1. The document discusses leveraging information and communication technologies (ICT) to improve public healthcare delivery in India. It outlines India's current healthcare infrastructure and challenges in access. 2. The Piramal Health Management and Research Institute (HMRI) experience shows how ICT platforms like telehealth, mobile health units, and health information hotlines can help bridge gaps and expand access to care. 3. Key factors for successful ICT-enabled healthcare include developing integrated frameworks, building human resource skills, fostering collaboration between government, industry and non-profits, and establishing policies and standards around areas like telemedicine, electronic health records, and infrastructure.

1. ASSOCHAM Summit
Changing dimensions of Public
healthcare in India – harnessing
ICT enabled care delivery
New Delhi, June 4 - 2014
For discussion purposes only

2. 1
Agenda
A. Healthcare in India – An overview
B. ICT in healthcare
C. Piramal HMRI experience
D. ICT enabled care delivery – key attention areas

3. 2
Government
Hospitals Beds Doctors
13,76,0132
1,01,523335,4161
(Hospitals available
including CHCs)
Private sector ~10,00,0006
1,2 .Govt hospital & beds information was given by the Union Minister of Health & Family Welfare Shri Ghulam Nabi Azad in written reply to a question in the RajyaSabha august
2013; 3. indicates the Number of Government Allopathic Doctors and Dental Surgeons of 2011 India; 4. Per Private Healthcare Sector in India - A Framework for Improving the
Quality of Care by PH RAO, where private infrastructure is 58% of total health infra in 2011- assumed the same 5. Assumed Pvt. Bed ratio is 0.82 and grew at 13% CAGR from
2010- stats from McKinney report on Indian Healthcare 6. indicate the approximate allopathic doctors as on 2011, http://www.cehat.org/publications/ra01r6.html;
7. http://www.ihs.com/products/global-insight/industry-economic-report.aspx?id=1065985237; 8. Worldwide spending on Healthcare report by Emergo Group;
~14,00,0005
India spends INR 33,700Cr7 on health healthcare (2014-2015) and the expenditure has
increased by 94% vis-à-vis a decade ago8
The Public and private sectors invested in healthcare infrastructure and
manpower……
~58,0004

4. 3
Source(s):
1.Worldwide spending on Healthcare report by Emergo Group; 2,3,4,5,6,7. WHO World Health Statistics 2013; Immunization coverage is the average % of Measles, DTP3,HepB3;
NCDMR: Non communicable diseases mortality rates; CDMR: Communicable diseases mortality rates
148%
133%
94%
72%
138%
120%
112%
174%
Country and healthcare expenditure
increase from 2001-20111
Maternal
Mortality2
Infant
Mortality4
Neonatal
Mortality3
CD6Immunization
Coverage%5
NCD7
…. but a lot more needs to be done
26 37
32 47
15 25
06 09
02 04
08 11
08 11
12 17
96
64
72
97
99
99
98
95
240
200
220
029
016
035
048
059
344
363
244
185
29
79
153
122
702
685
647
526
355
623
675
607
Bangladesh
Indonesia
India
Malaysia
S. Korea
Sri Lanka
Thailand
Vietnam

5. 4
Beneficiary of healthcare
~31% of population with
access to
• ~ 70% of care infrastructure
• 4 lakh doctors accross 120 cities1
• multiple formats of care delivery
~ 69% of the population with
• 30% sub centres, 36% PHCs2
functional
• limited available manpower3
only 24% of doctors
only 47% of nurses
only 12% of specialist doctors
• # PHCs w/o a single doctor : 2,5334
Unaddressed and the underserved
…and a few realities need to be addressed..
Access to care: 31% of Indian
population outweigh the rest
1. http://www.moneycontrol.com/news/cnbc-tv18-comments/ims-survey-
reveals-skewed-doctor-density-across-india_929890.html
2. McKinsey report on Indian Healthcare
3. Why Are India’s Young Doctors Refusing To Serve in its Villages –
Yahoo News 23 Aug 2013
4. http://www.tenet.res.in/Publications/Presentations/pdfs/Healthcare_in
_India.pdf

6. 5
ICT platforms can play a pivotal role in bridging the gaps
Re-imagineRe-engineer
Incremental
Purposive disruption
Care Transparency
+
Care Traceability
=
Care Accountability
Efficiency
Effectiveness
Expansion of care availability
Reduction of care costs
Business model innovation
Benefit Change
The dual benefits of ICT platforms in healthcare

