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IoT andthe future ofIndian Healthcare

A close look at the current stateof healthcare in India, and how IoT is poised to bring big changes to the sector.

State of the Healthcare Market in India

02

Total healthcare spending is seen rising to $195.7 billion in 2018 vs $160 billion now

`

India’s Universal Health Planwill spend $24.03 billion

over next 4 years

Telemedicine is growing at 20% a year and there are 20 mHealth initiatives currently active

India has around 1 MRI machine per million citizens

600,000-700,000 bedsare required over next 5-6 years

Source: KPMG, Deloitte, Research on India, Frost & Sullivan, LSI Financial Services, ASA & Associates LLP, TechSci Research

03

As clearly shown, the Indian healthcare sector is a mixed bag.

The sector is expected to become a US $160 billion market by the end of this year, and likely to reach US $280 billion with a CAGR of 23% by 2020. This is likely to improve the two key indicators of the healthcare sector’s performance—Infant Mortality Rate (IMR) and Maternal Mortality Rate (MMR).

On the other hand, the sector still has a lot of ground to cover, thanks to the huge gap between the number of healthcare practitioners, facilities and the patients. For instance, India still has only one doctor for every 1,674 patients, which is well below the 1:1000 ratio recommended by WHO. Likewise, the number of hospital beds stands at 1.3:1000, whereas WHO recommends that it should be at least 3.5:1000.

Moreover, the distribution of doctors is also heavily skewed toward large metros.

Poor quality of healthcare services, an overburdened healthcare staff, and an inadequate healthcare infrastructure are some other bottlenecks in the sector. These call for an urgent action plan to improve the healthcare scenario in the country.

Of course, it is easier said than done, because India is a vast country with a very large population and rapidly varying health profile.

Area-wise distribution of doctors

75% 23% 2%

Metros and urban areas Towns Rural Areas

And 15% of the population has zero access to healthcare facilities

Healthcare workforce and infraper 1000 population in India

WHO: 1India: 0.65

WHO: 3.5India: 1.0

WHO: 2.5India: 1.3

Source: PwC analysis

Doctors Nurses Hospital Beds

04

One of the challenges is very low government spending on healthcare, which keeps quality healthcare out of bounds for ordinary citizens. Even though the allocation for healthcare in the Union Budget 2017-18 has increased by 23%, the per capita spends are still well below international norms.

US $300-1000

Indiaspends $60

for every citizen

China & Brazil both spend

*

The draft National Health Policy 2015, as well as the erstwhile five year plans, had advocated for increasing the public sector spending to 2.5% of GDP, but this is yet to be achieved. In 2015-16, this figure stood at only 1.3% of the GDP, according to WHO’s World Health Statistics 2015 report.

The Indian government has introduced a number of policy driven initiatives to improve the situation, which will help, but only to a certain extent. Some of these initiatives are:

• 100% FDI under automatic route for greenfield projects.

• 100% FDI under government route for brownfield projects.

• Impetus to Pradhan Mantri Swasthya Suraksha Yojana (PMSSY) that decentralizes tertiary care by setting up six AIIMS like specialty hospitals in different states and upgradation of existing Government Medical + Colleges.

However, the only way to significantly improve the quality of healthcare is by using smart technologies. This requires innovative thinking and adoption of ICT throughout the service delivery value chain. Certain steps would maximize the impact and multiply the usage of existing infrastructure.

*World Bank.

Implementing IoT

05

This technology can play a key role in bridging the gap between healthcare practitioners and patients through remote monitoring

While this would be a welcome addition to the life of an urban-dweller, it would be nothing short ofa boon for the rural masses, who make up over 60% of India’s population.

IoT can decentralize the otherwise specific hi-tech constituencies in the healthcare domain. Conventionally, ICUs, labs, radio diagnostics and operation theatres were the adopters of advanced technologies, including those enabled through ICT. With IoT, the healthcare sector can connect the dots by erasing the boundaries of a hospital or clinic and create a real-time continuous interface between doctors, patients and other important stakeholders of the healthcare infrastructure.

A healthcare firm specialising in diabetes.

Launched the world’s first remote diabetes monitoring device using Vodafone’s IoT Service Platform.

How does it work?

