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Digital Health has accelerated during the COVID-19 pandemic, enabling the health ecosystem, providers and patients to adopt new medical technologies and digital health solutions, specifically in remote patient care and telehealth. However, beyond addressing near-term pandemic issues, the full potential of digital health in tackling chronic care remains untapped.
To achieve this, we need to strike a balance between immediate priorities and investments for a digital future in a value-based care era. With a growing ageing population across the Asia-Pacific region and increased patient demand for access to care at a time and modality of their choice, digital health innovation is no longer an option, but a necessity for health systems if we aspire to emerge stronger from the pandemic.
It is for this reason that the Asia-Pacific Medical Technology Association (APACMed) formed the Digital Health Committee to drive proactive dialogue around key themes such as regulation, reimbursement, interoperability, and cybersecurity. The committee recently conducted an extensive research on Policy Pathways for Value Assessment and Reimbursement India and Australia were the two archetypes studied for the purpose of this research. Interestingly, for both archetypes studied – Australia (mature health system seeking to optimize UHC) and India (developing health system seeking to achieve “4.0” status), the core issues identified as part of the current landscape boiled down to policies that either inappropriately treat Digital Health as an unmonitored B2C platform, or the exact opposite - as a classic medical device. The three key challenges identified were, the lack of value assessment framework, fragmented coverage efforts and complex evidence generation.
Collectively, the efficacy of Digital Health can be improved to achieve the healthcare quality that our populations deserve, and simultaneously accelerate the time-to-market for innovations that will have wider socio-economic benefits. To begin this journey, it is critical to understand the unique socio-economic and health system challenges that countries in Asia Pacific could typically face.
India for instance, is a much younger population with only 6.4% aged above 65; the poverty rate steep and internet penetration lower (34.4%) in comparison to other developed nations. The healthcare system in India is still evolving with only 3.6% GDP allocation towards healthcare and only 30% for healthcare facilities supported by public entities. The country also has a very low ratio of doctors and beds per capita.
Incorporating Digital Health formally into the UHC (Universal Health Coverage) ambition in India will be very important especially considering COVID-19 and the challenges that it has been imposing on the country recently. read more at https://health.economictimes.indiatimes.com/news/health-it/harnessing-digital-health-in-asia-pacific/84059339
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A report by the World Health Organisation (WHO) reveals that patients living in low-income countries experience as many disability-adjusted life years lost due to medication related harm than those in high-income countries. For patients in hospital, the impact of clinical errors is greater, and this may be attributed to the complexity of certain diseases and the use of complicated medication regimes. In children and elderly, medication errors often occur due to administration of wrong dosage, incorrect therapeutic route and a failure if the patient does not follow the prescribed treatment.
The Crucial Role of Digital Tools for Better Patient Outcomes
Today, with the increase in disease profiles and the influx of information available across online mediums, there is a dire need to have a platform that can provide filtered, precise and reliable medical information. Moreover, as the pandemic has posed unprecedented challenges for the healthcare industry, the need of the hour is a database with different treatment types used for both non-communicable and communicable diseases. Considering this, digital healthcare technologies such as Clinical Decision Support (CDS) systems are providing healthcare professionals with innovative diagnostic and treatment solutions that enable them to deliver quality patient care.
