Building a Smart Healthcare Ecosystem



Trend In Healthcare

Globally, the challenges of healthcare delivery vary widely, yet health systems around

the world have similar objectives :to deliver the highest quality care to the most people

possible at the lowest possible cost .Healthcare spending around the globe continues to

rise at unsustainable rates, consuming an ever -increasing slice of the world ’seconomy .

As measured by the percent of GDP healthcare, costs rose from 8.2to 9.4percent from

2000 to 2009 .The burden of chronic diseases is rising in both developed and emerging

markets, fastest among lower -income countries, populations and communities, where

they impose large costs in human, social and economic terms .

In response, the

worldwide healthcare industry is undergoing radical transformation, driven by a

fundamental shift in the expectations of all stakeholders :patients, governments,

insurers, employers and providers . Increasingly, healthcare delivery organizations

worldwide are rethinking the services they offer as funding and payment models evolve,

focusing on wellness and outcomes rather than volumes of services consumed .


transformation to succeed, organizations will need to adopt both technology and

process improvement strategies to enable secure access, exchange and analysis of

patient information and to create greater efficiencies in both business and clinical

processes .These strategies will give rise to amore patient -centric care model through

better monitoring and management of wellness and chronic disease and enable cost

containment while improving overall delivery system health .The evolving trends in the

Indian healthcare sector have increased the urgency of addressing these challenges .

Some of the major trends are more patient -focused care, value -vs volume -driven healthcare, continuum

of care and increasing digital integration .

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Patients today are more conscious, tech -savvy and more

willing to embrace emerging technology .As aresult, anew trend has emerged, where the focus has

shifted from the provider to the patient .Patients want to take more control of their health and are open

to new ways of receiving care .They no longer want traditional models of healthcare that are usually

disparate and siloed .Another trend is the continuum of care beyond the hospital —Specifically, home

health .With an inadequate number of beds, many healthcare providers are focusing more on how to

install digital technologies for remote patient monitoring, such as telemonitoring, IoT, connected

devices and wearables .This helps enhance patient convenience and reduces healthcare costs for the

provider .

Indian health care is astory of great contradictions :ithas one of the lowest cost health care systems in

the world, yet itis unaffordable to the large majority of its population .While we have institutions and

providers, both private and public, that are comparable to the world ’sbest in secondary, tertiary and

quaternary care, we have along way to go in providing basic primary care beyond the urban limit where

70 % of the population resides .While the Government of the day, during the last decade, has been

speaking the language of “Right to Health ”and “Universal Health Cover, ”yet the public expenditure on

health at around 1% of GDP isone of the lowest in the world .For 16 % of the world ’spopulation we have

adisproportionately high share of global disease burden at 20 % coupled with one of the fastest growing

noncommunicable disease incidence . At the same time, we have one of the weakest health

infrastructures at around 1.3beds per 1,000 people . 2

State Of Healthcare In India

Healthcare in India iscomplex due to the multi -layered architecture of health system administration .

There are various considerations for this multi -layered hospital administration architecture .

These include whether itgets public (Central or state government) or private funding, what location it

covers (rural or urban) and what demography and prevalent diseases itcovers .


Short and Medium long Term Goals

1.1Patient and Family Preparation

• Develop materials and consistent messaging to increase awareness for patients and

families .For example, working as patient and family advisors .

• Develop and implement standardized training programs that explain roles, outline

expectations, and prepare patients and families for partnering with healthcare

organizations, including helping them understand organizational structures,

unfamiliar terms, quality improvement processes, and how to effectively share

their stories and input .

1.2Clinician and Leadership Preparation

• Implement mechanisms for patients and families to partner with leaders of

medical, nursing, and other health professions schools on curriculum development

and planning oversight .

• Develop a national curriculum to address patient and family engagement

competencies .

• Provide opportunities for experiential learning, observation, and hands -on practice

related to patient and family engagement .

• Formally assess student ’spatient and family engagement competencies and skills .

At Home Even Before Entering The Hospital Within The Hospital

2.1Care and System Redesign

• Employ communication techniques that support patients, including active listening,

asking questions to understand the patient perspective, and using teach -back methods to

assess understanding .

• Employ communication approaches, such as motivational interviewing, that encourage

patients to identify and work toward their own goals .

• To Create advance directives and orders that are readily accessible, for example, in

electronic health records .

• Implement support programs to address clinician’s emotional well -being .

• Leverage technology to support and manage the flow of data across all healthcare

providers and systems, for example, acommunity -wide health information exchange with

one patient portal .

2.2Organizational Partnership

• Develop and implement training programs to help clinicians, staff, and healthcare leaders

understand ways in which patients and families can participate in organizational design

and governance, for example, working as patient and family advisors .

• Establish patient and family advisory councils in hospitals, primary care settings, nursing

homes, and other healthcare organizations .

• Include patients and families as members of organizational quality and safety

committees, including root cause analysis teams and quality improvement teams .

• Partner with patients and families on hiring and staffing issues, for example, performance

evaluations . 4

Short and Medium long Term Goals

3.1transparency and accountability

• Structure electronic health record fields to enable patients to include information that

isimportant to them, for example, patient goals .

• Provide unbiased, evidence -based information that can be easily accessed and used by

clinicians, patients, and families to support care planning and decision making .

