayushman Bharat Health and Wellness Centers (AB-HWCs) to bring more and more citizens,

Dr Rohita Shetty, Senior Manager-Medical Affairs, Abbott India opines, “Encouraging regular health screenings is critical to identify conditions at early stages, sometimes even before symptoms are apparent. This can take place with communitywide screening programs, as well as targeted screening for women with risk factors for specific conditions, including age and family history. To ensure that all people have equal opportunities in being healthy, we must help bridge the rural-urban divide to reach women in underserved regions of India, from awareness to care. Working with Health and Wellness Centres and on-ground community members like Accredited Social Health Activist (ASHA) workers is important to scale such initiatives for education and diagnosis at a primary care level.”

“Tangible change can come with collective action. Public-private partnerships across the healthcare ecosystem can be a way to drive change and help prioritise women’s health needs. By promoting early preventive and proactive measures, we can help empower more women to improve their quality of life and health outcomes, so they can live healthier, fuller, and more thriving lives”, she added.

As per Dr Choudhary, “Community health workers can play a crucial role in improving access to diagnostic tests for women in rural areas. They can educate women about the importance of diagnostic tests, help them to access healthcare services, and provide support during

Encouraging regular health screenings is critical to identify conditions at early stages,sometimes even before symptoms are apparent

Dr Rohita Shetty

Senior Manager-Medical Affairs,Abbott India

Rather than assuming that all women will be able to authenticate and afford health care services in a remote location,it is critical to bring more diagnostics services to the doorstep of women

Sujata Pawar Co-founder and CEO, Avni

the diagnostic process.”

According to Sujata Pawar, Co-founder and CEO, Avni, “Rather than assuming that all women will be able to authenticate and afford health care services in a remote location, it is critical to bring more diagnostics services to the doorstep of women. Rural communities’ diversity mandates local solutions to local problems. Healthcare institutes, private stakeholders, and the government in each region of India can work together to reduce the rural-urban testing divide by empowering a mix of medical workers, including midwives, pharmacists, and community health professionals so that they can educate women and neighbourhoods about the benefits of testing as well as aid in reducing stigma, and dispelling myths about diagnostics.”

◆ Lack of trained healthcare professionals in rural areas: Dr Dang shares, “Despite all the efforts from the government, there are still several challenges facing the women's health diag-

nostics industry in India. One of the major challenges is the lack of trained healthcare professionals, particularly in rural areas where access to quality care is often limited. Another challenge is the lack of awareness about women's health issues and the importance of preventative care, particularly among women in rural areas. This can result in late diagnoses and poor outcomes for many women. To address these challenges, the Indian government and private players in the women's health diagnostics industry need to work together to provide affordable and accessible diagnostic services to women in all regions of the country. The government could provide subsidies and other incentives to private players to encourage them to invest in rural areas and provide high-quality diagnostic services to women in these areas.”

Kalyan Sivasailam, CoFounder and CEO, 5C Network considers combining healthcare with technology to bridge the

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gap. He added, “India currently has an average of 15,000 radiologists who are mostly in top tier cities. Teleradiology platforms enable radiologists to report anywhere and anytime and allow them to provide accurate diagnostic reports in less time to people living in remote areas. Combining healthcare with technology can help overcome women's health literacy barriers and create better community health centers that are technologically powered.”

On strengthening of the healthcare workforce, Shah said, “Improving the quality of healthcare services in rural areas requires a well-trained and motivated healthcare workforce. The government could consider investing in training and capacitybuilding programs for healthcare workers in rural areas, with a focus on women's health.”

◆ Increase investment in telemedicine: Telemedicine has the potential to bridge the gap between rural and urban access to diagnostic tests. The government should invest in telemedi-

cine infrastructure and services in rural areas so that women can access quality care without needing to travel long distances.

Rai stresses, “Bridging the rural-urban divide in the access to diagnostic tests for women in India is a critical issue that needs to be addressed. With advancements in telemedicine and pointof-care technologies, access to care in rural areas has increased. These technologies allow for rapid and accurate diagnostic testing to be performed at the point of care, rather than requiring samples to be sent to a laboratory. This can greatly improve the speed and efficiency of diagnosis, especially in areas where laboratory services are limited. Point-of-care technologies can also reduce the cost of diagnostic testing, making it more accessible to women in rural areas.”

Wayforward

Provide subsidies and other incentives for diagnostic tests: The government can provide subsidies and other incentives to encourage people living in rural

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areas to avail diagnostic tests and related treatments. This will help in making these services more affordable and accessible to women living in rural India.

Talking about way forward, Dr Tiwari said, “In order to ensure good health of women, it is imperative to educate them enough about their health and wellbeing. It will start with everybody, including the players in the private sector pitching with their set of enablers without expecting everything to be done by the government. Our women folk must also prioritise their health and be aware of the facilities that are being provided to them by the government and other bodies. Public-private partnership is very crucial to make healthcare and diagnostics services accessible in every nook and corner of the country at an affordable prices thereby ensuring universal health coverage in the true sense of the word.”

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Feminine health: Adiagnostic approach to a lifetime of wellness

Suparna Banerjee Bhattacharyya ,Chief Financial Officer & Head-Shared Services, HORIBAIndia stresses that it is high time that the diagnostics industry considers the physical and mental wellness of females at an equal level.This demands the development and use of innovative diagnostic tools for identifying diseases in women much before they advance to a critical stage

Acquiring close to 50 per cent of the world population, as per the statistics index of Jan 2023, women’s health has often been limited to only reproductive health. On ground reality, medical science claims that women are disproportionately more prone to chronic diseases and in some cases hereditary diseases too, such as thyroid, arthritis, etc.

It is high time that the diagnostics industry considers the physical and mental wellness of females at an equal level. This demands the development and use of innovative diagnostic tools for identifying diseases in women much before they advance to a critical stage. Medical science shall also include more female samples in their clinical trials for common diseases in both genders.

These eye-opening facts support the diagnostic need for women to attain a lifetime of wellness.

◆ Osteoporosis: 1 in 3 women over age 50 will experience an osteoporotic fracture (bone health), which sometimes leads to dependence on others and disability too

◆ Thyroid: 1 in 8 women develop thyroid diseases during their lifetime

◆ Cervical cancer: is a major reason for death in most women. The American Cancer Society recommends cervical cancer screening to begin at age of 25, however in India mostly it is linked with marital status or after the age of 30.

◆ Arthritis: Being associated

with life stages such as pregnancy and menopause, about 24 per cent of all women suffer from arthritis as compared to 18 per cent of all men

◆ Anemia: is the most common health problem affecting the well-being of women. In India, the prevalence of anemia is 52 per cent among females of the reproductive age group.

These points are self-explanatory on how crucial diagnostic testing for women is. This not only supports the importance of early diagnosis and monitoring of these diseases but also promotes the need for their prevention and overall wellness.

Educational camps on health literacy, investment in women’s medical science research, the inclusion of more women samples in clinical trials and emphasis on the overall wellness of females are required in creating a wellness atmosphere for females worldwide.

HORIBA Medical, being the leading player in the diagnostic industry, supports the overall well-being of women through a wide range of Hematology, Hemostasis and Clinical Chemistry product range.

At HORIBA we understand the importance of female wellbeing and to support the same, particularly on the anemia front, we have initiated a campaign “A2A: An Approach to Anemia” with a pledge to bring awareness for an advance and more comprehensive approach towards diagnosing anemia and not simply considering it as a Hb or nutrition deficiency.

Our CSR activities of female health awareness camps, distribution of female hygiene kits and upliftment of the women in slum areas are major components of the initiative. HORIBA is committed to the socioeconomic development of society through our cutting-edge analytical techniques.