CDS systems improve patient safety, discard unnecessary tests, reduce cost, and increase satisfaction of patients and clinicians. The platforms use biomedical information, patient-specific data or a mechanism that integrates knowledge and data to present useful information to the doctor when healthcare is delivered, enabling quicker action. All healthcare professionals and hospitals should use CDS systems that can provide them information that is verified by doctors who have years of experience. It is imperative to understand that clinical errors do not occur due to medical negligence, in fact they include a range of honest errors and innocent mistakes which are beyond the healthcare provider’s control, despite enough caution. We experienced an onslaught and sudden surge in use of healthcare technologies owing to the pandemic. In the post pandemic, the trend of virtual care is anticipated to grow even more that will ensure smarter and quality care. And when we say digital healthcare technologies are here to stay, the rationale is to not get rid of paper record, but to adopt more patient-centric methods. read the entire article at https://health.economictimes.indiatimes.com/news/industry/a-case-for-eliminating-medical-errors-with-evidence-based-decision-support/82818497
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The Indian Air Force has launched a mobile health (mhealth) app to provide health information to the users, including first-aid and other health and nutritional topics The 'MedWatch' was launched on 8 October on the occasion of IAF's 85th anniversary and was conceived by the doctors of IAF and developed in-house by Directorate of Information Technology (DIT) "'MedWatch' will provide correct, Scientific and authentic health information to air warriors and all citizens of India. The app comprises a host of features like information on basic First Aid, health topics and nutritional facts; reminders for timely Medical Review, vaccination and utility tools like Health Record Card, BMI calculator, helpline numbers and web links The 'MedWatch' is first such health app to be built by any of the three armed forces. check out the press release : http://pib.nic.in/newsite/PrintRelease.aspx?relid=171664 check out the original unedited article : https://www.firstpost.com/tech/science/indian-air-force-launches-medwatch-a-mobile-health-app-on-its-85th-anniversary-5349871.html
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On October 3, 1978, due to the pioneering effort of Dr Subhash Mukhopadhyay and his team in Calcutta, a girl—Durga—was born through IVF. It was the second such attempt in the world, a repeat of what his English counterparts Robert G Edwards and Patrick Steptoe had achieved barely days ago, on July 25. The news boded well for thousands of infertile couples, but there was no noise around the achievement. Perhaps because the couple chose to keep mum and didn’t want themselves or the child’s image to be shaped by the manner of conception. Battling ignominy and failure to be recognised for his monumental work led him to take his life on June 19, 1981. But recognition did come his way, posthumously, and 25 years after the birth of Durga, the physician was “officially” regarded as the first doctor to perform IVF in India. Later on August 6, 1986, Dr Indira Hinduja and Dr Kusum Zaveri helped deliver—Harsha—India’s first test tube baby. Now, State-of-the-art-technologies are making their parenthood dream of many come true A latest Ernst & Young (E&Y) report records high prevalence of infertility affecting nearly 10-15 percent of married couples in India, of which women account for 40-50 percent. Infertility attributable to male factors is on the rise and constitutes 30-40 percent of the segment. Only 1 percent of infertile couples in India seek treatment, says the E&Y report. It highlights the rise in the population of women in reproductive age (20-44). This proportion could go up by 14 percent between 2010 and 2020. The climb is skewed towards women aged between 30 and 44 (20 percent increase estimated between 2010 and 2020), who typically display lower fertility rates. This shifting demographic trend coupled with rising contraceptive use is likely to scale up infertility rates in India.
Age has an important part to play in conception. Tech to Rescue The fertility treatment landscape has drastically improved over the years. The services at a fertility centre range from the simplest that involves IUI to the most advanced ones such as IVF,
IMSI (intracytoplasmic morphologically selected sperm injection), ICSI (intra-cytoplasmic sperm injection) and PICSI (a new method of sperm selection for ICSI).Today any IVF specialist is lucky to possess the latest techniques to combat the disadvantage of advanced maternal age, prevent unnecessary transfer of embryos, prevent and reduce implantation failure and give quick results. Performing genetic diagnosis prior to embryo implantation could prevent abnormal pregnancies. Various categories of hopeful mothers are advised this screening method. They are:
1. Women who suffered repeated implantation failure or recurrent pregnancy loss while undergoing IVF
2. Patients aged 35 years
3. Women with recurrent miscarriages after IVF
4. Women with a positive history of chromosomal aneuploidies in the family or are diagnosed carriers of chromosomal abnormalities
5. Or have a combination of some of the above factors
read more at http://www.newindianexpress.com/magazine/2018/sep/30/the-great-baby-race-1878013.html
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In a bizarre move, the Medical Council of India(MCI) — the apex regulatory body of doctors and the medical practice in the country — has decided to shrink its own jurisdiction. It has reinterpreted its code of ethics regulations as being applicable only to individual doctors and not doctors' associations.
Clause 6.8 of the Code of Medical Ethics Regulation 2002 clearly states that it pertains to "code of conduct for doctors and professional association of doctors in their relationship with pharmaceutical and allied health sector industry". However, the executive committee of the new MCI in its meeting on February 18 decided that the term "association of doctors" be deleted from the clause. It went on to add that any action it took it against any association of doctors by virtue of clause 6.8 shall be nullified and that such proceedings would stand annulled.
