Presidential Oration in UPAPICON 2021 at GSVM Kanpur

1. Health Care Transformation in the Pandemic Era
Dr.Veerendra Singh
Chairman API UP Chapter

2. While the year 2020 has been negative throughout, it has
certainly reminded us that “health is the true wealth” and
that life really is unpredictable.

3. Spanish flu and 2009 H1N1 (Swine Flu)
more than 214 countries
Influenza A
1918
Severe Acute Respiratory
Syndrome Corona Virus
Infection (SARS- CoV-1)
Guangdong, China
More than 30 countries
2002-2004
Zika Virus Epidemic
Federated States of Micronesia
Africa, the Americas, Asia Pacific
2007
Middle East Respiratory
Syndrome (MERS)
Saudi Arabia (Camel Flu)
more than 26 countries
2012 The Ebola Virus Pandemic
Guinea, Africa, Spain, USA,
UK, Italy.
2013 -2015
2013
Viral pandemics in the past two decades
SARS-CoV 2 Pandemic
COVID 19
Dec 2019,Wuhan, China
Ongoing global pandemic

4. The coronavirus pandemic has hit the world severely,
representing the most severe threat to human health
in more than a century.

5. Healthcare systems seemed unable to cope with the sudden, intense
surge in demand especially in the settings of acute care.
COVID-19 pandemic, a reality check for many aspects of
healthcare systems

6. Potential delays in major decisions such as lockdown measures
significantly altered healthcare outcomes

7. The speed at which a global public health issue translated into a
financial downturn was underestimated.

10. The positive and negative effects of Covid-19.

11. Level of airborne aerosols over India
Source: NASA and ESA
Nature seems to have hit the reset button, reclaiming the spaces to heal itself

13. COVID-19 pandemic transformed the social, political,
economic, and healthcare aspects globally.
Need to translate experiences into actionable lessons to
improve the whole spectrum of healthcare delivery.

14. Thus, a new model of healthcare delivery emerges with more
emphasis on preventive measures, remote care, and substantial
technological dependence.

15. Covid-19 has enabled a faster adoption of technology.
And nowhere is this effect better seen than in the
healthcare sector.

16. The future of healthcare in a post-COVID-19 world

17. Telehealth is use of technology for health and health related services
including telemedicine.

18. Telemedicine allows healthcare providers to evaluate,
diagnose and treat patients without the need for an in-
person visit.

19. Categories of telemedicine
• Interactive telemedicine/telehealth
allows physicians and patients to communicate in real time.
• Remote patient monitoring/ telemonitoring
allows patients to be monitored in their home
• Store-and-forward/ asynchronous telemedicine
share patient information with another healthcare provider.

20. Tele-ICU/e-ICU models
• A technology model to remotely manage ICU patients by
delivering critical information to remote caregivers from a
command centre.
• Tele-ICU startups Springer Healthcare , Tattvan E-clinics and
Cloudphysician delivered remote intensive care to over 15,000
patients during the pandemic.

21. Point Of Care Diagnostics
POC diagnostic devices help in providing diagnostic tests at the
point where the patient receives their care, i.e. at the doctor’s
clinic or in the field by the frontline health worker.

22. Artificial intelligence (AI) has the potential to radically alter the
field of healthcare.

24. Robotics in a post-pandemic Era
• Cobots or Human Collaborative Robots
as an assistive and supportive system for medical professionals
• Surgical Robots
reduce the mental and physical exhaustion of surgeons
• Telemedicine
allow doctors to engage with patients without physical visit
• Personal Care Robots
as companions can converse to them or deliver timely medications

25. • Indian consumer robot maker Milagrow has launched its 4
new humanoid robots – Robot DiCaprio, RoboJulia, RoboNano
and RoboElf which are specially designed to cater to hotels,
hospitals, restaurants and corporate offices.
• The Covid-19 robot also comes with a video calling feature in
case a patient wants to connect with a doctor.

26. On 8 Sep 2021, Dr. Raj Palaniappan, Lead Bariatric Surgeon,
Apollo Hospitals Chennai, performed India's first fully robotic
gastrointestinal surgery "One Anastomotic Gastric Bypass“ on
Mrs.Taniya, a 50 year old woman from Bangladesh.