It monitors glucoseand blood

pressure levels

promptsmedicines

automatically sendsthis data to

specialist clinicians

straight from thepatient’s home

Diabetacare

06

Take the example of Ekso Bionics. The bionic exoskeleton manufacturer built the world’s first and only exoskeleton that is FDA-cleared for use with both stroke patients and spinal cord injuries - the Ekso GT™.

These robotic exoskeletons are strapped onto the patient and helps them begin walking again, something which its users were not able to do before. The communication marvel here is that it tracks the progress of the patient and sends this data to therapists and doctors, helping speed up recovery. At the same time, it also provides routine diagnostic data to technicians, helping them keep the device working as per requirements. Thus using Vodafone's IoT solutions, this device connects patients, doctors, technicians and brings them together for a common goal - providing better healthcare.

A restructuring and reorientation of this kind would change the definition of healthcare and evolve new business models. The resultant scenario can be a win-win situation for everyone.

The biggest challenge here would be to create IoT infrastructure that improves healthcare for ordinary citizens, and makes it more affordable and available even in remote areas.

Affordability would be a key criterion because financial constraint is the biggest hurdle in seeking medical treatment, as stated by 55% and 60% of the urban and rural respondents, respectively, as per the latest National Sample Survey.

Currently, citizens consider private doctors as the most significant source of treatment in both rural and urban areas, according to the same survey.

The affordability challenge can be tackled by increasing the uptake of health insurance in the country, which is currently very low.

Over 80% of Indians have no health insurance

07

India is also now uniquely positioned among very few countries where the identity of the citizens is digitized.

Through the globally acclaimed Aadhaar initiative of the UIDAI (Unique Identification Authority of India), a unique 12-digit number issued to each citizen in the country, every citizen can now be identified, verified and then linked with benefits that governments have for them.

In the healthcare sector as well, using Aadhaar infrastructure, where over 98% of population is now registered along with their basic demographic profile of age and gender, the benefits meant for cross section of society can now precipitate through the value chain without any pilferages.

This will not only optimize the return on government spending in the social sector, but also enable health profiling of the country. A timeline can now be drawn for each citizen registering the story from birth to death.

Linking of Aadhaar with healthcare sector will enable creation of several IoT applications directly benefiting the government, healthcare sector and the citizens, especially in the critical areas where authenticating the identity of the end-beneficiary is critical for deriving the actual use of the technology platform; in this case an IoT application.

How can IoT help increase adoption of health insurance?

Insurance companies can offer health monitoring devices

Customers can then be motivatedto take up insurance

These devices can monitor health data

Data can then be used to drivespecial plans and policies

Source: MarketResearch.com

The world-wide IoT market is poised to grow at a CAGR of over 30% and hit $117 billion by 2020 in the healthcare segment. Various industry reports also peg IT spend levels in the range of 2-4% within healthcare. Driven by IoT, the IT spends would be around 5-7% by 2020.

08

Integration of IoT platform with various healthcare initiatives like ‘Pulse Polio Immunization’, ‘Neonatal Healthcare’, etc, can yield results for a wide base. The persistent monitoring of patients and the treatment timelines will throw up immense data which could be used by the government for defining KPIs (Key Performance Indicators) for a healthy nation. This big data will also take research to new heights and create more opportunities for defining proactive healthcare systems.

Citizens stand to gain the most because they’re looking for quality as well as affordability in healthcare services. With IoT applications and sensory networks, physical interaction requirements between a doctor and a patient could be minimized. As a result, there would be real-time diagnosis and reduction in number of visits to a doctor.

IoT usage in healthcare can enhance the RoI on ICT spending by providing higher efficiency and effectiveness in healthcare services with minimal interventions

Benefits of IoT in HealthcareSpecifically, different stakeholders can benefit from IoT in the following ways:

Government

Citizens

Doctors

Long queues of patients in clinics and OPDs of hospitals are unfortunately a sore sight in the country today. It puts doctors under tremendous pressure because they have no options of prioritizing which patient to see first—those who’re coming back to show their diagnostic reports or the patients coming for the first time. With the help of wearables and sensors, several basic but important parameters like blood pressure, ECG, etc., can be shared with doctors any time over the internet.

09

The resources in hospitals are scarce, especially those in the public sector. During disease outbreaks, there is invariably more than one patient occupying a single bed.