The push for women’s employment as a part of diversity inclusion at HORIBA India regional offices in New Delhi, Bangalore, Chennai and Kolkata, HORIBA India Technical Center at Pune and Medical reagent manufacturing facilities in Haridwar and Nagpur along with HORIBA’s Joy and Fun work culture promotes the physical and mental wellbeing of the females.

References:

1. Website: https://countrymeters.info/en/World

2. Report by The Economist Intelligence Unit https://impact.economist.com/p erspectives/sites/default/files/i mages/abbott-6_womenshealth_report_final_may_17.pdf

3. HORIBA Medical webpage: https://www.horiba.com/int/ medical/

Educational camps on health literacy,investment in women’s medical science research,the inclusion of more women samples in clinical trials and emphasis on the overall wellness of females are required in creating a wellness atmosphere for females worldwide

Cervical cancer in India: Ahidden epidemic

Dr Sarabjit Chadha ,Regional Technical Director,India and SE Asia,FIND and Dr Angela Muriuki, Director-Women’s Health,FIND stresses that there is a growing epidemic in India,which continues to sit quietly out of the spotlight.Since 2019,cervical cancer has been the cause of 4.1 million deaths among women in India.What many don’t realise, however,is that this disease,one of the deadliest cancers faced by women in India, is

India is currently faced with a large and growing cancer burden. Among women (those between 15 and 44 years of age), cervical cancer is the second most common cancer type, surpassed by only breast cancer. India accounts for one fourth of the global cervical cancer burden, with more than 75,000 women dying every year from the disease. The stark truth is that many of these deaths are preventable.

Prevention and early diagnosis are vital in reducing the risk of dying from cervical cancer. Screening in combination with early vaccination against the Human Papillomavirus (HPV) that causes most cervical cancers, can help in reducing the burden of cervical cancer. This strategy has been successfully implemented in numerous countries worldwide, but India still has some way to go.

With a vision to eliminate cervical cancer by 2030, the Government of India has undertaken some strong steps to tackle this disease. Government guidelines, published in 2016, recommend that all women between the ages of 30 and 65 years should be screened for cervical cancer, at least once every 5 years, till a low-cost, reliable HPV test is available.

A network of Ayushman Bharat health and wellness centres, created to deliver free, comprehensive primary healthcare to communities across India, is providing cervical screening services. Over 26 million women have been screened since 2018. Yet, the

uptake of screening remains low, with fewer than 1 in 10 women screened for cervical cancer in India in the past 5 years. In 2021, India introduced a locally produced, cost-effective version of the HPV vaccine, with the intention to distribute via state-run services, initially to almost 50 million girls between the ages of 9 and 14 years.

While the government initiatives are certainly well-intentioned, there are several barriers which threaten the progress.

Awareness of cervical cancer especially in the rural areas remains particularly poor. Women and healthcare workers are uninformed about the dangers of this often-asymptomatic disease, and there is little value given to screening and vaccination. Screening reluctance is amplified by the intrusive nature of the screening tests. These tests require a pelvic exam, warranting a preference for female providers to conduct the examination. Such a scenario also rev eals system barriers like availability of trained

care provider. Expanding access to women-centric technologies for screening, such as self-collection, at community and primary healthcare levels, with timely return of results and linkages to treatment, could increase screening, early detection and treatment while reducing the burden on the health system.

There is an urgent need to take advantage of these advances, raise awareness and promote positive health seeking behaviour. Cervical cancer is preventable and treatable, if diagnosed early. While prevention of cervical cancer warrants access to HPV vaccine for girls aged 9-14 years of age, timely identification requires stringent implementation of cervical cancer screening services, even at the primary healthcare level, with linkages to treatment.

female staff, workload, and associated challenges.

Access to screening and vaccination is also problematic, particularly for those in rural communities, due to poor availability, transportation, familial support, and cancer-related stigma. Given the clear gap between intentions and reality, collective efforts to break down barriers to screening and vaccination are essential to realise India’s goal of cervical cancer elimination.

There is good news on the

horizon, though. Newer, highperformance affordable HPV tests, coupled with self-collection, can be used to implement community-based care models.

Driven by evidence, the value of such models show that quality of self-collected samples is equal to those collected by healthcare providers. Furthermore, studies of women’s preferences have shown that self-collection is both acceptable and preferred to pelvic examinations conducted by a health-

With awareness comes understanding, and with effective education and engagement campaigns delivered through appropriate channels, the uptake of both screening and vaccination can be improved. Structured training programmes for primary healthcare workers will promote skills and confidence in screening and encourage advocacy to help generate demand for improved screening methods and, where possible, sample self-collection. By prioritising cervical cancer screening and vaccination India has an opportunity to eliminate this preventable disease that is currently taking the lives of so many of our mothers, grandmothers, sisters and daughters.

readily preventable

Awareness of cervical cancer especially in the rural areas remains particularly poor.Women and healthcare workers are uninformed about the dangers of this often-asymptomatic disease, and there is little value given to screening and vaccination

Dr Sarabjit Chadha

Dr Angela Muriuki

HEALTHCARE IT

Digital therapeutics is not a ‘future need’but a ‘need of today’

This June,Lupin Digital Health will begin a first of its kind digital therapeutics (DTx) clinical trial across 10 centres pan India,assessing the impact of DTx in improving heart health of the patients over a period of 12 months. Sidharth Srinivasan, CEO,Lupin Digital Health in an interaction with Viveka Roychowdhury reviews existing examples of DTx solutions and addresses possible concern areas

Explain with examples how DTx works to improve clinical outcomes and improve patient care. What kind of disease conditions has such an approach proved beneficial?

Controlled trials and realworld evidence studies by different entities have shown that chronic diseases (e.g. Diabetes, Hypertension, ACS, HF) can be better manged through DTx. Livongo health has been able to show average HbA1c sustained reduction of ~1 percentage points (7.8 per cent to 6.9 per cent) at 12 months post enrolment. Similarly, Virta health did a study to show 1 percentage points drop in HbA1c after 10 weeks of using their digital therapeutics kit. In Cardiac therapy, Mayo clinic, John Hopkins & Corrrie health have been able to show that a better managed lifestyle and regular vitals monitoring can reduce chances of a Major adverse cardiac event (MACE) by up to 42 per cent

Are patients prone to selfmedicate more, as connected medical devices like smart phones tracking pulse rates or portable ECGs allow them to see their health vitals in real time?

DTx solutions provide easier access to professional medical consultation for the patients, thus ensuring lesser selfmedication. By keeping the healthcare provider and care

giver in loop, these digital solutions make it easier to have timely interventions for managing patients’ health.

How have healthcare practitioners taken to DTx approaches? What are their concerns, and how have they been addressed? Leading doctors across key therapy areas like cardiology are acknowledging the fact the digital therapeutics is not a ‘future need’ but a ‘need of today’. Our survey with 750 doctors indicated that 70 per cent of those doctor's rate regular monitoring and data tabulation as one the top 3 needs for patient management. Further, 40 per cent of the cardiologists also said that they do not have the support system to provide 360-degree care of patients. Leading practitioners across the country are keen to adopt the technology for better patient outcomes and a means to engage with their patients remotely.

One of the key concerns for doctors has been the lack of local clinical evidence showing the improvement in outcomes from such solutions. To address this concern, LDH is commissioning first of its kind DTx clinical trial across 10 centres pan India with a large number of patients’ outcomes being studied against a control group.

How much does a DTx

approach add to the cost of treatment, and what is the RoI for the patient, as most medical care is out of pocket in India?

DTx solutions lower the risk for patient re-admission significantly, as shown by well reputed studies (e.g. Mayo clinic, John Hopkins & Corie health). Average cost of hospitalisation could be anywhere from 2-5 lakhs for a patient. So, Rs 1000-2000 per month investment in a DTx solution has a very high ROI for chronic patients.

DTx devices accumulate a lot of confidential healthcare data. How is this protected?

