Smart Health for Smart Citizens

A publication by the author in Distribution of Neurologists and Neurosurgeons in India: and Its Relevance to the Adoption of Telemedicine 2015 in Feb 2015 clearly revealed that 935 million Indians lived in areas where there was not a single neurologist or neurosurgeon. While the exact numbers may vary, this is the story for all super specialties and most specialties. 80 percent of India’s specialists physically cater to only 20 percent of the population. At the same time India is a paradox. We have a billion active mobile phones and the rural teledensity has already reached a staggering 77 percent. It is equally true that not even in the life time of my great grandchildren will there be enough brick and mortar hospitals, enough human resources, and enough medical colleges to cater to every sixth human on this planet. Bridging this colossal urban rural health divide can only be possible through deployment of information and communication technology. The term telemedicine is being replaced by the more all encompassive term telehealth.

Promoting wellness the eWay is today’s mantra not treating diseases, which need not have occurred at all.Working smart is more important than working hard. Smart health for smart citizens in smart cities would include the ubiquitous meHealth (m stands for mobile, e for electronic, and me for the personalized healthcare of tomorrow).

Challenges in Introducing Digital Health

Challenges include evaluating the appropriateness of existing healthcare ICT (HCIT) applications. Impact and effectiveness in the delivery of health services, standardization, interoperability, reliability, and robustness need to be considered. Human resource development, and skills in information systems design and implementation, is critical to successful deployment of HCIT. These skills need to be staged and nurtured preferably locally. Building competencies, finding, and retaining skilled personnel, enhances access to information and resources. This leads to patient empowerment enabling informed healthcare decisions. This in turn improves quality, value, and patient satisfaction. Users want credible reliable information, convenience, accessibility, and assurance of privacy. All these can be provided digitally. Issues to be considered in deploying HCIT would include availability of data-related standards, regulatory and legal frameworks, electronic content that is relevant, applicable, and culturally appropriate and options to ensure continuity and sustainability of ICT projects.

The technology should be simple, relevant, and local, built on what is already available and is being used. Users need to be involved in the design by demonstrating benefits that would accrue to them. Experience demonstrates that there is no single solution that will work in all settings. The complexity of choices of technologies and the complexity of needs and demands of health systems suggest that the gradual introduction, testing, and refining of new technologies, would be the way forward.

Homo Digiticus

As one born as Homo sapiens, initially a spectator, but slowly entering center stage, it has been my privilege to see the new species Homo digiticus evolve. Marty Cooper inventor of the cell phone and Sir Timothy John Berners-Lee creator of the World Wide Web could never have foreseen that they would disprove Charles Darwin.According to Darwin’s hypothesis, it has taken tens of thousands of years, for a new species to evolve. Marty and Timothy reduced this to four decades. Interestingly the speed of mutation is more in the emerging economies. Today, 6 out of 7 billion Homo sapiens have become Homo digiticus. To me, chips were something one ate, discs were part of the spinal column, tablet was something a doctor prescribed, semiconductors were people wishing
they were heading an orchestra and out of sight was out of mind –to Homo digiticus these have a totally different connotation!

We are living in a stage of transition. HD uploads 25 hours of video content every minute or 3.25 billion videos per day. If HD watches videos for 24 hours a day it would take 1100 years to see all videos presently on YouTube. Facebook has 95 billion photos. 188 million emails are sent per minute in addition to 16,000 new e-queries every second. That we are in the midst of a digital upheaval, which is truly transforming the society of yesteryear, is obvious.

A PhD student from the United States insisted, that her apparently normal India-based mother, consult me for a brain scan, because there were too many new errors, in the e-mails she was now receiving .The scholar was right. A benign tumor was diagnosed.

Anyone, anytime, anywhere at affordable cost, making geography, history, and distance meaningless will be the new mantra. This is what Digital Health is all about. In India meHealth could be the specific answer to improve the quality-of-care, without significantly increasing costs. The most important enabler to make these breakthroughs come true, is not further advances in technology, but meticulous attention to what is in it for me for every single stakeholder in the entire ecosystem. The question what is in it for me has to be satisfactorily answered if digital health is to be incorporated into the healthcare delivery system.

A solution is not a solution unless it is universally accepted. Digital Health should produce not just customer satisfaction but customer delight. Creating awareness aggressively with success stories is a prerequisite. Lars Leksell the inventor of the Gamma Knife, had remarked half a century ago – I quote a Fool with a Tool, is still a Fool. He also observed that when one has a hammer everything around you looks like a nail, particularly when the hammer is expensive. Technology should not go in search of an application. We should develop a technology for a specific necessary application. Digital technology should be viewed as an enabler to achieve an end, not an end by itself. As one belonging to the BC (Before Computers and Before Christ are one and the same) era, I strongly feel we should not become slaves to technology. TLC should continue to be tender loving care not only telephone or TV linked care.