In effect, the MCI has stated that the action it took against the Indian Medical Association (IMA) for endorsing products of Pepsi and Dabur in exchanges for crores of rupees or against the Indian Academy of Paediatrics for accepting funding from pharmaceutical companies will no longer be valid.
"It is a ridiculous position. The MCI itself had argued in an affidavit filed in the Delhi high court that what is prohibited for an individual doctor cannot be done by the doctor along with another bunch of doctors by forming an association," said Dr K V Babu, who had filed the original complaint against the IMA for endorsing products.
Endorsement is expressly forbidden by the code of ethics, which says that no doctor ought to endorse any commercial product or drug or therapeutic article. In November 2010, the MCI had initiated action against officer bearers of the IMA on the endorsement issue. When one of the office bearers challenged the removal of his name from the medical register for six months before the high court, the MCI had argued in its affidavit that "...what is not allowed to be done directly cannot be permitted to be done indirectly".
more at http://timesofindia.indiatimes.com/india/MCI-shrinks-own-ambit-doctor-bodies-out-of-ethics-code/articleshow/30873980.cms
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Hours after the US drug regulator banned imports from a fourth factory of Ranbaxy Laboratories Ltd, the drug controller general of India G.N. Singh chose to back the Indian company, saying the current situation may not require withdrawal of its medicines from the local market.
On Friday, the US Food and Drug Administration (FDA) barred Ranbaxy, a subsidiary of Japan's Daiichi Sankyo, from producing or distributing drug ingredients manufactured at its Toansa facility in Punjab for the US market.
The FDA has already banned imports from Ranbaxy's plants in Mohali in Punjab, Dewas in Madhya Pradesh and Paonta Sahib in Himachal Pradesh. At the Toansa facility, the regulator found the company's staff found that workers retested drug products to produce acceptable findings after the items originally failed analytical testing. While the US has banned imports from these facilities, the Indian pharma market continues to use raw materials from these plants. Singh in an interview said, "Indian pharmaceutical companies cannot be judged by American standards." Edited excerpts:
Were the other three plants of the company found to be in violation of India's Drugs and Cosmetics Act?
We had approached them last year after US FDA flagged certain issues. Some of those were found to be true and my office had told Ranbaxy to take corrective measures. Similar procedures will be followed in this case as well. But I do not think this is a situation which will warrant withdrawal of drugs from the domestic market. Our biggest objective is to maintain good quality of medicines and we are doing that. There are no drugs in the Indian market that are not up to the standards stated under the Drugs and Cosmetics Act. We will shortly be in touch with Ranbaxy's management to find out what went wrong at the Toansa plant.
Will such decisions adversely affect India's image as a manufacturer of safe, affordable drugs?
As of today, India supplies low-cost drugs to over 200 countries. Our pharmaceutical sector is a huge success. We cannot be doing well if our drugs were of substandard quality. Many multinational pharmaceutical companies stand to gain if India loses its image as a supplier of quality drugs. However, we will take appropriate action. We are in the process of streamlining the drug regulation in India and fundamental changes will be taking place soon. I am not worried about issues of quality
Read more: http://medcitynews.com/2014/01/indian-pharma-firms-cant-judged-u-s-standards/#ixzz2rNuMeTBQ
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The pandemic accelerated the humanizing of digital technology – it brought people together at a time when physical distancing was legally mandated in many parts of the world. One year on, digital solutions – in every sector – have truly come of age. The pandemic has ushered in a new era and meaning for digital tech, as organizations, businesses, and institutions began to function through virtual mediums almost exclusively. Perhaps most crucially, it demonstrated just how powerful digital interventions can be in last-mile delivery of essential services, particularly in hard-to-reach, underserviced areas, and how they should be leveraged even in times of normalcy without such severe supply chain disruptions. Nowhere is this more apparent than in health care services. In the early months of lockdown in India, several essential health services were disrupted, and one of the hardest hit was maternal health care. Childbirth stops for nothing and no one – the ecosystem had to adapt almost overnight to meet the new challenges of maternal health care delivery. For instance, a quality improvement and assurance program called Manyata, which trains health care staff in private maternal care facilities on a set of 16 evidence-based clinical standards for quality and safe care, moved its entire training and certification