Any solution that is launched in the market needs to meet or exceed the laws of the land, including IT regulations and telemedicine guidelines in India. These ensure a hygiene level of data security and privacy. Furthermore, DTx players are on the path of certifying themselves to higher security and privacy guidelines prescribed in western markets.

Vulnerability and Penetration assessments are also done rigorously so as to provide the necessary confidence.

This is an ever-evolving space, and healthcare players will continually want to up their game to ensure that laws are met in letter and spirit.

And if patients switch doctors or doctors switch

DTx solutions provide easier access to professional medical consultation for the patients, thus ensuring lesser selfmedication

HEALTHCARE IT

DTx providers, is the move seamless in terms of access to data and past treatment regimes?

Extensive patient and doctor interactions has helped us realise that rather than wanting to switch doctors, patients want a deeper engagement with their treating doctor. Given the understandable pressures on a doctor’s time, a closed loop monitoring and tech-enabled support platform is the need of the hour. DTx solutions ensure that the patients have access to their treating doctors around the clock and have access to monitoring, and if needed emergency services when needed.

viveka.r@expressindia.com viveka.roy3@gmail.com

India's healthcare: At the intersection of technology& collaboration

Atul Chadha ,Business Head – Patient Care Solutions,GE HealthCare South Asia in an interaction with Express Healthcare talks about the role of technology in transforming healthcare space and highlights that today,we can observe both technologies and service providers embracing digitisation in every aspect of care delivery

The healthcare landscape has undergone rapid transformation post-COVID. What are the key trends in the digital healthcare space?

The emergence of the COVID19 pandemic has resulted in a clear shift from physical healthcare centres to Virtual –First care. There has also been a transition from medication to holistic addressable adjacencies, disrupting traditional pharma practice. The healthcare industry, too, is fast changing.

Healthcare service providers are forced to come up with the adoption of new systems or solutions driven by next-gen technologies like Artificial Intelligence (AI), Machine Learning (ML), Blockchain, and the Internet of Things (IoT). Today, we can observe both technologies and service providers embracing digitisation in every aspect of care delivery. For instance, technologies like AI and ML supported by hybrid clouds and blockchain have contributed exponentially towards improving the daily operational capabilities of hospitals. They can share or get real-time information and data from any part of the world. Wearable Adoption is growing, and there is substantial data to handle for clinicians, which is forcing the industry to work on reliable, secure, and intelligent data management systems.

Contactless care is gaining ample momentum, and the focus is moving towards reducing and optimising several touch points between the health system and health seekers without compromising

the quality required by clinicians. This includes decision support for virtual treatment enablement and the need for an ecosystem of digital health, open networks, and protocols.

How has technology like remote monitoring (eICUs) helped overcome geographical barriers?

Remote monitoring is a technology that enables healthcare providers to monitor patients outside of their conventional clinical setting. For instance, a patient can consult their doctor on a phone call or through online software overcoming all geographical barriers and making care more accessible.

Technologies like remote OPDs are the new normal in the post covid scenario, which has helped create a huge positive impact.

However, more severe health issues that require intensive care are still not accessible to all. With automation and solutions like

Tele ICUs or e ICUs where the real-time basic & advanced physiological patient data along with patient laboratory reports and radiological images can be accessed by Intensivists virtually, where intensivists assist patients and capture their information digitally through both audio and video mediums along with automated data. This has redefined the doctor-patient relationship by making it geographically agnostic. The doctor can monitor a patient and guide the intensivist from a different location. The Indian govt. has laid down clear guidelines with regulations, which has attracted numerous top healthcare delivery players both in private and government sectors to establish their eICUs and command centres as their new business segments but also conducting clinical studies around the same.

Which key stakeholders will significantly increase the

penetration/reach of digital healthcare across India?

In the current scenario, the government and private institutions are the primary stakeholders that can increase the existing momentum in digital healthcare transformation. The key opinion leaders who run the market also have a significant role. However, there is a pressing need to redirect the focus of stakeholders to increase the penetration and adoption of technology. Govt and private players must work closely to enhance Skilling and specialty expertise.

According to studies, the prevalence of cardiovascular diseases will significantly grow in the coming years as India’s young population is highly susceptible to cardiac conditions. How can India address this problem through digital health solutions?

A preventive care digital-first approach, supported by information and technology, is the most efficient method to diagnose and manage the burden of cardiovascular diseases in India. It is essential to prioritise prevention through early diagnosis. First-level indicators can be identified with technologies like IoT, AI, and wearables. Smart gadgets like watches and mobile phones are equipped with ECG to detect and track early symptoms. The data from these devices enables doctors to access a patient’s medical history for a more precise diagnosis. However, the accuracy and reliability of

these devices should match the actual needs of clinicians so that they can make decisions.

Reasonable diagnostic quality solutions are available today to monitor, analyse, and share real-time patient data with cardiologists in seconds. These digital records play a significant role in understanding the patient’s history and providing an accurate diagnosis.

India contributes to a significant number of neonatal fatalities. With a lack of in-person facilities, the risk has further increased. How can digital healthcare solutions help neonatal care from an accessibility point of view?

Maternal health and neonatal health are correlated. It is essential to understand that the course of pregnancy is as important as the care required for an infant postbirth. Many new technologies, such as nonstress tests, enable mothers to track the well-being of the baby in the uterus regularly. It is a noninvasive test and is reasonably priced. New remote neonatal ICUs often help make neonatal care more accessible. Furthermore, measures such as emergency training and awareness for individualised care are crucial for neonatal care; while we firmly believe that the technology should reach more neonatologists in the non-metro and regional markets, the learnings will enable this further and boost neonatology care, making it more accessible across the country.

Remote patient monitoring systems: Role and importance

Hari Subramanium, Co-founder & CEO,LifeSigns highlights that our healthcare institutions must do more with less resources by investing in intelligent infrastructure and technologies like remote patient monitoring systems

During the COVID-19 outbreak, when both patients and physicians were unable to go to hospitals in the usual sense, virtual therapy and data collection were essential.

India's vibrant start-up culture and urban adoption of cutting-edge technologies like cloud computing and Artificial Intelligence (AI) have propelled the growth of health technology firms in the nation. By merging tried-andtrue techniques with cuttingedge technology, these innovative companies make medical treatments more efficient. Telemedicine and the internet delivery of healthcare services are contributing to the growth of these firms in India.

A digitally changed, intelligent healthcare system provides a seamless, patient-centered experience that improves patient outcomes, boosts productivity and revenue, and improves eco-efficiency. Our healthcare institution must do more with less resources, which may be accomplished by investing in intelligent infrastructure and using technology.

Internet of Things (IoT) and AI have become pervasive forces in business because they provide more methods to connect and exchange data, as well as operational advantages. It's a fantastic notion for medicine, where the IoT and Remote Patient Monitoring (RPM) are converging to revolutionise the core concept of care. Biosensor technology might revolutionise healthcare and people's everyday lives in the future by enabling you to make better choices and monitor your health. Clinicians are aided by remote pa-

tient monitoring, which improves their clinical awareness of patients' status between office visits and provides tools to support proactive care delivery. With RPM, a practitioner may track how a patient's symptoms change over time, allowing them to identify trends and adapt the patient's therapy accordingly.

The cost of delivering care online for a patient is less than the costs associated with brick-and-mortar care. When a company implements RPM, net patient revenue may grow as a result of improved process efficiency, higher personnel productivity, and decreased administrative costs. RPM also provides opportunities for compensation and

monitoring, which gives clinicians with near real-time status reports, enables them to prioritise therapy administration more effectively. Several RPM technologies may integrate with the provider's electronic medical record to reduce paperwork. RPM may help ease the burden of overbooked in-person appointments in the face of major staffing shortages by allowing clinicians to provide a portion of therapy online. It requires a provider-friendly approach to team-based care.

