Remote Health Care Program: A Value Chain Analysis

Healthcare delivery system is attracting the attention of business houses, health care professionals and public health experts all over the world. With the inclusion of ICT (Information and Communication Technology) services being part of the healthcare delivery system the reach is improving slowly but steadily, with remote medical treatment being the new area of focus. The biggest beneficiaries of this would be the rural population and those in isolated places who have hardly any access to specialist medical facilities. Patients, those have to face the agony of travel and spend exorbitant sums of money to benefit from such remote expert medical treatment.
The actors in such a business ecosystem include the healthcare providers and technology firms. Its extends into the support organization which involves technology provisioning like the telecom providers, health delivery supporters which is majorly carried out by NGOs and charity organization in the rural areas and also organizations like C-DAC and ISRO (Indian Space Research Organization) which streamline funds from Government bodies into technology development for such causes.

There is multi-disciplinary involvement is delivering effective healthcare to the patients, who are at one end of the value chain.
There are noticeably two broad classifications of patients – those with chronic illnesses and others with acute ones. Remote healthcare seem to work more effectively for the former, where diagnosis and monitoring are essential, needing the senses of sight and sound, and occasionally touch to be transmitted from a remote location to the medical practitioner. Acute illnesses often warrant a physical visit, for a procedure or hands-on treatment. Ophthalmologic care centres like Aravind eye hospital, Madruai and Sankara Nethralaya, Chennai are effectively using tele-diagnosis and monitoring to follow up on or initiate a visit.
But, in many instances presently, there is a not-for-profit organization working between the healthcare provider and the patient. These NGOs may be independent ones, like the Rotary clubs across India, Development of Humane Action (DHAN), which promotes DISHA project to implement telemedicine in rural health centres and World Health Partners, who work on the Sky Health rural healthcare venture with Neurosynaptic Communications. Or, they are bodies floated by a particular hospital or technology firm, as in the case of Sankara Nethralaya at Gummidipoondi near Chennai. They, also, co-ordinate with ICT providers, and push for better and faster connectivity to enable this essential service to those who need it the most.
Provision of ICT is still at an academic, as opposed to a commercial, stage as far as remote rural healthcare is concerned in India. For one, ICT providers may be linked to academic research organizations on a mutual usage-research basis. In other words, the cost of technology for commercial viability of remote healthcare remains unexplored as connectivity is given by academicians or by government organizations as a donation. The best example is ISRO (Indian Space Research Organization), which is the only nation-wide provider of satellite communication systems for many tele-diagnosis platforms. It provides VSAT (Very Small Aperture Terminal) connectivity, for free, where as VSAT can by no means be the most efficient, cost or otherwise, if remote healthcare were to be treated as a commercial proposition. Sanjeevani and Aravind Eye Hospitals remote heathcare solution work on web based architecture.
Some potential areas for exploration in ICT for Internet Service Providers are broadband services based offering, kiosk models set up with a leased line, and GSM based services covered by good rural reach like BSNL.
The academic or research partners in these ventures have proved high efficiency of their methods in 'laboratory conditions'. IIT-Madras’ TeNet works with ReMeDi , which is part of the Sky Health Centre. Similar work is done by IIT-Kanpur’s Sehat Sathi with Infothela on Media Lab Asia funding. SGPGIMS and CDAC developed Sanjeevani and Mercury. AIIMS is working on a replicable model for IT based health system at the grass root level called the Ca: Sh, again funded by Media Lab Asia.
It is at the level of the hospitals that remote monitoring and diagnosis is truly varied and experimented on. Ranging from primary health care centres, where such endeavours are envisioned to provide monitoring for pregnancy, through medical colleges to corporate hospitals, many efforts are prevalent today. A PHC (Primary Health Centre) or a Government hospital may use it for anything from mobile awareness campaigns to stimulating hospital visits; corporate hospitals use it for long distance consultations. A good example of this is Apollo at Chennai.
The role of tech firms in the value chain is under-explored, as for one, connectivity is provided not-for-profit mostly, while some remote healthcare centres simply use the commercial internet service. However, there are tech firms like Philips which runs the DISHA. Wipro, CDAC and GE work with Apollo foundations to provide technology at the software end, in the form of software services named Radworks. Bangalore based Neurosynaptic has partnered in the research done by TeNet of IIT-M and developed ReMeDi, used in 'Sky Health Centres'.
Sales and servicing of ICT equipment, yet again, is underdeveloped. In fact, ISRO omits servicing out of its donation of VSAT equipment to hospitals, who then find it financially not viable to maintain them.
For such a niche area, the recommendations for a technology player are as follows.
1. Complete technology mapping is required
a. Specific areas of medical and ICT technology requirements to be identified
b. Areas with Low IT penetration should be identified and should be made potential markets
2. Mode of Operations
a. Involvement of NGO and Local skilled workers for logistics and health care delivery is required
b. Early entry into emerging projects and government ventures to be deliberated for early mover advantage
3. Business network development
a. Network with Hospitals and Insurance companies to be considered for better outreach to rural population
b. Project specific revenue models can be more successful than the out-right retailing
c. Must leverage present market presence in healthcare to generate business leads
4. Service delivery
a. Has to be benefit driven with low cost focus for rural population
b. A trickle down of international exposure and quality will increase marketability in the eyes of the consumer.