architecture online to continue providing this crucial capacity-building to under-resourced nursing homes. And thus, digital interventions came to the rescue. With the immediate challenges of the pandemic addressed by a plethora of digital innovations, we must retain this momentum to chart a path for realizing India’s Universal Coverage Health goals. The digital ecosystem offers path-breaking and efficient solutions for accelerating the three pillars of UHC – availability, affordability, and quality – by advancing transformations in health care on both the demand and supply side. Digital tech can be a game-changer. In terms of supply, it is enabling reach and scale at levels that were previously unimaginable. Digital solutions can increase the penetration of quality care mechanisms to remote parts of the country through telemedicine and remote training sessions for health care staff. On the demand side, tech has tremendous potential to amplify grassroots voices from beneficiaries and patients, both as a means to incorporate their feedback in designing healthcare solutions (or improving existing ones), and encouraging demand for affordable, high-quality care. However, while leveraging digital interventions for improving healthcare and service delivery is crucial, it cannot be done in silos. The pandemic has exposed fragilities in the very foundations of our healthcare ecosystem. We must therefore create strong structural support that can enable availability, affordability, and quality to become all-pervasive, by rallying the health ecosystem and incentivizing the participation of both private and public sector. Perhaps most crucially, the private sector needs to be integrated into the total health system in order to complement and augment government efforts in strengthening the health care ecosystem. The important role of the private sector was amply reinforced in the aftermath of the Covid-19 pandemic, as the government turned to private sector facilities to help in its frontline response to the virus. So, too, with building a digitally-enabled health ecosystem. The visionary National Digital Health Mission (NDHM) is poised to revolutionize Indians’ experience of health care access and delivery. However, for the NDHM to achieve scale and speed of impact, extensive private sector involvement is crucial. A strengthened and integrated health system must put its weight behind digital interventions if we hope to facilitate a transformation in the months and years ahead. read the original , unedited version at https://timesofindia.indiatimes.com/blogs/voices/digital-technology-the-next-frontier-in-healthcare-delivery-in-post-covid-india/
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In a breakthrough in research, IIT-Bombay scientists have developed technology to leverage a patient’s immune system to cure cancer. Researchers made use of gene and cell therapies to reengineer immune cells to attack and kill cancer cells in the body. Such immunotherapy using CAR T-cells, a treatment for cancer, which costs Rs 3-4 crore in the US, can be made available for Rs 15 lakh if the technology is developed in the country. Purwar's team has been working on CAR T-cell technology for six years. ''It is an autologous cell therapy for personalized medicine, where cells are taken from patients, re-engineered and re-infused in the patient. We got immune cells from volunteers and clinical patients with help from TMH and re-engineered them using the technique. The modified cells were positively tested in laboratories on artificially grown cancer cells.'' said Purwar. T-cells (a type of white blood cell or WBC), an integral part of the human immune system, can identify tumors and destroy them. But in advanced stages, the cancer cells adapt to the presence of T-cells and remain undetected. In the new approach in immunotherapy, called CAR (chimeric antigen receptors) T-cell therapy, the T-cells ability to detect and kill cancer cells is restored. CARs are the protein that assists T-cells to recognize and attach to protein or antigen, present on cancer cells. These proteins help to destroy cancer cells. ''Our team has delved into strategies that would improve the efficacy of the technique and demonstrated that a single injected dose can lead to multiplication of modified T-cells that can destroy cancer cells,'' said Punwar. Globally, over 600 clinical trials are in progress for CAR T-cell therapy, many of which are on in China said, Dr. Narula from TMH. ''It has got huge potential. With the cancer burden, we have, the therapy will be considered a success, even if it is applicable to only a fraction of patients currently. Technologies are being developed globally, but are exorbitant. There are high expectations from this technology as it can create pathways for developing newer technologies, for newer therapies, for more forms of cancer. Thousands of Asians can benefit,'' said Narula. Read More: https://timesofindia.indiatimes.com/city/mumbai/iit-bombay-scientists-now-develop-cheaper-tech-to-cure-cancer/articleshow/72483167.cms