This technology also aids in preventing the transmission of disease. By using RPM, patients may avoid potentially infectious hospital and clinic environments. Those with a greater risk of infection, such as the elderly, the chronically ill, pregnant women, and those with compromised immune systems, are spared this potential danger by avoiding direct contact with others.

Remote monitoring makes it possible to detect the complexities and changes happening in real time with the patient and to act at the appropriate moment to rescue the patient. To do this, healthcare institutions need the appropriate resources, expertise, and cutting-edge technology.

competitive advantage.

With the assistance of remote patient monitoring, patients may get care regardless of their location and at any time. It offers the ability to connect patients in rural areas with the necessary experts. It is also an excellent method for reducing appointment no-shows.

The use of remote patient

Remote patient monitoring aids physicians and patients by increasing communication possibilities, therefore strengthening the patientprovider connection and enhancing patient loyalty. It gives patients the reassuring impression that their clinician is always monitoring them, making RPM a clear and consistent winner for patients, caregivers, providers, and prayers throughout the sector.

IoTand AI have become pervasive forces in business because they provide more methods to connect and exchange data,as well as operational advantages

Empowering healthcare providers with advanced CRM solutions

Sharda Kumari, Staff Systems Engineer,Airbnb explains about Customer Relationship Management (CRM) systems in healthcare and highlights that CRM is an integral part of the digital transformation of enterprises

CRM systems are built of three essential components: technologies that enable external parties to interact with the business, technologies for internal operations, and technologies that facilitate vital tasks such as data analysis and information dissemination. Multiple solutions that a company deems best suitable for them could be incorporated into custom CRM software applications.

A healthcare organisation's CRM capabilities innovate new services by generating and tracking valuable resources and combining them with its basic operational tasks. CRM encourages strong provider-patient connections by allowing patients to participate actively in their care, thus increasing patient satisfaction and retention. Up to 83 per cent of the mistreatment of patients is preventable at an annual cost of billions of dollars. CRM software significantly reduces these risks and others in healthcare. CRM software facilitates the monitoring of fluctuating patient wants and preferences, strengthening relationships, and the generation of better returns.

CRM drives success in the healthcare sector by developing a customer-centric culture. Healthcare organisations can scale therapeutic-specific and innovative programs using CRM to save operational costs and deliver more tailored experiences.

Innovating the healthcare industry with CRM cloud

Various tools are accessible when discussing CRM systems or software, including operational, analytical, sales intelligence, collaborative, and campaign management CRM. [1] However, custom CRM software might integrate multiple systems that an organisation thinks are most suitable for them; it is

not a one-size-fits-all approach to organisational innovation. CRM's primary function in these industries is to organise, automate, and synchronise customer or patient service, marketing, and sales-related procedures. [2]

CRM systems are comprised of three primary components: technologies that allow external parties to engage with the business, technologies for internal operations, and technologies that drive crucial tasks such as data analysis and information dissemination. [3]

The healthcare industry must constantly conform to distinct and ever-changing sets of laws, guidelines, and regulations, resulting in more significant expenses without an increase in sales. The deployment of a CRM for operations management connected with key business processes can significantly aid healthcare firms in overcoming these obstacles. [4] CRM can be utilised efficiently to consolidate and integrate corporate and operational operations and solutions that assure compliance with industry best practices. In addition, the healthcare industry

might use CRM for acquisitions and mergers. For instance, one CRM software provider created a unique CRM platform that allowed both organisations to be fully connected within four months with minimal disruption to the business's daily operations. [5]

Healthcare firms have obstacles when implementing CMS (Content Management System) software. Common barriers include company culture and leadership rejection, insufficient information technology or financial resources required to launch and maintain the system, and the complexity of these two connected but vastly distinct areas. [6] However, CRM can benefit the healthcare industry by retaining, attracting, and maintaining existing and new clients and patients.

The healthcare sector and innovation

CRM assists healthcare firms in acquiring new patients or clients, retaining the ones they already have, and reducing the expenses associated with marketing and patient services. This

technology is an integral part of the digital transformation of enterprises. It is increasingly employed as a strategy for managing patient interactions involving the organisation, automation, and coordination of business activities. [7] However, it is also utilised as a tool to fulfill complex healthcare goals, both administrative or business-related and related to patient care.

CRM capabilities of a healthcare organisation create innovative services through creating and tracking valuable resources and integrating them into their core operational activities to remain flexible with changing market conditions.[8] Social drivers also contribute to innovation by fostering the development of systems, workflows, skills, and expertise in the marketplace that an organisation may have never encountered before. The bottom line is that innovative services are developed through responsive activities by adjusting to customer needs as determined by CRM.

One of the challenges of CRM in the healthcare industry is the complexity of behavior toward technological innovation, which is a variable that is constantly changing. Effective CRM, according to one study, necessitates the collection of comprehensive data from inpatients and outpatients via multi-media platforms such as hospital information systems, electronic health records, laboratory information systems, web platforms, call centers, and even cellular messaging systems. [9] In other words, CRM integrates data from multiple locations that often do not communicate well with one another regarding technology.

Relationship management and patient communication

Relationship management

encompasses not only patrons but also interaction and collaboration between all of an organisation's stakeholders. [10] CMS for healthcare can be complex. Patients evaluate their experiences in the context of non-technical and social information or interactions, influencing patient behavior and outcomes. [10] Nevertheless, the reporting module of CRM systems can be configured to better comprehend the patient population and generate specific metrics, such as patient retention rate and length of stay, to measure progress over time. [11]

CRM usage in the healthcare industry is often known as ehealth, which refers to Internetdelivered or upgraded health services and information. [7] While technology may never replace the standards of healthcare delivery and its foundation, it provides more convenient access to services. It gives providers the opportunity to learn more about their patients and what they anticipate when receiving healthcare services. Managing relationships between a healthcare provider and its patients to foster mutual understanding, trust, and patient participation in decision-making is an essential component of health. [7]

Effective communication between a provider and a patient improves patient satisfaction and quality of life in managing diseases and disorders. However, if CRM is just used to increase customer satisfaction, it may not be fully effective. Instead, these activities should be viewed as a strategy for bolstering happiness, patient or consumer loyalty, and advocacy through several means. [2]

Web-based CRM is being utilised to attract new patients and harness the power of opinions regarding care and

HEALTHCARE IT

experiences, such as arranging appointments online, having access to medical records, and being able to address issues or ask questions outside of a visit. Other applications for CRM include case management, data management, and management of care services. [9] It is not surprising that to maintain a leading position in the market in the face of increased competition, a greater emphasis has been placed on delivering "diversified customer-tailored services," which is the hallmark component of CRM.[12]

Utilising internet-related technology, CMS makes innovations to improve health education. This enables patients to actively participate in their care, fostering strong provider-patient relationships and communication. Multiple studies have indicated an improvement in the quality of service, patient happiness, patient empowerment, regulatory compliance, and staff retention through CMS. [10] CMS can also assist healthcare facilities in refocusing their efforts on patient-centered technologies and health promotion via preventive services.

Human error and patient safety

Healthcare organisations have everyday challenges in sustaining high-quality care, guaranteeing patient safety, and minimising total expenditures and other costs. [9] Utilising CRM in healthcare has resulted in improved services and workflow, data-driven decision-making, increased support for clinical decision-making, increased quality, and safety, more effective patient care, fewer medical errors, fewer hospital admissions, and decreased spending and administrative responsibilities. [9]

CRM applications inside healthcare organisations include CRM systems for sales, marketing, services, social interactions, support, analytics, collaboration, startups, communities, volunteering, remote work management, or custom systems capable of integrating several applications. [13]– [15] One of the most significant advantages of CRM in healthcare is the reduction or even elimination of human errors, such as billing or

patient care errors, which can result in budgetary restrictions and noncompliance concerns.

