30 minute read
Single Specialty Hospitals
A game changing healthcare delivery model in Asia
Modernisation since the start of the 20th century has catalysed specialisation in line with the predominant economic thought of the era. As was first espoused by eminent British economist David Ricardo, the virtues of comparative advantage gave birth to focused industries and lean production leading many sectors of the economy to be more specialised.
Within the global healthcare sector, demand for such focused healthcare operations is fast catching on. This new wave of decentralised, customer-centric treatment options is evident from the mushrooming of multi and single
Arriving at an era of focused healthcare operations, single specialty hospitals allow for a healthcare delivery structure that is nimble and efficient thus enabling hospital networks to optimise their performance. They help to ensure continuity of patient care and that urgent medical care is available for all those in need. In Asia, where the pandemic has led to disruptions in the healthcare industry, single specialty outfits can reduce the overburdening of healthcare infrastructures and ensure continuity in patient care.
Anwar Anis, Director, ALTY Orthopaedic Hospital
specialty hospitals, specialised units within general hospitals as well as freestanding ambulatory surgical centres.
While the COVID-19 pandemic led to disruptions in the global healthcare industry, it also acted as a catalyst to revisit conventional operational strategies to ensure industry sustainability. Once again, several Asian markets including Malaysia rose in response by integrating technology and healthcare to provide digital healthcare services to ensure continuity in patient care.
The pandemic has also opened discussions around better patient management and addressing urgent patient needs in times when most hospitals are already overburdened. This has shifted the conversation around patient management to focus on single specialty hospitals as effective delivery models to address patient needs.
Arriving at an era of focused healthcare operations, single specialty hospitals allow for a healthcare delivery structure that is nimble and efficient, thus enabling hospital networks to optimise their performance. They help to ensure continuity of patient care and that urgent medical care is available for all those in need, without overburdening the existing healthcare infrastructure.
Addressing the gaps in Asia’s current healthcare delivery
Most countries within Asia operate renowned healthcare systems, with both government and private healthcare facilities offering quality treatment to patients. However, the pandemic has led to several challenges within this ecosystem. This includes paranoia among patients to visit multispecialty and government facilities, overburdening of hospital resources, the need for timely action to respond to patient needs, and fatigue among healthcare workers.
In the post-pandemic era, single specialty hospitals can provide focused and superior services in healthcare. Single specialty hospitals are designed to cater to specific patient types and are fitted with the right resources and operational strategies to address urgent patient needs, without the hassle of long waiting periods and competing for resources with other specialties. This is especially crucial in the current healthcare scenario where medical care needs to be accessible, convenient, and efficient. For patients suffering from non-infectious diseases, single specialty set-ups therefore provide a fast and safe option for treatments, without having to further delay medical care.
Between general and specialised healthcare
Multi-specialty hospitals cover a vast spectrum of medical specialties, from childcare to geriatric care, orthopaedics, cardiovascular diseases, dermatology, women’s health, and reproductive services, just to name a few. It is not entirely a new phenomenon, but single specialty hospitals have in recent decades increased in popularity and are commonplace in major cities around the world. This has stirred a heated debate between specialised and general healthcare.
Proponents argue that single specialty hospitals are more efficient and can deliver operational advantages relevant to the specialisation compared to general hospitals. Multi-specialty hospitals on the other hand, can sometimes deliver far too broad a range of healthcare services leading to conflicting goals at an operational level. This can ultimately result in mediocre performance in health outcomes and costs.
Through the increased focus and specialisation of services, single specialty hospitals not only deliver healthcare services with greater efficiency but also promote innovation. This is motivated in part by such hospitals behaving like “focused factories.” Because of the focused approach of specialty hospitals, it permits a standard of care which can be embedded and controlled along the entirety of the healthcare sequence – from patient admission, to care and finally discharge.
This allows facilities to deliver predictable, high-quality outcomes across the clinical hierarchy to junior doctors and even nurses, thus lowering costs without compromising quality. It also enables a steeper learning curve for staff creating a dynamic learning environment for them which is congenial for innovation and sustained improvement. Similar developments have taken place in other industries which have successfully
undergone a transition towards more specialised production units, such as in manufacturing, transportation, education and even banking. Studies comparing different types of healthcare delivery units have also shown significant advantages for specialised facilities.