27. Artificial Intelligence in Administrative workflo
• AI helps analyze data on patient visits, medications, lab tests, and
procedures performed, as well as data outside the health system -- such as
social media, credit cards, Internet search activity that contain valuable
health information.
• AI can assist in predicting diseases, preliminary diagnosis, computer-aided
interpretation of medical images and heart sound analysis.

28. Artificial Intelligence : Smart Assistance
• Image recognition and machine learning can see far more
details on MRI and X-ray images than human eyes.
• In pathology, AI can diagnose the result at a micro level, which
can avoid errors in diagnosis.

29. • In government medical college Thiruvananthapuram, Kerala,
Qure.ai has implemented its A.I. algorithm on the CT scanner.
Every time it gets a CT scan with a critical abnormality it alerts
radiologists with a message.
• Qure’s product qER can quickly detect intracranial bleeds with
a high accuracy comparable to that of an expert radiologist.

30. Artificial Intelligence solutions
• Qure.ai tool, qXR, built into the X-ray machine could interpret
the X-rays quickly and predict the Covid-19 likelihood—high,
medium, low, and none.
• The patients, who were suspects, were triaged and the RT-
PCR results on them were almost 80-85% positive.

32. Convolutional neural networks (CNNs), using a dataset of
129,450 clinical images was tested against 21 board-certified
dermatologists on biopsy-proven clinical images with
keratinocyte carcinomas versus seborrheic keratoses; and
malignant melanomas versus nevi.
The CNN achieved performance on par in classifying skin cancer with a
level of competence comparable to dermatologists.
Esteva, A., Kuprel, B., Novoa, R. et al. Nature 542, 115–118 (2017).
https://doi.org/10.1038/nature21056

33. The FDA authorized the marketing of Paige Prostate, the first ratification-
intelligence (AI)-based software designed to identify areas with high
likelihood of cancer on images from a prostate biopsy.
News release. FDA. September 21, 2021. Accessed September 24, 2021. https://bit.ly/3kAFZk2.
AI used to create a new drug regime for children with a deadly form of brain
cancer, in which survival rates have not improved for 50 years
WION Web Team, Published: Sep 23, 2021, 06:06 PM(IST)

34. Artificial Intelligence (AI) can assist in
• New Insights into a Disease
• Drug Discovery
• New compound testing

35. Application of AI in the face of Covid 19
• Helped early production of vaccines
• Protect caregivers
• Contain the pandemic.
The virus structure generated by AI saved prolonged experimentation
Moderna used an AI based technique on mRNA to develop covid vaccine.

36. Remote care or telehealth services
• Prior screening of patients and triage assessment
• Routine monitoring of patients at home

37. Connected health and RPM technologies
• The AltumView system,
Alert system for senior care
- to send alerts of emergencies such as falls.
- face recognition, gesture recognition, geo-fence.
• Carnation Ambulatory Monitor (CAM) Patch
Ambulatory arrhythmia-detection device.

38. • Everion
Armband wearable captures temperature, blood oxygenation
and other physiologic signals and reports to healthcare
provider through a mobile app.
• Biovitals
Data collected from wearables and AI-based treatment
algorithms enable clinicians to intervene and prevent
hospitalizations.

39. Electronic Health Records (EHR) and Analytics
• Epidemiological monitoring and the early identification
of emerging hotspots.
• THB*, a Gurgaon-based start-up has a database of about
500,000 microbial culture samples with antibiotic
sensitivity patterns.

40. Patient education and awareness platforms
• e-platforms like Aarogya Setu app help consumers find health-
related information, to make more informed decisions about
their health.
• Many content platforms like Lybrate have been able
to monetize their platform.

41. Self-Health management enablers
• Digital therapeutics (DT) and smart wearables that
complement clinical care have been slowly but steadily
gaining acceptance in India.
• DT apps record health data and provide guidance on diet and
exercise to dynamically manage blood glucose/ pressure
levels.

42. Home Healthcare
• Tribeca Care, based in Kolkata, offers a variety of geriatric care
services 24/7 emergency response, home safety IoT, home
nursing, and telemedicine, as well as medical, paramedical,
and non-medical services.
• Other startups in this space are Gurugram based Healthians,
CallHealth, Portea medical & healthcare at home.