In actuality, up to 83 percent of patient mistreatment is entirely preventable, which costs billions of dollars annually. [13] Some of the greatest CRM systems in healthcare are secure, comply with HIPAA and other regulations or standards, link with electronic health records, employ medical decision aids or support systems, automate scheduling and other managerial services, and offer a secure location for patient records. [13]

Increased efficiencies and profitability

CRM can contribute to enhanced profitability in numerous ways. Patients and other consumers may perceive a higher quality of care, resulting in improved satisfaction and loyalty. However, this cannot be achieved without understanding the consumers' opinions. Negatively viewed aspects of care or business could be altered to increase customer satisfaction and loyalty. However, it also assists healthcare and other staff, which impacts employee retention. Numerous studies have repeatedly demonstrated these positive outcomes. [16]

CMS can give a facility a competitive edge in some geographies where healthcare facilities and practitioners are highly competitive to help contain rising costs while increasing patient satisfaction, which can also increase the number of referrals and word-of-mouth ratings to increase the number of patients. In addition, CMS software aids in keeping track of changing patient demands and preferences, enhancing connections, and generating greater returns on investment.

According to several studies, the net income of medical facilities might grow from 25 per cent to 85 per cent if the client attrition rate is reduced by

5 per cent. [12] However, one study indicated that the CMS system's quality must be improved to increase staff and patient satisfaction with the system. [12] One source quotes a 30 to 40 per cent rise in the healthcare industry's profitability due to the decrease in wait times, simple access to patient data, the reduction of errors, and the automation of various reminders. [17] As a result, CRM systems in healthcare businesses promote quality improvement actions strongly. [18]

Automation through CRM

One of the primary benefits of CRM in the healthcare industry is automation in multiple areas. In addition to data dashboards, data visualisations from various sources could be aggregated into a single location to provide sales personnel and other staff with a rapid method for making crucial decisions. For instance, a CRM system can be used to construct a drug database where prices and additional information are recorded in one location, allowing for more effective sales methods in the end. [1] Automation in healthcare could look like medication and visit reminders in addition to creating appointments without speaking to anyone. Automated scheduling of sales visits is another function that helps to ensure that sales opportunities are never missed and improves employee productivity. It is always beneficial to keep track of patient experiences and general happiness to increase openness regarding their wants and how healthcare organisations can best meet them.

References

[1] I. Bartosinska, “7 Benefits of Customer Relationship Management in Pharma,” BinarApps, 2021. https://binarapps.com/7-benefits-ofcustomer-relationship-managementin-pharma/ (accessed Oct. 18, 2022).

[2] A. Blanchard, N. Koscal, and A. E.

10.1108/09604521011057487.

[11] Sequence Health, “5 Benefits of CRM in Healthcare Industry,” Sequence Health, 2020.

https://www.sequencehealth.com/blo g/benefits-a-crm-in-the-healthcareindustry-can-provide (accessed Oct. 18, 2022).

Burke, “A Sense of Belonging,” N. Engl. J. Med., vol. 383, no. 15, pp. 1409–1411, Oct. 2020, doi: 10.1056/NEJMp2022637.

[3] O. H. Salah, Z. M. Yusof, and H. Mohamed, “The determinant factors for the adoption of CRM in the Palestinian SMEs: The moderating effect of firm size,” PLOS ONE, vol. 16, no. 3, p. e0243355, Mar. 2021, doi: 10.1371/journal.pone.0243355.

[4] Avenga, “Pharma CRM ServicesLife Sciences CRM Solution Development - Avenga,” 2022. https://www.avenga.com/industries/pharma-life-sciences/pharmacrm/ (accessed Oct. 18, 2022).

[5] Accenture, “Accenture Helps Zydus Wellness Build an Enterprise Platform to Drive Digital Transformation,” 2020. https://newsroom.accenture.com/ne ws/accenture-helps-zydus-wellnessbuild-an-enterprise-platform-todrive-digi tal-transformation.htm (accessed Oct. 18, 2022).

[6] J. Farokhzadian, N. D. Nayeri, and F. Borhani, “Rocky milieu: Challenges of effective integration of clinical risk management into hospitals in Iran,” Int. J. Qual. Stud. Health WellBeing, vol. 10, no. 1, p. 27040, Jan. 2015, doi: 10.3402/qhw.v10.27040.

[7] M. Anshari and M. Almunawar, “Framework of Social Customer Relationship Management in E-Health Services,” J. E-Health Manag., pp. 1–15, May 2012, doi: 10.5171/2012.766268.

[8] P. Kumar, S. K. Singh, V. Pereira, and E. Leonidou, “Cause-related marketing and service innovation in emerging country healthcare: Role of service flexibility and service climate,” Int. Mark. Rev., vol. 37, no. 5, pp. 803–827, Dec. 2020, doi: 10.1108/IMR-03-2019-0101.

[9] Y. Baashar et al., “Customer relationship management systems (CRMS) in the healthcare environment: A systematic literature review,” Comput. Stand. Interfaces, vol. 71, p. 103442, Aug. 2020, doi: 10.1016/j.csi.2020.103442.

[10] H. Chahal, “Two component customer relationship management model for healthcare services,” Manag. Serv. Qual. Int. J., vol. 20, no. 4, pp. 343–365, Jul. 2010, doi:

[12] J. D. Choi, S. Koh, and D. Kim, “Comparison of Urethral Length and Anterior Vaginal Wall Thickness between Continent and Incontinent Women,” Korean J. Urol., vol. 50, Jan. 2009, doi: 10.4111/kju.2009.50.1.28.

[13] N. Kvartalnyi, “10 Benefits of CRM in Healthcare Sector - Inoxoft,” 2022. https://inoxoft.com/blog/10benefits-of-crm-in-healthcare-industry/ (accessed Oct. 18, 2022).

[14] R. Shah, “Everything You Wanted to Know About Healthcare CRM Software But Was Afraid to Ask,” Osplabs, Feb. 18, 2022. https://www.osplabs.com/insights/ev erything-you-wanted-to-knowabout-healthcare-crm-software/ (accessed Oct. 18, 2022).

[15] C. Team, “What is the Importance of CRM in the Healthcare Industry,” Apptivo, 2021. https://www.apptivo.com/blog/what -is-the-importance-of-crm-in-thehealthcare-industry/ (accessed Oct. 18, 2022).

[16] N. Bahri-Ammari and K. S. Soliman, “The effect of CRM implementation on pharmaceutical industry’s profitability: The case of Tunisia,” Manag. Res. Rev., vol. 39, no. 8, pp. 854–878, Aug. 2016, doi: 10.1108/MRR-11-2014-0258.

[17] A. Pletnov, “10 Benefits of CRM In Healthcare Industry,” KeenEthics, 2022. https://keenethics.com/blog/benefits-of-healthcare-crm-software (accessed Oct. 18, 2022).

[18] H. Pham-Singer et al., “Using a Customer Relationship Management System to Manage a Quality Improvement Intervention,” Am. J. Med. Qual., vol. 36, no. 4, pp. 247–254, Jul. 2021, doi: 10.1177/1062860620953214.

[19] M. Azeem, S. Aziz, J. Shahid, A. Hayat, M. Ahmed, and M. I. Khan, “The impact of customer-centric business strategies on customer relationship management: pharmaceutical field-force perspective,” Int. J. Pharm. Healthc. Mark., vol. 16, no. 1, pp. 138–154, Feb. 2022, doi: 10.1108/IJPHM-09-2020-0083.

[20] S. Baum, “Rethinking pharma CRM: It’s not just for sales anymore,” MedCity News, 2020. https://medcitynews.com/2020/12/rethinkingpharma-crm-its-not-just-for-salesanymore/ (accessed Oct. 18, 2022).