Services offered in single specialty hospitals can often be easily detached, independent, planned, repetitive, predictable and with a low degree of patient comorbidity. Patients at these hospitals have access to extraordinary expertise, resources and therapy programs that aren't often available anywhere else. Single specialty hospitals often have physicians or surgeons with decades long experience of treating individuals within their specific field of specialisation. These hospitals then have the necessary dedicated facilities for patient and family support to help them overcome and navigate through their medical trauma.
In contrast, the multi-specialty or general hospital model can be highly capital intensive, given the need to cater to multiple specialities. As such, they accrue high fixed costs which can inflate the costs for treatment across the board. This also leads to added bureaucracies that are more doctor-centric rather than patient-centric. On top of that, co-locating different specialties within a fixed space and limited staffing options makes it a challenge in ensuring smooth hospital operations. The complexities that ensue result in the fundamental inability for these hospitals to tightly link input costs to output value. Consequently, patients are potentially left to deal with higher hospital bills.
A potential game-changer
As single specialty hospitals continue making waves throughout the region, more emphasis is now put on the healthcare consumer per se. The striking difference of how patients are treated today compared to a generation ago is in the quality of care and attention provided. The pandemic has also ushered in a major shift in people’s perception towards doctors and hospitals with many now realising that getting the best care for their ailments necessitates a focused environment which a single specialty hospital engenders.
Just imagine a patient in need of an orthopaedic surgery having to compete for medical attention from doctors who themselves must deal with patients of varying medical conditions. Under a single specialty hospital environment, that patient would get everything under one roof – multiple doctors who are specialised in orthopaedic function as well as an end-to-end suite of services including post-operative care. They are seen to deliver better amenities for its patients and achieve a higher percentage of patient satisfaction.
This patient-centric approach is already gaining currency in places where people are opting for increased comfort alongside expert treatment and care. For some healthcare procedures, it is often more comforting for patients to enter a single specialty centre which is less intimidating than a multi-specialty facility. The patient can rest easy knowing that the resources available in a single specialty hospital will be catered to his or her condition and this in effect improves the chances of positive medical output.
These hospitals also put greater management responsibilities on the doctors that help to improve quality as well as productivity. This is exemplified in the physician ownership structure which most speciality hospitals operate on.
The value of physician leadership and collaboration in hospital design, management, and operations to improve quality and efficiency must be recognised. An article by the Harvard Business Review (HBR) concluded that the best hospitals are indeed ones which are managed by doctors themselves1. They make the best leaders simply because they have a deeper understanding of their fellow physician’s motivations which then better inform their leadership and managerial decisions.
If a manager understands via their own experience the requirements to complete a job to the highest standard, they are able to inculcate a high-quality work environment, set appropriate goals and accurately evaluate colleagues. Having an exemplary physician at the helm of a hospital also sends the right message to external stakeholders including patients, new hires and investors on the hospital’s organisational priorities and methods of operation.
The popularity of specialty hospitals over the past few years has increasingly raised significant opportunities for emerging healthcare businesses across a gamut of subspecialties, especially in the Asian region.
Optimising healthcare delivery with a focused approach
Moving beyond the narrative of the COVID-19 pandemic, single specialty hospitals are acquiring a unique position of accountability, affordability and agility in operations thereby garnering greater interest from healthcare professionals and patients alike.
Without the operating costs of
1 https://hbr.org/2016/12/why-the-best-hospitals-aremanaged-by-doctors
a larger multi-specialty hospital and other administrative expenses, single specialty hospitals can drive down costs and improve outcomes (Value Driven Outcomes), thus increasing accessibility to affordable and quality care for patients.
In a single specialty hospital, seamless patient care also becomes a reality as the healthcare professionals working within this set up are trained and equipped to cater to the needs of patients. Preliminary checks, followups, post-surgical assistance, and other similar patient requirements can easily be managed through a central system, making personalised attention and care possible, giving patients more control on their overall health outcomes.
On the operative front, lower costs allow hospitals of this nature to invest more in technology and equipment, and be more efficient in the Operating Rooms, and more agile in the decisionmaking process. In the long run, this allows for better optimisation of overall processes and improved patient outcomes.
With a focused approach on specific conditions, single specialty hospitals also allow specialists and healthcare professionals to fully develop their professional knowledge and expertise. They also act as a platform for doctors to work on their niche specialties and dedicate time to research which improves the overall delivery of treatments.