One way to combat this is to reduce the length of stay (LoS) of patients. With such moves, hospitals can cope up with the patients’ inflow without compromising on quality.

A typical reason for high LoS in hospitals is that patients need to be monitored for some time before being discharged, typically after a surgery.

Even though many surgical procedures have now been reduced to just a few hours, hospitals are forced to hold patients back primarily to monitor their condition. With the help of IoT sensors, hospitals can send patients home and monitor their vital statistics remotely. The sensors would raise an alarm only in case of an emergency. This brings two benefits: one, patients get to stay in the comfort of their homes after being discharged, and two, the doctors get more time to see other patients.

Some hospitals in the US, like El Camino Hospital, have achieved 55% reduction in Healthcare Acquired Conditions (HACs) due to reduced Average Length of Stay (ALoS) of patients. Typically, doctors in India and several other countries administer heavy doses of antibiotics to patients after surgical procedures so as to minimize the chances of Nosocomial or Hospital Acquired Infections (HAIs). As per INDICAPS – Indian Intensive Care Case Mix and Practice Patterns, a nationwide study done in 2012, 1 out of 4 ICU patients got sepsis, and out of those, 50% eventually died.

While cleanliness in hospitals is important to reduce HAIs, reducing the LoS of patients in hospitals is the best way to minimize the chances of such occurrences.

Hospitals

In cosmopolitan cities, working couples find it extremely difficult to maintain their work life balance. Moreover, as the trend is shifting from extended/joint families to nuclear families, they’re not able to attend to the needs of their parents and children. If there are differently abled people at home, then the situation becomes even more difficult. Though maids and domestic help are available, finding reliable ones with a clean record is a challenge in itself. They might be good with handling home chores, but may not have the required experience to take care of people.

There are enough horror stories around of violence by domestic help, which makes matters even worse.

There are many companies offering IoT based solutions to manage healthcare of people who need extra care.

One such technology company is Svaast (a Hindi word for healthy). The company has introduced an IoT-based platform to record child growth statistics in different countries. They monitor, compare and evaluate individual development and nutritional status against WHO parameters. This helps doctors detect several future medical conditions by comparing results with the benchmarks, thereby enabling them to take corrective measures in time.

Similarly, IoT-based electronic tablet dispensers like uBox and MedMiner ably assist old age patients to be regular with their medicines. Not only do they help the elderly take their medicines on time, but they even ensure correct dosage.

10

Social innovation and IoT in Healthcare

IoT can play a key role in improving healthcare management for children, elderly people, and the differently abled.

12

Healthcare in 2020Given the pace of innovation, one can expect a lot of innovations around healthcare by 2020. There would be an uptake in the demand for connected and wearable devices for real time diagnosis.

Advancements and additions to the stable of hi-tech technologies like Artificial Intelligence, Machine Learning, Virtual Reality, Augmented Reality and Immersive technologies will have more than anticipated disruptions in healthcare.

IoT would be the center piece for all these technologies, without which none of them would really add any value. One can therefore say that IoT could be the next resident doctor.

Some of the challenges of present day healthcare scenario would be beautifully bowled out. For instance, a patient often undergoes several unwanted tests. And disease discovery by trial and error can also be dangerous, especially if the diagnosis is incorrect. At last, the patient ends up losing precious time and money. By the time, the actual disease is discovered, the damage is done.

Such incorrect diagnosis could actually be prevented with the help of VR technology. By using VR, a doctor could create a similar environment as the patient’s medical condition. This could help identify the cause faster and prevent any mishap.

Another common challenge that doctors face today is that patients cut-short their prescribed tenure of medication and visits to the doctor. As a result, if the medical symptoms in the patient recur, then the doctor remains totally unknown of these realities and goes by the patient’s word. With the help of IoT, doctors can have a full and clear picture of the treatment pattern that the patient followed and observe any deviations from the same.

Doctors often try to find hereditary connections for a patient’s symptoms. In this case, the patients may not necessarily have any knowledge of their parents’ medical history or common hereditary medical conditions in their lineage. In such cases, particularly in rural and remote areas, it becomes very challenging for a doctor to confidently conclude whether a particular symptom is the first incidence, or it’s because of a family history.