The healthcare industry must constantly conform to distinct and ever-changing sets of laws, guidelines,and regulations,resulting in more significant expenses without an increase in sales

INSURANCE

Benefits of telemedicine and OPD coverage under health insurance

Ankur Nijhawan, CEO,AXAFrance Vie-India Reinsurance Branch emphasises that telemedicine can act as the first point of contact and also serve as a preventive measure to avoid last-minute hospitalisations by detecting multiple ailments in the early stage itself

For almost two decades, telemedicine has been available in India. Telemedicine refers to the use of electronic or digital devices to offer healthcare services, particularly when patients and physicians can’t interact in person. Despite this advantage, it has not seen widespread adoption across India.

There are multiple reasons for this, including the lack of proper pan-India connectivity and reluctance to trust doctors online since most people visit physicians via reference. Therefore, robust connectivity is vital for providing equitable online care, especially for people in far-flung areas who need it the most due to the inadequate healthcare infrastructure in these regions. Telemedicine can function as a bridge for the lack of healthcare infrastructure by helping patients avoid self-medication which can lead to serious complications.

Telemedicine can act as the first point of contact and also serve as a preventive measure to avoid last-minute hospitalisations by detecting multiple ailments in the early stage itself. Unfortunately, when people don’t seek early advice, the problems become severe, ultimately ending in surgeries or serious complications like black fungus or severe allergic reactions that could have been avoided if a doctor was approached in the beginning. In such cases, telemedicine can provide easy access to doctors.

Telemedicine is a boon in remote areas where medical aid is not easily available. Through telemedicine, people can seek a first opinion via an audio/video call. Later, they can proceed to

the second level of guidance as directed by the first doctor via telemedicine. If included under health insurance, policyholders can proactively avail the telemedicine facilities without having to wait for emergencies to contact a healthcare professional.

Issues and drivers of telemedicine

Another reason for telemedicine’s slow progress was the lack of clear government guidelines in terms of acceptance of e-prescription etc. This created major ambiguity among medical practitioners, resulting in limited acceptance of telemedicine. However, after the pandemic-induced national lockdown from March 2020 onwards, telemedicine gained greater traction, even in tier 2 cities and beyond. At this point, the then Medical Council of India, along with NITI Aayog, released the ‘Telemedicine Practice Guidelines’ for promoting greater adoption of telemedicine among doctors.

According to an EY-IPA Study (2020), India’s telemedicine market is anticipated to touch $5.5 billion by 2025. Driven by pandemic-linked tailwinds, telemedicine saw surging demand as multiple firms began providing online medical services after the government guidelines were released. While few big players were operational in India’s telemedicine segment, several private hospitals also began offering independent telemedicine services after the quasiregulatory guidelines were released.

Around the same time in June 2020, Insurance Regulatory and Development Authority of India (IRDAI) mandated

that all insurers providing Outpatient Department (OPD) coverage should also cover the costs of telemedicine. Although IRDAI's action was intended to give policyholders some relief, it should be noted that health insurance would only cover for telemedicine if policyholders have OPD coverage. Many policies don’t provide OPD coverage in the base cover, which is generally given only with all-inclusive policies.

In its 2020 circular, IRDAI stated that the rules of monthly, annual or sub-limits, specific to a policy, will also be valid for telemedicine claims. In other words, telemedicine limits are contingent on the cover chosen by consumers, being the same as the OPD consultation limit in the policy.

Advancing awareness, accessibility,availability and affordability

But insurance rules are not the only hurdles for patients. Accessibility, availability and affordability are also barriers in varied ways, which affect the continuity and continuum of care. While the World Health Organisation (WHO) recommends a physician-patient ratio of 1:1000, the ratio in India is only around 0.7:1000. Furthermore, in around 600,000 villages where 70 per cent of India’s people reside, only one-fourth the number of doctors is available in urban zones.

Again, telemedicine could play a pivotal role in improving the accessibility, affordability and availability of modern healthcare by offering anytime, anywhere services without patients in tier 2 cities and beyond needing to travel long distances to consult doctors.

By clubbing telemedicine with the PM’s flagship healthcare programme, AyushmanBharat, health insurance can be provided to marginalised sections of the populace,increasing accessibility and lowering inpatient hospitalisations

INSURANCE

Online consultations were most beneficial for patients and practitioners during the nationwide lockdown in the pandemic’s first phase. As a result, online consultations soared in rural areas, as people’s perceptions of telemedicine underwent a positive change.

By

clubbing

telemedicine

with the PM’s flagship healthcare programme, Ayushman Bharat, health insurance can be provided to marginalised sections of the populace, increasing accessibility and lowering inpatient hospitalisations. If telemedicine is provided to all policyholders, it could act as a gatekeeper by checking whether inpatient hospitalisation is necessary or not. Thereby, the burden on doctors and healthcare infrastructure would be reduced and benefit

insurers too by lowering overall claims through timely treatment.

To promote telemedicine successfully in India, it is important to have a 24x7 availability of doctors, including those who speak regional languages. Moreover, an equal number of male and female physicians should be available on call to make patients of either gender comfortable in discussing their health problems. Significantly, the most soughtafter specialists are dermatologists, gynaecologists and orthopaedists.

Also, feedback should be at the core of the service since constant improvements can be facilitated in this manner, making the concept more acceptable and helping reduce the burden on hospitals in the long run.

The role of health insurance

Besides benefitting telemedicine, the pandemic raised the demand for health insurance, including in tier 1 and tier 2 cities. As per a July 2022 research report from Just Dial Consumer Insights , health insurance demand recorded a 321 per cent post-pandemic spike. This was partly because people suddenly became more aware of health and hygiene issues to safeguard themselves and their family members from COVID-19.

The pandemic also made people realise the need for health insurance, especially cashless policies, so patients would not have to use their life savings for emergency care or suffer if they had none. The importance of linking insurance with primary care (online

consultations, diagnostics and medications) benefits is also being appreciated as people spend about 62 per cent of their OOPs on these expenses.

Even corporates have understood the significance of OPD and primary care coverage. Today, there is increasing demand for holistic health coverage plans as corporates are offering employees insurancelinked OPD benefits, apart from group health insurance. Where OPD is not provided by employers as a sponsored benefit, employees are using the top-up option to include this.

Nonetheless, healthcare quality and accessibility still show a sharp divide between urban and rural India. This is more pronounced in the Northeast due to low infrastructure development and poor connectivity with other

parts of the country. Although the Centre has multiple initiatives underway to augment infrastructure and connectivity in these regions, such programmes will take some time to complete. The increasing use of smartphones and efforts being made to improve internet connectivity throughout India, telemedicine can be the most effective way to fill gaps in the current healthcare infrastructure.

Alongside these trends, the growing acceptance of telemedicine and the criticality of ensuring OPD coverage in insurance policies are gaining more prominence. This is most appropriate because in-patient expenses represent a curative model while OPD services promote a p reventive approach. As a proverb asserts: ‘Prevention is better than cure.’

HEALTHCARE TRENDS

Howcan the medical communityprepare patients to become health-resilient in the loneliness economy

solutions

Whether we like it or not, the new loneliness economy, or lonely economy as it is sometimes called, is here to stay. In case you are wondering what this economy is all about, it is nothing but the new trend of single person households, as made famous by a McKinsey study on the subject.

While technically the loneliness economy is single person households, on a more practical sense, it is the gradual but definitive shrinking of people in a household during the past few decades - from six people including grandparents, to four people including two kids, to three people including one kid, to two people with no kids, and now single living, this has been a regressive slide.

This has been a global trend, even before the pandemic hit, but Covid just accelerated its momentum. But even now different countries are at different stages in this slide into the loneliness economy, with Europe and North America leading the way. India has so far shown much resilience, but the trend of this slide is definitely visible in our metro cities.

The demographics of the loneliness economy is also changing rapidly, even in India. While the citizens of the loneliness economy used to be mainly seniors until the last decade, now it is increasingly getting populated by middle-aged citizens and even the youth of both the sexes. An increasing number of men and women are shunning a second marriage after divorce, and some even the first marriage.