For example, at ALTY Orthopaedic Hospital, our dedicated healthcare professionals from consultants to nurses are trained to cater to patients suffering from orthopaedic conditions throughout their treatment journey, from patient registration to postsurgical care. Providing dedicated care for joint and spine health, we are also able to invest in world class imaging and diagnostic techniques, partner top doctors and specialists and create an overall infrastructure that ensures each patient we work with experiences the best in-class patient care. As a group practice, the patients also have access to top specialists in the country where complex cases are discussed weekly within the group to make the best management plan for the patient.
While single specialty hospitals are not novel to healthcare systems, their growth in Asia is inevitable. This also resonates with the changing preferences of consumers and the way healthcare services are consumed. In Asia, with a growing ageing population and the rise of affluent income households, there is a continued demand for healthcare services that are fast, convenient, affordable and accessible. The rising popularity of Asia as a healthcare travel destination also contributes to this growth, attracting more capital to the single specialty model of healthcare delivery.
The single specialty model of healthcare delivery will ultimately continue to grow, even post pandemic, and offer a long term alternative to relief the overburdening of healthcare systems and improve medical outcomes for both patients and healthcare professionals.
AUTHOR BIO
Anwar Anis started his career in healthcare when he joined Gleneagles Kuala Lumpur in 2003, setting up its International Business Development Department and subsequently heading the entire Marketing and Corporate Communications Division. Currently he is one of the Directors in TE Asia Healthcare (TE), an outfit which co-invests and develops single specialty centres around Southeast Asia. He is specifically involved in TE’s Malaysia projects, providing oversight, having successfully commissioned CVSKL, and now focused on the rollout of its orthopaedic hospital and a second cardiac hospital. Additionally, he sits on the Board of APHM (Association of Private Hospitals Malaysia) and is co-lead of a workforce in MPC’s (Malaysian Productivity Corporation) Productivity Nexus, having previously served as a Board Member in MSQH, the Malaysia Society for Quality in Healthcare.
Single-specialty hospitals — the choice moving forward
The popularity of specialty hospitals over the past few years has increasingly raised significant opportunities for emerging healthcare businesses across a gamut of subspecialties. This is especially the case in the Asian region which is now facing the ancillary effects of a global pandemic and a spike in elder population.
From the viewpoint of an insured consumer where elective care is feasible, the advantages of single specialty centres are aplenty – from observable amenities such as rooms with specialty specific design elements and more convenient locations to the quality of care demonstrated by a higher nurseto-patient ratio. This results in higher overall patient satisfaction.
Such organisations have continuously set a fresh benchmark for healthcare service providers by leveraging associated economies of scale and scope, by concentrating expertise with increased specialisation in augmenting patient choices. The result, lower healthcare costs and further enhanced quality of care. Therefore, it is no surprise that single speciality hospitals are fast becoming the primary choice for many.
Medtronic’s Strategic Objective
Accelerating healthcare technology innovation
What has been the effect of the COVID-19 pandemic on your operations and work power, and how did Medtronic respond?
When COVID-19 emerged in early 2020, it immediately impacted our business, industry, and daily lives.
Demand for our products and services began to dry up. Our APAC business, which grew at a consistent rate over the past several years, quickly declined. Hospitals cancelled all elective surgeries, delayed essential procedures, and banned non-employees – including our sales teams, who were used to spending their time in hospitals, supporting doctors in surgery, ensuring our devices run smoothly, and selling directly to staff.
We were worried about our business, but we made the collective decision to protect our employees above all else. We secured all necessary PPE for our teams, prevented them from traveling, and enlisted our medically licensed employees to assist anyone showing COVID-19 symptoms. We immediately introduced an employee engagement program, ‘We are Stronger Together’ to help our people, and their families, through this time of uncertainty. Focused on three pillars – Mind, Body, and Spirit – the program included trainings to upskill our employees and broaden their understanding of our business; equipment to work from home; weekly food delivery credits to offset the stress of working and cooking; and a Family Reunion Program that offers our expat employees paid flights home and extra days of leave to reunite with their loved ones after it is safe to travel.
Beyond that, we revisited our business strategy to see how we could pivot to better support our customers and patients under the new normal. Our Go Digital strategy, which we launched before the pandemic to drive digital transformation across APAC, became even more relevant. It allows us to use data and analytics to develop business intelligence and tools for salesforce effectiveness, to enable virtual training, and to drive customer engagement through digital and social media. We increasingly prioritised these areas and strengthened our digital capabilities even more with the launch of the Medtronic Open Innovation Platform (OIP).
