The MBBS Has Lost Its Relevance In India, Says The Man Behind The World’s Cheapest Hospital

Just 15 minutes into our conversation, Devi Shetty, one of India’s most renowned cardiac surgeons, pulls out his iPhone with the excitement of a teenager. The 66-year-old spends the next several minutes demonstrating how he uses audio commands on his device—sending a test SMS to his wife, making a call to his daughter—on a daily basis.

Next, he takes me through the Kaizala app, which an internal tech team at his multispeciality hospital chain, Narayana Health, has customised for themselves in partnership with Microsoft. “While I am sitting with you here, I can do the rounds in my ICU,” he says. “When you see a name in red, it means that the patient is in the ICU. On the app, I can see his post-operative status, including things like urine output, level of consciousness, etc. A lot of these updates come automatically and directly from the machines.”

What is that one job that will be most critical at hospitals in the future?

Given the way Indian healthcare is structured, doctors will continue to be the most important people in a hospital. You need to have a licence to practice, so doctors will always remain an integral part of the healthcare delivery model. The nurses and technicians are also extremely important. But once you have all this, if you want healthcare to reach out to everyone, you need outstanding administrators with the force to run the business. It’s not really a one-man show.

Is there a particular specialisation for doctors that you feel will be very critical in India going forward?

A doctor’s MBBS degree has lost its relevance now. He has to be a specialist in some area or the other. Unlike in other industries, where finance or marketing professionals can become CEOs, in the healthcare industry, it doesn’t work like that. I am licensed to do cardiac surgery, if I do something else, I can lose my licence. So, we need a large number of specialists mainly because the type of diseases has also changed.

Around the time of India’s Independence (in 1947), infectious diseases were the main problem to which the entire government budgets were allocated. Malaria, tuberculosis and HIV were the priorities at the time. But now, across the world, these three diseases kill about 4 million people each year, whereas the lack of access to safe surgery kills 70 million people. You scan the healthcare strategies of any developing country and you will see how they do not talk about surgery even by mistake. I am not even talking about heart surgery or brain operation, I am talking about three basic bellwether procedures: emergency caesarean section for obstructed delivery, laparotomy for a burst appendix, and surgery for compound fractures (when the bone is exposed).

If these three surgeries are done, 90% of the country’s healthcare problems will be taken care of. But that is not the priority of the government.

Technologies such as data analytics can play a big role in the healthcare industry. How far have you and Narayana Health adopted technology?

The disruption caused by Airbnb and Uber is nothing compared to how technology will disrupt the healthcare industry. People talk about the use of data analytics and artificial intelligence (AI). But all these technologies need data. Now, how do you get the data when 95% of the hospitals in India don’t have electronic medical records (EMR). If you don’t have EMR, you are looking at manually typing in the data, which will not be 100% accurate. So the big game of data analytics making a big difference in healthcare will only happen if every hospital is using EMR and every patient has his own personal health record in a digital format.

We have been working on this for the last 20 years. Five years ago, we brought in a team of about 150 software engineers in Bengaluru to build out EMR and hospital management system, etc. We realised that the existing custom made products for other industries won’t suit our requirements so we have to do it ourselves.

Are you using data you have collected for preventive healthcare?

We are using data for predictions. Around 15% of all the heart surgeries done in India are done by us. That’s a huge volume of data, and based on that we can predict what are the chances of a patient who has had one surgery having future problems. The predictions are based on machine learning. We are using this data to consult with our patients.

Has this investment in technology started showing results for you?

Oh yes, it is amazing. While I am sitting with you here, I can do the rounds in my ICU on the Kaizala app. It’s like a WhatsApp group. We will soon be starting live streaming of the cardiac monitor in the app as well. So if I am not happy with something, I can add my comments. And this is all HIPAA (Health Insurance Portability and Accountability Act) compliant, so the data is safe.

For the last few months, we have also started using apps that use data analytics to keep a check on our financials and give us quick access to data on how much amount is outstanding with insurers or another company. We have another app that shows us data on how much money we spend on each heart operation, how much antibiotic we used, etc. It also shows data on how much money each doctor spent. Whenever I am free, I see it. So I don’t have to wait for the end of the month to see what’s the financial situation. Essentially, we believe that everything we do in healthcare will undergo a dramatic change.

How far are we from robots operating on people?

There is no need for robots to operate on people right now. The need right now is to address primary care, secondary care, and tertiary care. Once these things are done, getting robots to do a surgery is a minor thing. Of course, it can be done, but we should not get distracted by those things without building the foundation.

Do you think doctors will need to learn maths and statistics in the future?

That is natural.

We are now launching a campaign asking people to quit the keyboard. We believe that keyboard is the biggest deterrent in accessing data and information. If you don’t have a keyboard, and you are using your voice to communicate with your phone, it is amazing. Especially in the future when celebrating 90th or 100th birthday is going to be a norm, and loneliness will become the biggest problem. You need a phone that knows you very well, it wakes you up on time, reminds you to take the medicines on time, and if you don’t wake up after some reminders, it calls your family to inform that you haven’t woken up. It can check your physical activities, it knows exactly what your pulse rate is, etc and you can be constantly monitored. This will protect your life, and it is going to disrupt the industry completely.

Do you think technology is a threat to a medical professional’s job?

No. So, the radiology profession is often considered under threat because of AI. There was a very interesting statement by a radiologist made: “Radiologists who use AI will replace the radiologists who don’t use AI.” The technology to fly a plane without a pilot was there 25 years ago, but how many of you want to get on to a plane that does not have a pilot?

Do you think healthcare education has caught up with the changes happening in the industry?

The education system still needs to evolve. My son graduated about 10 years ago, and the way he was taught was exactly how I was taught 45 years ago. But things are changing now with the National Medical Commission taking over.

You have earlier said that if prime minister Narendra Modi’s initiative Ayushman Bharat is executed well it will be a game-changer. Could you elaborate?

It is a game changer. People who could never dream of going into a private hospital are now walking into these places just by flashing a card. There are some flaws just like it is at the start of everything. But it’s a matter of time when things will get streamlined. The biggest challenge to its execution is the shortage of skilled doctors. For example, we do about 26 million surgeries a year in India, and we need to do 65 million. To do that we need at least a few lakh surgeons, which we don’t have right now.

I believe that India will become the first country in the world to disassociate healthcare from affluence. All over the world, people always thought that if the country becomes rich, everyone can afford healthcare. But that did not happen anywhere because the cost of

healthcare keeps going up. But India is going to defy that.

But if and when that happens, hospitals will take a hit in terms of earnings.

It will get compensated by the numbers. It’s all about economy of scale. If a hospital thinks that we can offer services to 10 patients and make money, forget it. – Quartz India