• Employ portals that allow patients to access their electronic health records anywhere .

• Provide patients with personalized, estimated costs to use in decision making around

various treatment options and in care planning for managing chronic conditions .

• Implement procedures for sharing organizational performance related to safety —such

as never events, near misses, and medical errors —with patients and families in ways

that promote transparency without creating apunitive environment for clinicians .

• Make all healthcare cost, pricing, and charge data public .

3.2Measurement and Research

• Develop measures that assess patient and family experiences and outcomes relative to

patient -specified goals, for example, ask patients about their treatment goals, record

these, and measure whether they are achieved .

• Explore methods that collect more detailed and personalized data about patient

experiences and outcomes, such as using video to capture interactions and

observations .

• Create patient experience maps charting staff and patient input to understand

expectations at various care points and identify areas for improvement .

Movement Across Hospital After Exiting The Hospital Along With

Consideration For Follow Up Care

4.1After exiting the hospital

• Require that all hospitals create and implement a community

benefit plan to improve the community environment and address

community health needs .

• Require that hospitals hold at least one public meeting annually .

• Develop opportunities for patient and family representatives to

be involved in decision making related to setting clinical quality

standards, reviewing research grants, and determining research

priorities .

• Prepare background information on important policy topics and

programs to help patients and families become familiar with key

issues .

• Frequent communication with the patient and family members .

• Customize plans so as to ensure patient actually follows the

advice .


The continuum of care is important to caregivers and patients alike, and it leads to an improvement of the satisfaction level , reduces costs and improves health. Keeping up the continuum of care is

especially significant for those patients who are more dependent on the health services, elderly patients, patients suffering from complex medical conditions, mentally vulnerable patients and

patients with chronic diseases. Some of the technologies that are relevant across the care continuum to create real -time standar ds based interactive digital information and collaboration

environment are:

Ensuring privacy of patients through double verification,use of biometrics.

a) IBM cloud:

• Ensuring privacy of patients through double verification, use of


• Re -identification of users at quarterly basis .

• Secure end to end, providing an environment of trust .

b) Blockchain :

• Optimization of cost and less double entry book keeping .

• Ensuring improved cash flow due to faster transaction settlement .

• Drug traceability in order to avoid illegal prescription .

• Efficient management of patient data .

c) Systems :

• Upgradation of systems to quantum computing, enabling quicker and

precise analysis of data .

• Watson Cognitive computing excels by providing confidence levels for

various healthcare recommendations .

• Example :Watson provides evidence -based treatment options for

oncology patients based on outcomes and allows for personalizing

therapy .

Recommendations On Care Continuum

The world is rapidly becoming more digital, and any business not realising and

incorporating this trend will fall behind .India has the potential for digital growth,

given its current technology penetration, advancing economy, growing population and

accelerating healthcare industry .The rise of digital technology is pushing India to

achieve health for all, putting the country at the forefront for foreign investment .With

these opportunities, India isemerging as the global leader in digital health

Digital Health Ecosystem

What does itmean for healthcare in India

• Improve access

• Quality care

• Better information

• Better patient outcomes

• Increase patient engagement

• Enhance information flow


Improving Care Outcomes

Patient centred care is central to the mission of healthcare, yet traditionally

neither patients nor the public have had the power to shape the services they

use and pay for, or define their value. In India, the issue for billions of people is

not whether care is patient centred but whether it is available at all, its poor

quality, and its high cost.

It’s time to get real about delivering person centred care. It ’s not a panacea for

all of medicine ills, but we should not underestimate its contribution to

tackling them. Working collaboratively and sharing decisions about care,

services, and research is challenging. It requires a sea change in mindset

among health professionals and patients alike. But its rewards are rich and

reaped mutually

• Respect for patients ’values, preferences and expressed needs : Involve

patients in decision -making, recognizing they are individuals with their own

unique values and preferences .Treat patients with dignity, respect and

sensitivity to his/her cultural values and autonomy .

• Coordination and integration of care : During focus groups, patients

expressed feeling vulnerable and powerless in the face of illness .Proper

coordination of care can alleviate those feelings .Patients identified three

areas in which care coordination can reduce feelings of vulnerability

1)information on clinical status, progress and prognosis .

2)information on processes of care .

3i)information to facilitate autonomy, self care and health promotion

• Continuity and transition : Patients expressed concern about their ability to care for

themselves after discharge .Meeting patient needs in this area requires the following :

Understandable, detailed information regarding medications, physical limitations, etc .

Coordinate and plan ongoing treatment and services after discharge .

• Emotional support and alleviation of fear and anxiety : Fear and anxiety associated with

illness can be as debilitating as the physical effects .Caregivers should pay particular

attention to:

Anxiety over physical status, treatment and prognosis

Anxiety over impact of the illness on themselves and family

Anxiety over the financial impact of illness

Involvement of family and friends

• Access to care : Patients need to know they can access care when it is needed .Focusing

mainly on ambulatory care, the following areas were of importance to the patient :

Access to the location of hospitals, clinics and physician offices

Availability of transportation

Ease of scheduling appointments

Availability of appointments when needed

Accessibility to specialists or specialty services when areferral ismade

Clear instructions provided on when and how to get referrals .


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