We often see that in times of uncertainty, the reaction is to pull back: play it safe, save money, and do the minimum. Our teams did the opposite. And we showed our partners – and each other – just how far Medtronic is willing to go to support our people and ultimately, our patients. This resulted in a +14-point increase in Employee Engagement and our revenue is back to growth.
Medtronic has been named as one of the world's best working environments for innovators. Would you be able to share a little insight into the market drivers and the necessities that Medtronic is responding to?
At Medtronic, there is the fundamental belief that good ideas can come from anyone, anywhere. We may be the world's largest medical technology company today, but we started humbly: a 25-year-old electrical engineer, his brother-in-law, and a garage-based medical equipment repair shop.
This October, we officially launched the Medtronic Open Innovation Platform (OIP) through an MOU with the Singapore Economic Development Board.
OIP aims to build capabilities and innovations in Artificial Intelligence, Robotics, Machine Learning, Internet of Things, and Digital Health, in addition to the Medtronic Portfolio.
At its heart is MDT Spark, and internal program that we introduced three years ago. Any employee can submit their idea to accelerate revenue growth,
drive simplification, or improve employee engagement across APAC. We then provide the funding, senior counsel, and resources to implement the most promising ideas. Of the 531 ideas submitted to date, we have invested in 24. And those have delivered millions of dollars in additional revenue or savings for our business.
The other two OIP pillars are the Medtronic APAC Innovation Challenge (MAIC) and the Digital Medtronic Innovation Center (dMIC). Our dMIC, which will open in early 2022, will prove an immersive space for us to explore new technologies with our partners; MAIC, which we just launched will allow us to identify – and invest in – startups offering innovative solutions to attack the most complex and challenging health problems in the region.
Ultimately, this is our goal in everything we do: to innovate, develop new medical technologies, and improve the lives of our patients.
According to you, what are the most critical emerging technologies in APAC?
We are advancing many technologies here in APAC, but one of the most significant is Robotic-Assisted Surgery (RAS). Surgical robotics will be increasingly important to how we deliver for our patients. Patients who undergo minimally invasive – as opposed to open – surgery, can experience fewer complications, shorter hospital stays, faster return to normal activities, and smaller scars.
Recently the first procedure using the HugoTM Robotic-Assisted Surgery (RAS) system in APAC was successfully completed in India. It was a huge milestone – not just for our India team, but for our teams across the region. Technological developments like HugoTM make minimally invasive surgery more accessible to doctors and hospitals; our training centres and curriculum, like our newly inaugurated Surgical Robotics Experience Center (SREC) in Gurugram, India, ensure that medical professionals know how to use them. Together, they will play a critical role in addressing the region’s future healthcare needs.
Chris Lee
President Asia Pacific
But these are just the start. It is not possible for one company to deliver every new technology – but we can bring key players together, to collaborate and open-source innovation. And we created the Medtronic APAC Innovation Challenge (MAIC) to do just that. Through MAIC, we will seek out ideas that can lead to life-changing technologies, better outcomes for growing markets across the region, simplified healthcare, or more personalised healthcare solutions.
COVID-19 has brought challenges for all stakeholders in the healthcare space, from travel restrictions to border closures, supply chain stresses, remote working, and drops in medical tourism and non-essential hospital visits. What have been the key items on your clients’ agenda over the past few months?
From a product perspective, medical professionals across the region (and worldwide) have asked for our ventilators. To meet this demand, we made several unprecedented decisions for our business: we openly shared the design files for our Puritan BennettTM 560 ventilator system so manufacturers – in our industry and beyond – could increase production of our lifesaving ventilators; we partnered with SpaceX and others to temporarily produce a critical valve for our most complex ventilators; and we reached out to collaborators and competitors alike to form the global Ventilator Training Alliance.
More broadly, we have heavily invested in digital solutions to meet medical professionals’ needs. For example, Augmented Reality Vuzix Smart Glasses are one of the tools we are now using to make virtual trainings for HCPs more engaging. The Smart Glasses capture the trainer’s viewpoint and augments it with virtual elements so that trainees viewing remotely can get a more immersive experience despite the distance.