While the loneliness economy is challenging to many sectors from automotive to housing, and from groceries to life insurance, nowhere else is its impact more felt than in healthcare.

Right from meeting the

exorbitant cost of healthcare single-handedly, to coping with the lack of a familial care provider, to the worsening of various lifestyle diseases due to loneliness, and to the surge in loneliness induced mental conditions like depression, anxiety, paranoias, panic disorders and suicidal tendencies, the loneliness economy is an enormous challenge before patients and healthcare providers alike.

There have been knee-jerk reactions to meet the emotional needs of the citizens of the loneliness economy. The rise of smartphone apps like RentAFriend and emerging service providers like professional cuddlers are among such early solutions. But their exorbitant cost, their temporary nature and the emo-

tional disconnect makes their sustainable future anybody’s guess.

When you analyse the nature of the challenges posed by the loneliness economy to the healthcare sector, one thing that becomes self-evident to the discerning mind is that the best solution for all those distinct challenges is to shift from treatment based solutions to preventive solutions.

Not so long back such preventive solutions would have been imperfect. But not anymore as the advent of genomics has been a game changer in this regard. Today, with the help of a genetic test like EPLIMO it is possible to detect the genetic chances for developing any among hundreds of lifestyle dis-

eases like diabetes, hypertension, cancer, cardiovascular diseases like heart attack & stroke, dementia, COPD, neurodegenerative diseases like dementia, Alzheimer’s, Parkinson’s etc., in one go.

Once we know these genetic chances, it is possible to suggest research-validated lifestyle modifications for keeping such diseases at bay. Such personalised lifestyle modifications can be very powerful or epigenetic in nature, that is they can positively modify the expression of these hard-coded genetic risks, especially when they are comprehensive, or in other words, spanning diet, nutrition, exercise, yoga, meditation, breathing exercises, de-stressing, detox etc.

While such personalised epigenetic lifestyle modification solutions present the cutting edge of preventive healthcare or Health 5.0 as it is technically known today, solutions like EPLIMO go further by perfecting the preventive process by including a detailed metabolic assessment too along with genomic data, and by employing artificial intelligence to generate the best possible personalisation, and by targeting the most effective destinations like the gut microbiome.

Preventive solutions like EPLIMO cost only a tiny fraction of the latter day invasive interventions like surgeries, angioplasty, chemotherapy, radiation etc., not to speak about the superior safety accorded by preventive systems. This is especially useful in a loneliness economy as there is only one person’s insurance contribution to meet the heavy expenses of treatment protocols. The genomic preventive systems are also much more cost-effective than taking daily medicines for life for a few common lifestyle diseases like diabetes, hypertension, heart disease etc.

The loneliness economy is also demanding its citizens to work for longer years, as the savings or pension of a retired single person is often insufficient to meet their financial needs for the rest of their life. But to remain in the workforce they need to enjoy a great health-span and high productivity even into the senior years like the 70s or 80s. This kind of peak performance is also a pleasant side effect of genomic solutions like EPLIMO, as everything that aids performance like diet, nutrition, exercise, yoga, meditation etc. are personalised.

Another exciting direction that preventive healthcare or wellness is taking now, and which can help overcome the challenges of the loneliness economy are solutions that combine the latest technologies like blockchain, NFT, metaverse, VR/AR/XR etc. for nextgeneration healthcare delivery. For instance, Limoverse, the world’s first blockchain based health & wellness ecosystem and metaverse, has a unique move-to-earn model called HealthFi that encourages users to walk, jog, or run by rewarding them financially with Limo crypto tokens each time they undertake these aerobic exercises outdoors.

While renting a friend for a few hours or paying for a cuddling session are never going to be holistic or sustainable solutions for the loneliness economy, blockchain and metaverse based community healthcare projects like Limoverse can go a long way in connecting health seekers together and also in connecting them with the best of health and wellness experts worldwide. Such virtual connectivity along with an active lifestyle also helps in beating the loneliness economy’s psychological impacts like depression, anxiety, heartbreak etc.

Sajeev Nair,Founder & Chairman,Vieroots Wellness Solutions asserts that the best solution for all the distinct healthcare challenges posed by the loneliness economy is to shift from treatment based solutions to preventive

HEALTHCARE TRACKER

Sysmex’s cutting-edge solution for UTIs

Clinical Chemistry,Urinalysis,Events and Branding

AUrinary Tract Infection (UTI) isan infection in any part of the urinary system. The urinary system includes the kidneys, ureters, bladder, and urethra. Most infections involve the lower urinary tract-the bladder and the urethra. A UTI develops when microbes enter the urinary tract and cause infection. Bacteria are the most common cause of UTIs, although fungi rarely can also infect the urinary tract. E.coli bacteria, which live in the bowel, cause most UTIs. Some of the symptoms of UTI are pain or burning while urinating, Frequent urination, Feeling the need to urinate despite having an empty bladder, bloody urine, pressure or cramping in the groin or lower abdomen.

UTI occurs more often in women than in men. More than 50 per cent women reports UTI at least once in their lifetime and 3 in 10 women will have at least one symptomatic UTI necessarily requiring antibiotic treatment by age of 24. Some women are at great risk, if they.

◆ Are sexually active: Sexual activity can move germs that cause UTIs from other areas, such as the vagina, to the urethra.

◆ Use adiaphragmfor birth controlor use spermicides(creams that kill sperm) with a diaphragm or with condoms. Spermicides can kill good bacteria that protect from UTIs.

◆ Pregnant: Pregnancy hormones can change the bacteria in the urinary tract, making UTIs more likely. Also, many pregnant women have trouble completely emptying the bladder, because the uterus (womb) with the developing baby sits on top of the bladder during pregnancy. Leftover urine with bacteria

in it can cause a UTI.

◆ Have gone through menopause: After menopause, loss of the hormoneestrogen causes vaginal tissue to become thin and dry. This can make it easier for harmful bacteria to grow and cause a UTI.

◆ Have diabetes,which can lower your immune (defense) system and cause nerve dam-

age that makes it hard to completely empty your bladder.

◆ Have any condition, like a kidney stone,that may block the flow of urine between your kidneys and bladder.

◆ Have or recently had a catheterin place: A catheter is a thin tube put through the urethra into the bladder. Catheters drain urine when you cannot pass urine on your

own, such as during surgery. Antibiotics usually are the first treatment for urinary tract infections. However, selfmedication or inadequate dosage of antibiotics may lead to anti-microbial resistance. Hance, culture & susceptibility testing become critical for identification of organism and effective antibiotic for the infection treatment. Although urine culture is still the best way to diagnose UTIs in a lab, it has disadvantages for lab operations. Additionally, its clinical efficacy is restricted; the initial results, which are available after 18 to 24 hours, are unable to reduce the over prescription of antibiotics or accurately forecast an infection. The dipstick leukocyte esterase nitrate reductase test is a quick and affordable test that finds nitrite, a metabolic by product of Enterobacteriaceae, and esterase, an enzyme secreted by white blood cells, indicating bacteriuria. However, this test has a significant false-positive rate and low sensitivity.

To reduce urine culture and sensitivity load of laboratories, Sysmex offers fully automated urine sediment and chemistry analyzer “UN series”, which has greater clinical and managerial values. UN

series consist of;

UF-4000/ UF-5000 : This is sediment module of analyzer based on fluorescence flowcytometry technology. Which can report all routine parameters like RBC, EBC, Epithelial cells, cast, YLC, Mucus, Sperm & crystal. Additionally it can give information like osmolality, conductivity, Bacteria, Bacteria class ( GNB, GPV), RBC morphology (Isomorphic/ Dysmorphic) and based on WBC, bacteria it can flag for UTI.