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The Medical College hospital (MCH) in Thiruvananthapuram, is a prominent healthcare institution in Kerela and attracts thousands of patients every day. MCH has undergone a series of changes in a bid to present itself as patient-friendly with special emphasis on technology. 1. The process to improve facilities at MCH kickstarted under the government’s ‘Aardram’ mission which aims to introduce a variety of technologies that will strengthen patient infrastructure at hospitals and make them easier to consult doctors. 2. An advanced virtual queue management system has been established through which patients at Akshaya centres, through computers at taluk hospitals can take appointments of doctors at a specific time and date. 3. Instead of waiting for hours at the hospital, patients can now get virtual tokens and just arrive at the hospital at the time of their appointment. This is aimed at eliminating extra crowds at the hospital during those hours. 4. SMS messages will be sent to the patient reminding them of their doctor appointments. 5. Through the e-health system, doctors at MCH can also avail a patient’s medical information via Aadhaar. This will help multiple doctors seeing the same patient access his/her medical history resulting in a fruitful exchange of information. 6. Doctors will soon be able to record their prescriptions digitally on their computer systems which will help them better treat their patients when the latter come for the next appointment. Officials at the pharmacy can also access these records helping in better delivery of medicines. 7. For the past one month, the entire OP block of the MCH barring a floor has been colour-coded for the benefit of patients. “The OP at MCH is vast and many a time, patients find it difficult to find the right OP and the doctor they wish to consult. We have set up LED systems on each floor guiding patients to the right blocks,” Dr Jose said. 8. LED lights in blue, orange, green and red have been set up for each department of the OP. 9. There are wall paintings along with normal signboards as part of patient-friendly measures to identify key departments.
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Do you still have a family physician? - In the time of super-specialisation in medicine and healthcare, patients seem to bemoan the scarcity of the family doctor who cured their sniffles without making them undergo a battery of tests. Where is the general physician now?
Sorry situation
India produces nearly 42,000 MBBS doctors every year. But of these, only 8,000 to 10,000 take up general medical practice as a profession
India does not offer an MD in family medicine. Of close to 8,000 seats that are reserved for a 3-year PG course offered by the Diplomate of National Board, only 5–6% of seats are allotted to family medicine
Another reason general practice is on the decline is that fresh MBBS graduates avoid practicing family medicine as a career because it pays less
Read the whole story at http://www.dnaindia.com/health/report-do-you-still-have-a-family-physician-1964306
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Winston Churchill once said, "Healthy citizens are the greatest asset any country could ever have." The UPA's effort to invest in citizen's health deserves better coverage and notice than it has attracted so far.
As we inch towards the end of United Progressive Alliance's (UPA's) second term, it is important to look back and reflect on what was accomplished and what is still to be achieved. If health indicators are any yardstick, then the UPA's thrust on social healthcare has led to improved health of citizens and set the stage for future reforms.
In 2004, when UPA came to power, expenditure on public health was around Rs 7,500 crore. This has now almost quadrupled to Rs 27,000 crore. In the beginning of UPA's regime, the National Rural Health Mission (NRHM), known to be "the most ambitious rural health initiative ever", was initiated.
The NRHM was formed to provide effective healthcare delivery to our rural population, especially women and children. The latest data shows that in the last 10 years, infant mortality rate (IMR) has come down from 58 per 1,000 to 44. This is further set to decline sharply.
During the National Democratic Alliance's regime, the IMR declined at a snail's pace of 1.3% annually, whereas now this deceleration is happening at 6.4% per annum.
With government focusing on early and periodic health screening of children through its Rashtriya Bal Swasthya Karyakram, children's health indicators could improve further.
With the Janani Suraksha schemes, institutional deliveries through skilled birth attendants have increased rapidly. Approximately 12 million deliveries per year are taking place at no expense to the beneficiaries. This is followed by cash incentives and other benefits.
As a result of such initiatives, the maternal mortality ratio of India has been reduced by 50% from 390 in 2000 to 200 in 2010.
Providing government-run health insurance to below poverty line (BPL) workers and their families through Rashtriya Swasthya Bima Yojana (RSBY) is yet another milestone achieved by the UPA government. The objective of RSBY is to protect BPL households from major health expenses that could wipe out their life's savings.