Our Digital Medtronic Innovation Center, opening in Singapore in early 2022, will advance our focus in this area by accelerating our efforts in digital technologies, Artificial Intelligence, and robotics. The ultimate goal is to benefit our customers and patients using technologies to overcome access barriers.
Is Medtronic’s APAC on the lookout for M&A opportunities or other forms of collaborations with start-ups in the region?
Yes. We just launched the Medtronic APAC Innovation Challenge, or MAIC, which gives startups the chance to shape the future of digital healthcare in APAC. Our goal with this initiative is to partner with startups in the region, provide them access to our network, partners, and existing MedTech solutions to ultimately lead to new life-changing technologies and accessible healthcare solutions.
While the MAIC is new, our commitment to advancing the startup ecosystem is not. We held our first Innovation Forum in Korea in 2018, to achieve similar goals. At that time, we received more than 70 applications, of which, two went on to develop commercial pilots with Medtronic. We are excited to build on this momentum across the rest of APAC, as I know it will lead to promising change for the region.
Medtronic has a robust product pipeline in the fields of heart and vascular field, restorative therapies and diabetes. How critical are these products for driving your development in APAC?
There are several trends driving the APAC healthcare market: our ageing population, rising healthcare costs, increasing adoption of digital technology, and shifting consumer expectations. The last one is particularly important; consumers are more informed about their conditions than ever, more engaged than ever, and they expect better healthcare experiences.
You mentioned diabetes, and I think that is a great example of how we are developing products to address these needs. Later this year we are bringing
Chris Lee is also a member of the Medtronic Executive Committee. He leads the APAC team, which includes more than 10,000 employees across 20 countries, in Medtronic’s Mission to alleviate pain, restore health, and extend life for millions of patients. Before Medtronic, Chris was Regional Head and Senior Vice President, Asia Pacific at Bayer HealthCare. He has a strong record of global leadership in the healthcare sector. He has worked in executive positions across pharmaceuticals and medical technology, instilling his inclusive leadership style, commitment to meritocracy, and proven business results.
our most advanced insulin pump system to several APAC markets. It mimics some functions of a healthy pancreas for balanced levels through auto correction dosing; allows people living with diabetes to instantly know their real-time sugar levels; and notifies them, their care partner, and doctor, if their levels are too high or low.
We are also bringing Micra™ AV to many countries in our region. It is the world’s smallest pacemaker – 93 per cent smaller than conventional pacemakers and with 63 per cent fewer complications. That means patients have no visible or physical reminder that they have a pacemaker, and don’t have the usual pocket-related and/or lead-related complications.
These kinds of technologies, in which we make it easier for people to address their health concerns, are what will continue to drive our development in APAC.
What technologies have you adopted for planning and forecasting for future pandemic conditions?
As the world’s biggest medical technology company, we are constantly evaluating and adopting new technologies to improve all aspects of our work – and all aspects of our patients’ lives.
But I personally believe that technology is only as good as the people behind it, which is why we are partnering with INSEAD to host the FY22 APAC INSEAD + Medtronic Leadership Camp. It is a customised 8-month training program that will upskill 30 of our top employees in the region to succeed in the future.
COVID-19 showed us that our future APAC leaders will need to be equipped to address the evolving APAC healthcare landscape, readily adopt and integrate new technologies and solutions, and manage through quick and dramatic change. Our hope is that this program will help give them the tools and critical thinking to do just that.
What do you see as the biggest challenges and opportunities facing the company and the life sciences sector going forward?
For Medtronic, I think our biggest challenges are also our biggest opportunities. The first is talent. We want the best people in APAC working with us to improve the lives of patients here in our region. The second is healthcare access. It is varied across our region, especially when you compare developing and developed markets.
We are investing heavily to address both. As an employee, I can confidently say that Medtronic APAC is a great place to work. Our people know that they – and their wellbeing – are our priority, but we want top talent outside our company to know that too. So we have been very focused on boosting our employer branding over the past year, winning awards and being named one of the top 30 Best Workplaces in Asia™ and #1 in the healthcare industry. This has translated into better talent coming into our organisation, and I expect that to continue.
Second, as we saw in the pandemic, healthcare access is unequal across the region and we have taken several major steps to address this. We recently restructured our organisation to increase the autonomy of our local teams in addressing – and quickly responding to – the unique needs of their markets. We invested in new technologies to bring robots into more surgical suites around the region. And we are continuously innovating new technologies, rethinking traditional business models, and improving healthcare delivery to reduce barriers to affordable care.
