Back to the Future
Simply Said

Back to the Future

Dr. Rajesh Prabhakaran

From the days of B-school that were laced with case studies of IKEA and Walmart, to recent times when the latter acquired Flipkart, the story of modern retail always seemed fascinating to me. As any retailer, in a constant effort to offer the best prices to customers, IKEA has traditionally followed a ‘do it yourself’ approach. This means that IKEA customers have to choose, take delivery of the product and assemble it- all by themselves with minimal support from any ground staff. Having visited many IKEA outlets around the world, this time I had noticed a lot more sales assistants and support personnel on the shop-floor in Dubai. Intrigued, I wanted to validate this surprisingly different approach.

As luck would have it, a few days later, and a few blocks from the central business district of Dubai, I had the opportunity to interact with someone from the leadership team of IKEA. Sitting and soaking in the ambience of his serenely decorated drawing room, I had to pop the question. The ensuing conversation made it clear that as part of improving customer focus in the region, the team thought it important to have more personnel on the ground, and thus offer a better buying experience to customers. By the end of the chat, I was left wondering that if customers are looking for validation and support from a human face when they are out shopping for home decor and furniture, wouldn’t that need be more pronounced when visiting a hospital or consulting a physician. Healthcare has traditionally been people intensive and human interface was a strong component of healing, especially between the physician and the patient. On the other hand, retail, whether traditional (brick and mortar) or modern (e-commerce), always had a strong technology component. Paradoxical it may be, the physician today is concerned if technology is adversely affecting their human connect. The retailer, despite the technological prowess at disposal, too desires to improve human connect.

Exciting Times

The world of healthcare-tech is indeed abuzz with the potential of Artificial Intelligence (AI) to Wearables, Automation to Nanotechnology and e-commerce to Internet of Things (IOT). Incidentally, a 2013 study published in the Indian Journal of Clinical Practice had found that more than ten thousand medicine brands in India were either similar looking or similar sounding. This challenge is extensive and spread across the country, and potentially could lead to compromising patient safety due to confusion. Leveraging on technology, the government is considering a databank for all medicine brands to prevent stakeholders from using the same or similar looking and sounding brand names for drugs.

The New York-Presbyterian hospital with a 45,000-strong workforce and an annual budget of about $8bn has embraced telemedicine consultations using video screens for everything from psychiatric consultations, to gathering second opinions, and even live video chat with an emergency medicine physician. In 2018, they would have more than 100,000 such virtual patient visits, thereby improving access to quality healthcare at much lower costs. As we read this, smartphones are assisting grassroots health workers in capturing data, new-age medical devices help in early detection of lifestyle ailments, drones are delivering medical supplies to remote locations, and the click of a few buttons enables access from medical consultation to diagnostic tests. Amidst all these exciting developments, let’s turn our focus to something simpler called Digitization and its implications.

Times of Digitization

Concerned stakeholders have realized the need to collect and use health related data in improving the public healthcare delivery system and, digitization is one of the key changes being attempted in India as well. Digitization of health records also allows clinicians to help patients in ways that hadn’t been possible before. The ability to adjust protocols electronically helps in rolling out changes faster as new clinical evidence comes in. The ability to pull up records from all institutions that use the same software can drive real improvements in care. Towards this, the manual system of collecting health data in India was reorganized and computerized to make way for a new Health Management Information System (HMIS) which takes care of all the health-related data needs. In addition to the health system and health programs, the use of HMIS has also increased in hospitals. However, it is widely accepted that the three main issues that concern HMIS are timeliness, completeness, and correctness of reports. A 2018 journal article focusing on such challenges in the state of Bihar pointed out that we are still lagging behind in achieving quality HMIS data, primarily due to lack of correctness and consistency of data entry.

At the outset, it may be interesting to know about what’s happening in other countries that are ahead in the curve of adoption of digitization of healthcare data. In his acclaimed book ‘How Doctors Think’, Jerome Groopman writes that the “three C’s” every patient seeks from her/his physician was Communication, Critical reasoning and Compassion. Even in the pre-digitization era, it was noted that, on an average, physicians interrupt patients within eighteen seconds of when they begin to tell their problems. In the article titled ‘Why doctors hate their computers’ published in The New Yorker, Dr. Atul Gawande explores different facets of digitization of health records. It is observed that physicians spend about two hours doing computer work for every hour face to face with a patient. In the examination room, physicians devoted half of their patient-time facing the screen to do electronic tasks. Research from Mayo Clinic has shown that one of the strongest predictors of burnout was how much time an individual spent time on computer documentation. As digitization spreads, health-care professionals are feeling similar effects from being screen-bound. Studies have shown alarmingly high rates of burnout among physicians already; data from US shows that 28% of residents experience a major depressive episode during training versus about 7% in similarly aged individuals in the general population.

Nostalgic Times

It was an early winter evening in the Garden city and catch-up time with friends. Sitting across the table was a childhood friend who had practiced medicine in the UK and was now attached to a tertiary-care teaching hospital back home. We compared the cultures of east and west, delved into Pink Floyd, sampled single malt, re-visited Hollywood, and of course, some ‘men will be men’ chats. As the evening progressed, we also did reminisce our days as medical students. Those days, when we were taught that evaluation of patients should follow a discrete linear method, and once every data is compiled, should we proceed to a decision making, thereby formulating a hypothesis on what may be wrong. Walking down the same alleys and corridors almost two decades later, but now matured as a teacher, my friend captured it well when he summarized, “It’s easy to capture the history and findings from a patient in a pre-defined format but then each patient has a different story. And I tell my students, it’s this unique human story that’s most important while assessing the patient.”

His words reminded me of studies in primary care that has proven that patients accurately gauge the fact how doctors actually felt about them, thereby stressing on the emotional dimension of the patient-physician dialogue. Technology will definitely increase our ability to make faster and accurate diagnoses, to better visualize the human body and even to offer personalized treatments. While technology can be the best of enablers working at the background, obscuring the interface between the Patient and Physician may not be the ideal approach. Digital screens could help us go green but it may also end up giving us more blues.

Post-script: For many other doctor friends, who may not be practicing in a top-tier hospital or city, and many a time operating amidst a crumbling infrastructure, it’s a grueling task to meet, talk, examine and diagnose up to 250-300 patients in their routine OPD sessions. I can imagine them asking perplexedly, “Digital what?”

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The author is Co-founder & Director @ BioQuest Solutions Pvt. Ltd, a Bangalore based MNC that has been partnering with clients across the life-sciences knowledge value chain since 2005. He is reachable on: rajesh.prabhakaran@bioquestglobal.com

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