7. 6
Health Information
Helpline
Re-imagine the
purpose of
communication
Healthcare information
access 24 hours,
365 days
Covered 416mn
population
Care advices provided
for 26mn incoming
calls
Mobile Health
Units
Telehealth
Models
Re- engineer
the services
GPS tracking and
unique beneficiary
tracking ensured
efficient care outreach
Covered 45mn
population
Addressed 13.5mn
care seekers
Re-imagine the tele
conference platforms
Specialist care and
second opinion access
Change Impact on Care delivery Outcomes (Inception – till date)
Piramal HMRI made attempts to leverage ICT enabled care delivery
platforms
Screening / diagnosis
of at least 5 chronic
conditions
Care in neighbourhood to
2Lac rural population

8. 7
• OS neutral applications
• Patient UID
• Drug tracking application
• Point of care diagnosis –
‘Dox in Box concept’
Piramal HMRI Experience: Key ICT platforms and applications
Tele-health
Health Information Hotline
• VOIP protocol neutral
applications
• Digitized disease algorthirms
• SMSplatforms for
prescription
Mobile Health Units
• GPS tracking
• Patient UID and finger prints
• Drug tracking systems
• Human reosurce attendance
tracking applications (Android
based)
• Video based learning platforms
• Digitized learning content (self
learning)
• Voice based learning
Virtual learning platforms

9. 8
Piramal HMRI Experience: A snapshot of ‘on the ground’ care delivery
A Mobile Health Unit passing through difficult terrains to
access beneficiaries in Assam
A pregnant woman receiving medical advice via tele
Medicine in Adilabad, Telangana
Pregnant women board ‘Mobile Unit to reach
telemedicine centre for consultation in Andhra Pradesh
Trained executives attend to basic healthcare queries in a
hot line centre in Hubli, Karnataka

10. 9
What facilitating role should policy
aim and in what direction
What integrated framework is required
to manage the overall ecosystem
What new integration
approaches need to be developed
Where is the unused potential
and how to unbundle
Which components need support
How will the human resources
handle ICT platforms
What areas of skills/training need to
be developed
Governance
Monitoring & evaluation
Legal, technical frameworks
Mobile network
Internet connectivity
Data compatibility
Device manufacturers
Tech. players
Telecom
Networkers
Implementers
Financers
Providers
Doctors
Nurses, ANM
Paramedics
Healthcare workers
Critical factors for success of ICT enabled healthcare delivery: Our
observations
What hybrid and innovative
models need to be developed/deployed
How to speed up projects/players from
successful pilot to scale
What optimum mix and scale need to be
developed for reducing costs

11. 10
ICT Policy for Healthcare ?
- Remote health monitoring
- Tele health - tele-diagnosis, tele-radiology, tele-prescription
- Standardization of devices used for POC diagnostics
- Standardization of guidelines for POC diagnostics
- Communication protocols for monitoring devices
- Interoperability and output guidelines for monitoring devices
ICT infrastructure ?
- NOFN at Block level and Gram Panchayat
- 2G, 3G availability in hinterland when Urban areas
gear up for 4G
Where is India on the critical factors?
How can other partners collaborate with Government
to augment care delivery?
- Role of industry
- Leveraging execution strengths of PnPP
How can we enhance the capabilities of manpower
to handle ICT enabled care delivery ?
- Building new work force
- Models to build the capabilities

12. 11
1. Telemedicine Act
2. National standards & State guidelines
• Electronic records
• Standardization of devices (POC/rapid diagnosis)
• Clinical data mgmt., data compliance & integrity
3. ICT infrastructure
• Rural focus
• Unbundling and optimal use of existing infrastructure
4. Healthcare delivery model (esp Primary healthcare)
• Focus on PnPP models for primary care delivery
• Single window clearance for healthcare PnPP projects
• Level playing/preferential access for pioneers during RFQ/Bidding
5. Fostering innovation
• National level fora/platforms to contextualize new ICT platforms for care delivery
• Pioneers/inventors/industry to get a representation in planning and execution of new models
• National seed funding for ICT enabled healthcare pilot programmes
6. Capacity building of Health human resources (esp. last mile health workers)
• State level platforms (with industry participation) to train manpower
• ICT enabled care delivery leveraging e-learning, voice based learning, podcasts etc.
Key areas of ICT enabled care needing attention

13. 12
Piramal Swasthya is a registered non-profit organization based in Hyderabad, Telangana State. Piramal Swasthya is supported by Piramal
Foundation and works towards making healthcare accessible, affordable and available to all segments of the population, especially those most
vulnerable. In order to achieve this goal, Swasthya leverages cutting edge information and communication technologies to cut costs without
compromising quality as well as public-private partnerships to scale its solutions throughout India and beyond.
Swasthya envisions a future in which all vulnerable groups have the necessary information to make informed decisions regarding their health
and affordable, available and accessible high quality health infrastructure to support the realization of those decisions.
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