How has Aster responded to handling the COVID19 crisis? 

Aster responded in humane approach based on science and technology. Knowledge is the best vaccine in these times. Aster quickly formulated a knowledge protocol needed for healthcare staff and trained experts. This is an ongoing process though - most of our staff have received prior training and continue to get familiarised with updates. While we gradually ceased routine services like OPD and elective procedures, we launched a COVID educative online service based on WHO guidelines, which can help patients understand risk factors. We also follow up with patients through a regular questionnaire. We also launched Aster E-Consult in order to facilitate telemedicine for our patients.

Tell us about the application of technologies like AI to improve quality of care at your hospital during this time?

AI can help improve quality of care in a significant way. In these unprecedented times, frontline workers are mostly stressed. We launched an AI-powered mental health support for our staff, which helps them cope with anxiety, isolation stress, work related uncertainty. It is a 24x7 virtual therapist available at your fingertips, whenever and wherever you need it. We are going to open the same device to our patients, which is need of the hour. 

How has the impact been harnessing technologies like AI? How has it affected your efficiency and treatment protocols?

Like a mental health chatbot, technologies like AI can be seen helpful in the current situation in following ways

For testing: AI-powered diagnostics for chest X-rays and CT scan can actually augment the diagnosis of COVID19. It is important to know that this is a new disease and there is very little understanding of the complete picture of it just yet. We are learning as we gather data every day. However, as we build a training module of positive cases of COVID-related pneumonia, we can also come up with a COVID radiological diagnostics very soon. It is also important to notice that the phenotypic (morphological) expressions of these diseases are geography and demography specific. Just the mere use of algorithms, which are developed in China (only because they had the first set of cases) aren’t going to be sufficient for the cause. As we train with local samples, specificity will be high 

Disease Pathway: As we observe the progress of the disease, which isn’t homogeneous erroneously, a follow-through of the symptoms and signs with lab parameters can help us arrive at the proper disease pathway as well early identification of high risk cases 

Digital Clinical Trials: We feel helpless currently because there is no drug or a vaccine yet for COVID19. One of the main reasons for this is also our inability to do clinical trials. As we execute digital clinical trials, we should be able to identify correlation and possibility of reuse of old medicines for this purpose with evidence.

Explain how telemedicine with AI capabilities is the future of healthcare delivery in India?

There isn’t any doubt on the high potential of AI in areas like telemedicine. We all have now realised the high importance of critical primary care in India due to the trigger caused by COVID19. That said, India has a high penetration of mobile phones and Internet, that too at a very affordable price. We can use this as the building block for our primary care. Preventive and promotive services like health education, normal ailments, vaccinations, exercise, mental health can be delivered via apps. It is also important to consider that we are discussing healthcare delivery to patients in areas where there aren’t trained healthcare professionals or adequate healthcare infrastructure. These gaps however, can be filled with AI. We have very encouraging research papers where clinically certified AI solutions have been able to effectively educate, triage and manage 80% of primary care problems. This is disruptively low cost and accessible. Since it is healthcare delivery, AI ascertains safety and quality. This quality and assurance applies to the doctor too, who requires a lot of assistance in terms of clinical decision support system so that he/ she can arrive at a conclusion that’s evidence-based. Documentation of the medical encounter is also equally important as this is highly time consuming in the current EMR setup available. Use of AI-powered technologies like NLP, OCR, caption capture, auto transcripts etc which are being used in other industries should be mainstay of telemedicine to be effective. The same way, the largest healthcare consumer segment currently, which is the chronic disease population, needs to be monitored from home with minimal dependency on physical visits. This will keep the burden away from the tertiary care system and make it sustainable. 