UC-3500: This is chemistry module based on reflectance photometry with CMOS sensor which enable for high accuracy measurement.

UD-10: This is fully automated urine particle digital imaging device and work as complement to UF-4000/ UF5000.

The cutting-edge technology of UN series helps to report WBC & bacteria presence in sample, information of bacteria class and to predict UTI as screening tool for faster and better treatment. This can be helpful in reducing lab work load of urine culture and sensitivity test, therefore faster turnaround for clinicians to conclude treatment decision for UTI in women.

Shobhit Jain,Senior Manager,Product -

Marketing,Sysmex emphasises on the major causes of UTIs and mentions about his company’s offerings to manage the same

HEALTHCARE TRACKER

Agappe indigenising CLIAreagents manufacturing

Agappe, your best partner in diagnostics, recently unveiled the state-of-the-art CLIA system with 180 test throughput, under the name i1000. With over 27 years of customer support in IVD segments including biochemistry, haematology, immunochemistry, urine, molecular diagnostics, etc., Agappe's leadership among Indian IVD businesses is further strengthened by this significant breakthrough into higher end immunology systems.

Agappe is the first IVD company in India to obtain permission for manufacture of CLIA reagents in India. Over 35 essential parameters are now available in the first phase of our manufacture. The company's R&D and manufacturing departments are working to expand the test panels with an additional 100 more parameters. These will unquestionably make the Agappe CLIA product panels the most complete in the Indian IVD industry.

The most common panels, including those for hormones and fertility, infectious panels, cancer indicators, thyroid panels, metabolic tests, etc, are already available. As our valued clients will attest, these Reagents are of the highest quality and are quite affordably priced. It has been incredibly gratifying to successfully navigate a variety of technological challenges in the indigenous development of these criteria and add to the inspiring idea of Atma Nirbhar Bharat. We can now be proud to have an AMH assay that, among all CLIA platforms, has the best open vial stability, the quickest testing times, and the smallest sample volumes with i1000.

Both CLIA equipment and reagents have been imported into India throughout all of these years. Agappe now plans to lessen its reliance on imports, increase patients' access to technology at affordable prices,

and give labs practical and convenient pack sizes.

The i1000 Automatic CLIA System use the Acridinium Ester (AE) direct chemiluminescence technology, which is based on magnetic microparticles. Due to its reliable performance, 180 test capacity, quick report turnaround, simple and convenient operations, and precise results, it is apt for laboratories. In addition to serving the demands of medium and small hospitals/labs for routine testing, the i1000's architecture is able to support the assay requirements and STAT tests of large hospitals. The compatible reagent sets, and well-defined traceability mechanism enable high accuracy of the results.

The i1000 CLIA analyzer can handle 180T per hour with the assistance of 30 reagent locations and 50 sample loading capacities simultaneously. It takes 14 minutes to complete cardiac parameters and 28 minutes to test all other parameters for the initial test result. An error-free reagent management system is made possible by reagent vials that integrate

RFID. A sophisticated cuvette handling system using disposable cuvettes with barcode support manages each test.

Insufficient sample volume is the primary reason for variations in immunoassay results. In the event of insufficient sample volumes, there is no reagent loss when the sample is first introduced to the cuvette. Individual cuvette-type instrumentation ensures lower recurring costs in the case of light workloads, in contrast to many other equipments with segmented cuvettes, where unused garbage cuvettes may suffer significant costs. By distributing emergency samples at random, the i1000 user can run more samples per run and save time. I1000 users can save time with online reagent replacement and more tests per batch. The i1000 offers improved result precision with minimal interfering factors, the lowest ongoing costs thanks to a clear traceability system, and less frequent consumables refilling. Additionally, it saves money and storage space for substrates.

Agappe CLIA reagents are offered in 1x100 T packets with two-point calibrators and integrated RFID. The calibrators are included in the package, and there is enough capacity for five calibrations to meet the criterion for open vials of 35 days of stability. The mono- and multianalyte controllers come in a variety of pack sizes. The reagents can be tracked against external quality assurance programs too.

In its world-class manufacturing facilities, which are connected with one of Asia's largest and most technologically advanced warehouses and cold rooms, Agappe produces and sells a wide variety of IVD equipments and reagents. To give its customers the finest uptimes in the industry, Agappe employs an equal number of service personnel and salespeople. Agappe now makes for the world, exporting its products to over 90 countries.

Thomas

John

,Managing Director,Agappe talks about company’s recently unveiled state-of-the-art CLIAsystem with 180 test throughput,under the name i1000

Sequoia Healthcare introduces the inspiration 64 Slice CTScanner

It provides exceptional CTexperience for the end users

Sequoia Healthcare, based out of Bangalore and intensely focused on driving global innova tion in the imaging solution segment manufactured indigenously in the country, has launched an advanced yet affordable Inspiration 64 Slice CT scanner with smart features and bore design recently.

The Inspiration 64-smart large bore Slice CT Scanner

comes with a 3D vision camera with auto-positioning and remote control. It brings in the finest quality of images and stable performance consisting of innovative workflow for topogram to diagnosis by generating HD Image Chain of 024 matrix. It is a new detector design for shortening the X-RAY path and improving on the image quality with the help of a 75 cm Gantry aperture that offers extra

scan facilities as compared to the standard scanning.

According to S. Viswanathan, Chief Executive Officer, Sequoia Healthcare, “The company’s purpose is to improve the quality of human life by helping healthcare providers to do more with technology. It guides our actions and is the key to deliver our strategy. Inspiration 64’s precision tomography is independently developed in a Hi-

Resolution, High-Definition Algorithm. Inspiration 64 adopts a unique low-dose technique to minimise the radiation dose to patients, which is better known as iDream. The adequate X-Ray tube heat storage and generator capacity are increased 2.7 times with the help of iDream software. He further said, “Sequoia Healthcare strives to bring in advanced and affordable in-

ternational technology, which serves in cost-effective healthcare. Sequoia believes in delivering radiology equipment accessibility for cost-effective healthcare. In short, we want to bring diagnostic reach to all. With high-tech services accompanied with new world Artificial Intelligence (AI), robotics, etc., Sequoia aims to become the number imaging devices manufacturer in the world.”

VIZI byMedikabazaar: Revolutionising hospital procurement and inventorymanagement

VIZI by Medikabazaar is an innovative solution designed to help hospitals make better decisions regarding procurement and manage their inventory efficiently

VIZI by Medikabazaar is a powerful tool that can help hospitals optimise their inventory and procurement, leading to significant cost savings of up to 30 per cent.

In the healthcare industry, efficient procurement and inventory management are essential for delivering quality patient care. However, managing inventory levels and procurement decisions can be

complex, leading to errors and inefficiencies that affect both patient care and the hospital's bottom line. This is where VIZI by Medikabazaar comes in, an innovative solution designed to help hospitals make better decisions regarding procurement and manage their inventory efficiently.

VIZI is an all-in-one procurement and inventory management software that provides hospitals with a

centralised platform for managing their inventory and procurement needs. With its management and procurement dashboards VIZI provides hospital staff with their procurement status, inventory levels, and pending orders.

VIZI with its advance intelligence, offers multiple methods of forecasting to help hospitals predict future demand accurately. The software uses historical data, trends, and patterns

to provide accurate demand forecasts for each SKU. The software calculates the optimal order quantity and reorder points based on historical data and demand forecasting, ensuring that hospitals never run out of critical supplies.

In conclusion, VIZI by Medikabazaar is an innovative solution designed to revolutionise hospital procurement and inventory management. With its powerful features like

actionable insights, management and procurement dashboards, multiple methods of forecasting, daily updates on SKUs to procure, and an extensive replenishment planner, VIZI provides hospitals with the tools they need to optimise their procurement decisions and manage inventory efficiently. By using VIZI, hospitals can reduce waste, lower costs, and deliver quality patient care more efficiently.