But by 2020, with the help of IoT-based data and advanced analytical tools, doctors might be able to draw learned inferences about a patient’s symptoms and then diagnose the exact medical problem. These are just a few examples of how IoT-based healthcare would look like by 2020. Similarly, there are ample studies available that give a fair understanding of how IoT would revolutionize healthcare in the future.

The possibilities of IoT

I forgot whichpill to take

Your BPis okay. Take 1

diuretic.

The mole has changed.

You shouldcontact

your doctor.

Your cut maybe infected.

Please checkthe device

for more details

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Structural and Policy ChangesIoT is transforming the entire healthcare space today, and with its continuous adoption, the sector would undergo further changes.

But in order for this transformation to be effective, there’s a need to make structural changes in policy in addition to re-engineering of existing healthcare.

For instance, in the future, several connected devices in an IoT solution will be used for diagnosis and treatment. The solution would work properly if all the components involved in it are accurate. It may become extremely complex to identify the weakest link affecting the performance of the solution.

Today, good doctors are recognized for their ability to quickly diagnose medical conditions and prescribe the right medication to patients.

Network QoS (Quality of Service) is a much debated topic in the field of communication. While some reduction in QoS could be accommodated in human communication, it may not be acceptable for mission critical applications. Maintaining 100% QoS would be mandatory for saving lives.

48 hours resolution for downtime is an industry accepted reality. In healthcare, however, even a few minutes of downtime could mean a potential risk of losing a life. All these factors need to be aligned as IoT becomes all pervasive in healthcare. Even the protocols followed by doctors and hospitals would need to be revisited. What ‘Code Blue’ means today may have to be modified to ensure quick response to attend emergency cases.

Similarly, at a policy level, how would medical negligence be ascertained and accountability fixed on people?

With the LoS (Length of Stay) getting reduced substantially because of IoT, how would it impact the insurance sector and what would be the guidelines of framing future insurance contracts? Presently, it is compulsory to have more than 24 hours of admission in a hospital to get several procedures claimed against insurance policies.

These are just few of the scenarios that would need to be revisited as IoT in healthcare becomes more visible.

IoT will call for an overhaul throughout the value chain at the policy, regulations, rules and guidelines levels.

14

Security ConcernsData breach is another key underlying concern as society is transforming into a digital world.

With IoT, there will be scores of devices in an always connected mode, and monitoring them is going to be extremely complex.

With IoT in healthcare, smartphones have started capturing a few parameters, but theft of a device would mean potential exposure to critical medical information.

Besides people beyond the healthcare fraternity getting access to patient data, another threat would be from hackers, who could break into a network and steal information about multiple patients.

While hacking is a serious matter in itself, hacking of IoT nodes for healthcare could even have dangerous ramifications. It could even mean death of a patient as the hacker just might change the behavior of the compromised device, like an abnormal increase in dosage in medicine, etc.

The whole idea of IoT in healthcare is to bring prompt responses to critical issues so that precious life-saving moments could be used efficiently. A hacker could compromise the device and make the remote monitoring show normal behavior to a medical practitioner, while the patient might instead need immediate attention.

The idea of explaining such scenarios is not to create fear about IoT in healthcare or advocate its non-implementation. However, IoT practioners need to take all this into account while planning its implemention.

Security in IoT driven healthcare must have a holistic and comprehensive approach. It should encompass the key elements of a service delivery platform that includes the key components or layers shown in the diagram below.

In a nutshell, while security should be enhanced by implementing various tools and solutions available, there is also a need to sensitize the entire value chain of the implications of any data exposure or breach that may happen out of sheer ignorance.

Data

Devices

Network

Application

Today, the mobile phone holds sensitive information about the owner. Personal, business, and financial information reside in the device which at one point held only SMSes, contacts, and emails.

WirelessWire CloudIoT

Vodafone India 2017. This document is issued by Vodafone India in confidence and is not to be reproduced in whole or in part without the prior written permission of Vodafone. Vodafone and the Vodafone logos are trademarks of the Vodafone Group. Other product and company names mentioned herein may be the trademarks of their respective owners. The information contained in this publication is correct at the time of going to print. Such information may be subject to change, and services may be modi�ed, supplemented or withdrawn by Vodafone without prior notice. All services are subject to terms and conditions, copies of which may be obtained on request.

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