43. Pre COVID status of telemedicine in India

44. Treatment was done through telephonic instructions by the
gynecologist to her staff

45. Lack of clear guidelines had created significant ambiguity
for registered medical professionals, raising doubts on
the practice of telemedicine

47. Telehealth in India
• Independent platforms
Practo, 1mg, mFine, iCliniq, myUpchar, doc online, credihealth and indiaopd
• Hospital linked platforms
Apollo health, Cloudnine, Fortis healthcare
India is now home to more than 133 telehealth startups and 5,295 health tech startups.

48. • The government’s ‘Mitr’ telehealth platform and subsidising to technology
startups marked the first steps in India's digital health journey.
• The introduction of the Aarogya Setu app, was a noteworthy effort towards
digitisation.
• e- Sanjeevani initiative, the national telemedicine service launched in
November 2019, had facilitated 3 million consultations by March 2021.

50. Hybrid Telehealth Model:
Alternating in- person and telehealth visits
• Allows triage and screening to prevent unnecessary contact, saves travel
time and cost, and increases affordable accessibility to specialists.
• Screening and diagnostic tests, physical examinations and treatments do
not fit in with a pure telehealth model, but it does work in a hybrid model.

51. Hybrid models can break geographical boundaries in India
• The eSanjeevani model operates on a hub and spoke model in the rural
areas, with medical colleges as hubs and primary health centres as spokes.
• This allows patients in rural areas to access specialist advice via telehealth
from medical colleges without travel and time cost.

52. Hybrid telehealth model and medical tourism
• Pre-Covid, India was gaining its popularity for medical
tourism, a practice of travelling to countries offering
competitive advantage of world class treatment at low cost.
• Post Covid, hospitals can achieve greater patient experience
by utilising a hybrid telehealth model where initial consults
can happen weeks before they arrive in India.

53. Tele-education in medical field in India
• The School of Telemedicine & Biomedical Informatics (STBMI)
was established by the SGPGIMS Lucknow with the objective
of creating human resources in various fields of healthcare
information technology.
• The SGPGIMS distance medical education program began in
September 2001 by networking with Sriram Chandra Bhanj
Medical College (SCBMC) in Cuttack, Orissa for postgraduate
students .

54. Post Graduate Tele Education
• Initial tele-education activities were started by SGPGIMS
Lucknow with Amrita Institute of Medical Sciences, Kochi in
March 2004
• Endocrine surgery department has been holding regular
teaching sessions with C M C Vellore, AIMS Kochi, SCBMC
Cuttack, KGMU Lucknow.
• Department of Urology started virtual clinical grand round
with their peers in AIIMS, New Delhi, and PGIMER
Chandigarh.

55. India already has a robust pharma supply chain
infrastructure:
We do everything from production of vials to medicines to
injections to vaccines.

56. E-pharmacies have seen a major boom in COVID-19
pandemic period.

57. Covid-19 prompted the government to
• classify e-Pharmacies as an essential service
• promote them through the Aarogyta Setu Mitr portal on the
Arogya Setu app

58. • Currently, there are close to 50 e-Pharmacies in India.
• Pharmeasy, Medlife, 1mg and Netmeds are the leading players.
e-Pharmacies
Bridging the gap in Indian healthcare
Sector is heading to integrate services such as doctor consultations,
diagnostics and e-Pharmacies as a one-stop-shop.

59. The positive aspects of the pandemic
• Behavioural change in patients and doctors.
• Importance of staying fit, strong, and increasing immunity.
• Hygiene, safety and sanitation at the clinical establishments.

60. The pandemic changed people’s perception that not only
gym but work out at home as well can keep you fit.
Digital fitness’ and ‘holistic well being

61. Instilling skills early on at medical and nursing school will help future
healthcare professionals in technology adoption
The future of India’s healthcare system lies in the hands of the
practitioners of tomorrow.

62. Our world is fragile — let’s work together to
preserve, enrich, and enlighten it
• There is no way of tackling the COVID-19 crisis at national levels only.
• International cooperation and multilateralism are the need of the hour

63. --------------- to conclude
• With the national public health initiatives such as Ayushman
Bharat and the National Digital Health Mission, India has an
incredible opportunity to become a digital health leader.
• Its citizens have changed the way they live, eat, travel,
interact, and work, perhaps irreversibly.
• In the new post-pandemic India, the state is more powerful
and present in everyday life than it was in pre-pandemic India.

64. • India went from importer of PPE kits to the second-
largest producer globally in just two months.
• This ecosystem worked together to create a home-
grown Covid-19 vaccine, making India one of the few
countries to have its own.