What are the strategic objectives you envision Medtronic to achieve, over the next couple of years?
Coming out of the pandemic, we have an ambitious new goal: for Medtronic to be the undisputed leader in healthcare technology. This will allow us to attract the best talent, develop industry-leading products, and better serve more patients.
We have several strategic objectives to achieve this: (1) accelerate innovation-driven growth: our product pipeline is the strongest it’s ever been, and we are focused on making it more sustainable – particularly through less invasive therapies; (2) bring our technologies to emerging markets; (3) create better experiences for our patients, customers, and employees; and (4) turn data, Artificial Intelligence, and automation into action.
On a more personal note, you have been with Medtronic since 2012, working in different various roles. What do you most like with regards to working for Medtronic?
At Medtronic we have industry-leading products and breakthrough technologies – but with purpose and meaning behind them. This combination of innovative tech and our Mission, to alleviate pain, restore health, and extend life for our patients, is what makes me excited to come to work each day.
KEEP CALM AND TELECONNECT
The pandemic mantra for keeping healthy!
Pandemics over centuries, such as the Bubonic plague (1346), Cholera (1817), the Spanish flu (1918), and now COVID-19 have been collectively responsible for millions of fatalities across the globe. Yet, unlike its historical counterparts, healthcare management of the COVID-19 pandemic can draw on new technologies for prevention, symptoms triage, self-isolation, quarantine and, medical management. Due to the new MCI telemedicine practice guidelines of March 2020, and immense acceptance across gender and age, healing at a distance (telemedicine) has successfully leapfrogged Indian healthcare. Triage, direct patient care are situations where it has been most used in India, which is but the tip of the iceberg. The scope is massive with homebased monitoring and quarantine, tele-ICUs, and community paramedicine or mobile integrated health care programs, which will allow patients to be treated in their homes, with higher-level medical support being provided virtually. The institutional best practices of Indian hospitals must be shared and policy-makers must take advantage of the telemedicine experiences reported during this outbreak to further define the practices of e-healthcare under laws of privacy and data protection
Naresh Trehan, Chairman and Managing Director, Medanta the Medicity (Global Health Private Limited)
The Covid pandemic has on one hand, increased patient hesitancy towards physically visiting a health care facility, and on the other increased the need for healthcare support. The field of telemedicine, in which clinicians use remote evaluation and monitoring to diagnose and treat patients, has leapfrogged in the last two years. The World Health Organization (WHO) defines Telemedicine as, “The delivery of healthcare services, where distance is a critical factor, by all healthcare professionals using information and communication technologies for the exchange of valid information for diagnosis, treatment and prevention of disease and injuries, research and evaluation and for the continuing education of healthcare providers, all in the interests of advancing the health of individuals and their communities.” The role of telemedicine in disaster management and pandemic control was understood by the health care systems and anticipating the increased need of telemedicine by health-care providers, the Medical Council of India released practice guidelines
in March 2020.These guidelines changed the face of Indian health care and the pandemic handling. They defined the diverse roles of telemedicine in acute care medicine settings, including virtual intensive care unit (ICU) care, after-¬hours medical admissions, and, most aptly, disaster management.
At Medanta hospitals, enabling delivery of remote, safe healthcare, the use of telemedicine rapidly scaled up during COVID. Telemedicine made quality healthcare more accessible and transparent, and ensured inclusivity and equality of access. Increased use of electronic diagnostic devices like electronic stethoscope, BP, and SPO2 monitors enabled doctors to engage in virtual consultation and remote monitoring of patient health. Telemedicine facilitated staffing of facilities that found themselves overwhelmed with pandemic-related patient overload. This helped in easing the pressure the increased covid admissions put on an already stretched healthcare system.
Telemedicine changed the way chronic care is delivered at a time when people are hesitant of stepping out of their homes to seek medical care. Telemedicine can be used for ongoing management of chronic diseases such as bronchial asthma, hypertension, and diabetes mellitus, patients who need regular dose adjustments, no more need to travel to the hospital physically to consult their doctor. They can easily do so from the safe confines of their home through a simple mobile device. This has helped maintain the continuity of care amidst the pandemic. As patients and doctors get increasingly comfortable with virtual consultations, this may well become a norm in the near future.