This scheme allows inpatient treatment up to Rs 30,000 per year, and since its inception in 2008, around 35 million families have enrolled in the programme. This scheme has been praised by global leaders for its unique, innovative and inclusive business model.
Making India free from the blot of polio is another achievement of the UPA. This was only possible due to massive immunisation and awareness efforts of the government. Nevertheless, the government should be in surveillance mode as we are surrounded by nations that are still afflicted by polio.
Due to improved life expectancy, the average Indian would live five years longer than he would have had a decade ago. An increase in life expectancy will be a driver of economic growth, as it happened in Japan, which saw an increase in life expectancy by 13 years after World War II, followed by rapid economic growth.
This is a battle half-won. We have people falling into the trap of poverty and indebtedness due to escalating healthcare cost. The government should speed up its intention to provide free medicine to all through public hospitals and health facilities.
more at http://economictimes.indiatimes.com/opinion/comments-analysis/the-upa-regime-a-decade-of-massive-healthcare-reform/articleshow/29430774.cms
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It is not in the interest of patients or doctors to remain on a collision course forever. While growing awareness among patients about their rights is a welcome trend, medical councils have to step up to the plate.
Aam aadmi (and aurat) at the high table in Delhi has buoyed the hopes of citizens’ groups across the country. As 2014 kicks in, be prepared to hear a lot more from one group whose interests have been long-neglected — the harried aam patient.
Over the past year, a series of developments suggests that patient activism is on the surge, and could be shaping the practice of medicine in this country.
People for Better Treatment (PBT), a citizens’ group which started on December 30, 2001, in Kolkata, is fanning out across the country. Last month new PBT branches sprung up in Delhi, Chennai and Hyderabad. Next on the list is Ahmedabad and possibly Lucknow. PBT’s goal is to raise public awareness about medical negligence. It is the brainchild of US-based
Dr Kunal Saha, whose wife Anuradha died due to negligence of doctors in a Kolkata hospital. Dr Saha fought a long, protracted battle for justice for nearly 15 years, boning up on toxic epidermal necrolysis in the process, and mobilising an international panel of experts to bolster his arguments.
Last October, the Supreme Court gave its judgment. The apex court’s ruling found three doctors of the private hospital, Advanced Medical Research Institute (AMRI), negligent in the civil case but dismissed the criminal complaint. The judgment grabbed headlines because of the unprecedented compensation amount in a medical negligence case in India — `5.96 crore plus interest for each of the 15 years — awarded to Dr Saha.
The landmark judgment of the apex court has unleashed a fierce debate on fair compensation for patients who suffer due to medical negligence. The medical fraternity led by the Indian Medical Association (IMA) and the Association of Healthcare Providers India (AHPI) is seeking a limit on the maximum amount that hospitals should be asked to shell out in such cases. Their argument: without a cap, hospitals will go bankrupt.
Patients’ groups such as PBT led by Dr Saha say that is not true.
Dr Saha says AMRI has not yet coughed up the compensation money. Instead, the hospital authorities have asked for an extension of the deadline to pay the sum. The Kolkata hospital has also partially resumed operations.
Dr Saha has responded by petitioning the Supreme Court against what he terms “deliberate violation” of its order. The case is listed for hearing early January.
The debate over a compensation cap is taking place in the backdrop of a Parliamentary Standing Committee on health’s report on the Indian Medical Council (Amendment) Bill 2013, introduced in the Rajya Sabha last March. The committee recommended that teams probing cases of medical negligence include external experts instead of just Medical Council of India (MCI) members.
“All of the members of the Medical Council of India are medical professionals and whenever any complaint of medical negligence or violation of code of ethics is brought before the council, such cases are decided by the medical professional themselves,” the committee noted.
The MPs recommended that all cases of medical negligence should be inquired into by a committee of experts drawn from various fields and experience, including social activists, patients’ representative and so on.
Although MCI is the regulatory body governing medical practice, there is growing concern that the few cases brought before it are not impartially decided as council members are very lenient towards their colleagues and hardly anyone is willing to testify that another doctor has been negligent. The fact that the MCI has been embroiled in various corruption scandals in the past adds to the concern.
more at http://www.asianage.com/columnists/oh-doctor-you-re-trouble-940
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