There have been multiple efforts on telemedicine, where the larger contribution has been from the “Tele” front ie connecting the patient and the healthcare provider. “Tele” alone isn’t sufficient for effective healthcare encounter. The ‘medicine’ part is crucial and critical, which separates a telemedicine consultation from a WhatsApp video call. We can focus on evidence-based approach powered by AI so that proper telemedicine platform can be developed. India can leverage some of the good ground work that has been done so far like Aadhaar, UPI, mobile internet penetration and highly affordable internet tariffs. A UPI-equivalent PHR model, which every citizen owns with prescribed privacy and security can be the basis of the new digital health revolution in India. Every patient should have control and access to health records and should be able to share it seamlessly with providers for his improvement of health. This data should also help generate an Indian clinical data bank which would be hugely helpful for research and to come up with newer treatment protocols. 

Can you tell us how Aster has prioritised healthcare innovation using technology? And do you think this will be a game changer for you?

We have a dedicated innovation team focusing on digital health in pre-primary care and after-care plus AI for efficiency in hospital care. We adopt nimble and effective open-innovation model where we select startups across the world to collaborate with us based on our playbook. The main issue with startups in this ecosystem has been the access to authentic data, specialists and simulations. We provide them all these to make their product successful. Its a win-win sustainable model. We have currently more than 20 cohorts, running at various parts of our huge network, many of which are adopted for patient outcome. For instance, from our leading cardiac centre (which is also one of the largest cardiac procedure centres in the country) we are able to remotely monitor patients for atrial fibrillation, stroke prevention as well rehabilitation of AMI & cardiac failure cases using a continuous ECG monitoring and AI-powered assistance. Similarly, we are working on technology-enabled solutions that can manage chronic diseases in cardiac, renal, pulmonary as well as diabetes through a patient app which is clinically proven and gamified for a seamless experience. We are also working on remote ANC for pregnant patients. 

Post COVID19, how do you think healthcare is going to change in India?

I am optimistic. I think regulations have been appropriately eased but at a very early stage. We cannot address primary care which is bulk (more than 80%) of our patient population by building newer hospitals. Health centres as part of Ayushman Bharat is a good start point. We need to enable them digitally so care can be evidence based and easy to deliver. Digital consultation and intervention should be encouraged and incentivised. For instance, many physical consultations are reimbursed higher compared to digital equivalent. This should change. Proportionate amount of reimbursement of Ayushmann Bharat should happen for prevention, screening and primary care services, which can be dome sustainably with lesser cost and better outcome using digital platforms. India is fortunate to have high quality digital professionals and startups in addition to a range of highly experienced healthcare professionals. We need to match the medical curriculum too with similar, up to date training for sustainable adoption of these technologies. We are planning similar courses for medical professionals like digital health, AI in healthcare, & digital clinical research to accelerate the cause. In last decade, India saw the rise of multiple incubators and accelerators. Like telemedicine (heavy in telecommunication) these tech incubators haven’t yet reached healthcare providers like us. We need these incubators in medical colleges and accelerators in hospitals. We are in the final stages of having a practical digital health incubator-accelerator involving a leading global digital health partner. 

How will a federated healthcare delivery architecture proposed by NDHB help?

This will be a great help. Federated PHR centric delivery is crucial. Every patient will own their data. We need to move away from EMR / hospital centric in-efficient, expensive model to patient /PHR centric, effective, outcome-driven model that’s widely accessible and affordable. Every citizen will participate in the federated health database, which is paramount for future research and low-cost newer treatments. India’s population can be the real advantage here. Modern technologies like federated architectures and blockchain make it possible for us now to have a secure, distributed and private database. The market forces will drive low-cost solutions as a healthy competition. For instance, UK genome bank Biobank is a very good example, which is open to bonafide researchers anywhere in the world, with the aim of prevention, diagnosis and treatment of serious illnesses.

The Indian government is working towards integrating healthcare in our country with the National Health Portal - what are the challenges & opportunities in this endeavour?

This is a very good initiative. However, it’s important to stress here the right representation of a think tank. Its heavily dependent on AI, blockchain, healthcare economics and usability professionals. There is no template to refer or copy. At the same time, this has to be futuristic, so that sensitive healthcare data can stay safe and secure yet available for research and entrepreneurship. We can stay optimistic with Aadhaar, DBT and Chandrayan experiences and move ahead. 

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