In addition, healthcare systems leveraging telemedicine for patient care will gain several advantages, including workforce sustainability, reduction of provider burnout, limitation of provider exposure, and reduction of personal protective equipment (PPE) waste. We utilised commercial telemedicine carts on-site at hospitals and laptops at home. Doctor workstations were enabled by adding web cameras to the existing workstations and purchasing additional laptops for new telemedicine providers. This made telemedicine a comfortable choice for both the user and the provider.
A feedback survey regarding the use of teleconsultations at Medanta revealed that both doctors and patients were satisfied with the experience. The Information Technology team was able to ensure ease of appointments and good quality of audio and visual support. Patients were comfortable with the punctuality of doctors and the time spent in the consult along with the explanation of treatment process. The comfort and privacy of this consultation was most appreciated by the patients. The initial experience of doctors included some concerns around inappropriate dressing by patients and attendants but this changed over time, when instructions were shared with patients. The overall patient rapport and communication was appreciated by the doctors.
It was interesting to note that the gender and age distribution was well represented, this surely emphasizes the fact that it was easy to use and therefore the acceptance of this technology was high in the population independent of age or gender. The use of the technologies did not vary over tier 1, 2 or 3 cities, with access of the internet reaching the hinterland, patients all over the country were comfortable using telehealth technologies.
Uses of telemedicine
Diagnosis and treatment: Telemedicine increases efficiency and the quality of care, reduces unnecessary patient transport, decreases exposure in the time of the pandemic and increases physicians’ and patients’ satisfaction Monitoring: Telemedicine can be used for ongoing management of chronic diseases such as respiratory, cardiac, liver and kidney diseases; particularly during a time when social distancing is encouraged. It can play an important role in also providing psychological support to patients and their family members without getting exposed to the infection. Telemedicine also expanded support by helping train care providers of the elderly, young children and other dependents
Community paramedicine: Community paramedicine is a new and evolving healthcare model. It allows paramedics and emergency medical technicians (EMTs) to operate in expanded roles by assisting with public health and primary healthcare and preventive services to underserved populations in the community. This is being tested along with telemedicine models in providing remote vaccination, and continued care for Tuberculosis and other chronic diseases in the remote community. Telemedicine has also helped in shouldering the challenge of health care during massive public gatherings, for example during Maha Kumbhamelas through Mobile Telemedicine system vans equipped with videoconferencing systems for visual communication enabling doctors in remote places connect to any of the telemedicine-enabled medical hospital and super speciality hospital for expert opinions.
Graph A: Trend of the number of Covid positive people – India
Source: https://www.worldometers.info/coronavirus/country/india/ (accessed on 20-07-2021)
Graph B: Trend in Teleconsultations at Medanta Gurugram
Trends of increased teleconsultation use overlapped with the covid wave patterns over the two major waves seen in India. This brings to focus that despite comfort with telemedicine, patients may revert to in-person visits when the pandemic subsides. A change in practice towards use of telemedicine even during a nonpandemic condition will need Information-Education – Communication (IEC) modules that will help hospitals in connecting with new patients and providing continued care to the old one. Although telemedicine holds promise for pandemic response, this technology has limitations. It requires robust IT infrastructure, training of both nurses and physicians, and modifications to integrate within hospital workflows. Major barriers encountered included cost, and equipment functionality. However, close coordination with executive leadership, and robust IT support, we were able to move past these obstacles in expanding our telemedicine infrastructure for support during this crucial time. The institutional best practices of Indian hospitals must be shared and policy-makers must take advantage of the telemedicine experiences reported during this outbreak to further define the practices of e-healthcare under laws of privacy and data protection. The greatest hope for use of telemedicine technology is that it can bring the expertise to remote medical practice and provide an opportunity for standardisation and equity in provision of healthcare, both within individual countries and across regions and continents. Combined with geotracking it can play a pivotal role in anticipating epidemics and real-time monitoring of diseases. With preventive and promotive health becoming even more critical in these times telemedicine can be an important tool for health communication and disease prevention, relaying relevant information, enabling informed decision-making, improving health care communication process, create support systems and promote self-care and domiciliary care practices.
AUTHOR BIO
Naresh Trehan is a worldrenowned cardiovascular and cardiothoracic surgeon and has been awarded the highly prestigious Padma Bhushan and the Padma Shri by the Government of India for his service to the nation. Trehan has over 90,000 successful openheart surgeries to his credit and is the driving force behind the one-of-its-kind hospital.
