More than two-thirds of the population in India lacks immediate access to trained healthcare professionals. The problem is acute in rural areas, where three-quarters of the nation’s population makes do with one-fifth of the country’s doctors. But even middle- and upper-class urban patients contend with long wait times to see a specialist.
That lack of access comes with a sort of upside: The severe need to improve access to clinicians is spurring a fast-moving, well-funded and highly innovative new industry aimed at delivering some forms of healthcare to patients over mobile phones. The so-called “mHealth” revolution is picking up steam in the U.S. and elsewhere, but nowhere is it rolling out into the hands of clinicians and patients as quickly and widely as it is in India. A 2012 study by international consulting firm PwC found that India ranks 2nd among developing countries studied on maturity and readiness for mHealth adoption.
The World Health Organization (WHO) calculates that India has only seven doctors for every 10,000 people, half the global average. In some central and eastern states, the number falls to under five doctors per 10,000 people. Patients routinely have to travel as far as 100 km to see a clinician, an enormous burden on India’s working poor.
Meanwhile, smartphone growth is exploding in India, expected to hit 200 million users by the end of 2016 — more than in the U.S., and second only to China. The availability of smartphones as cheap as US$7.50 (INR 500) and lower-cost data services will help maintain that rapid growth.
Early attempts in India at enlisting mHealth to close the healthcare access gap merely connected rural patients to community health workers for basic health information and advice. But now smartphone applications are giving a range of patients instant access to extended medical consultations, second opinions from the world’s leading specialists, the refilling of prescriptions with a click, and real-time monitoring of heart rate, blood pressure, and other individual vital signs.
Many of these mobile-health platforms are being developed by small, nimble technology startups with a Silicon Valley vibe. Lybrate, one popular healthcare app, connects patients to more than 90,000 doctors within its network. Lybrate is helping urban patients connect to a specialist for high-quality care, while providing baseline consultations to rural patients unable to travel long distances. “Our platform is focused on accessibility,” says Saurabh Arora, Lybrate’s founder. “We want to bridge gaps and make it very easy for patients to connect to doctors.” Lybrate enables physicians to share medical reports, pictures, and other records with patients, and anonymously connects patients with other patients and physicians in chat forums that often cover taboo topics such as mental health and sexual health. Lybrate boasts nearly 5 million monthly doctor-patient interactions since early 2016.
Practo Technologies, based in Bangalore, has risen to become a powerful force and emerging leader in India’s burgeoning healthcare startup scene. Practo already boasts over 200,000 doctors, 8,000 diagnostic centers, and 4,000 wellness centers in their provider network, spanning 35 cities in India. The company aims to create a fully integrated healthcare delivery system that caters both to providers’ needs for easier ways to manage patient data and advertise their services, and to patients’ desires for transparency and convenience. Their main offerings include Practo Ray, a clinic-management web-based product and Practo Search, a consumer-facing doctor search application. “Healthcare only works when it is addressed end to end,” said Varun Dubey, a marketing executive at Practo. “The last thing healthcare needs is more silos.”
The entire Practo model aims to include all the players across the healthcare delivery chain, including small players. Take scheduling a doctor’s appointment. Practo has developed a suite of patient-facing services intended to function like a healthcare concierge who supports patients throughout the entire process. Patients can use its consumer-search app to choose a physician, book an appointment, and even get a ride to the doctor’s office, thanks to a strategic partnership with Uber. After the appointment, patients and caretakers can schedule follow-up appointments, check-in with their doctors to ask any lingering questions, and set medication reminders that serve the dual role of automatically tracking treatment compliance. Practo is also experimenting with new features that will enable patients to refill prescriptions and order medication for home delivery automatically through the app. For patients who are unable to access a doctor in person, or for those who simply would like a more convenient way to get an opinion, the company also launched an e-consultation app in early 2016. Known as PractoConsult, the app connects patients with medical providers and enables them to get real-time medical advice. “One in five searches on Google are for healthcare, which drives self-medication and mis-medication.” said Dubey, explaining Practo’s rationale behind the new feature. “There are a lot of bad sources out there giving people poor information.”
Also helping patients zero in on good healthcare information online is MediAngels, which markets itself as an “online hospital.” MediAngels lets patients send queries to or engage in video chats with a network of almost 500 specialty doctors from 15 countries for a small fee. With over 100,000 registered consumers, MediAngels has established itself as a provider of second opinions and specialty consultations, and is rolling out at-home diagnostic tests and personal medical record management.
As with Practo and Lybrate, physicians in the MediAngels network must go through a vetting process, the results of which are available to patients to browse. In addition to user reviews, patients can peruse information about provider credentials, specialties and past research. Dr. Arbinder Singal, a pediatric urologist who founded and is now CEO of MediAngels, believes this open-marketplace approach to healthcare has a big advantage over the traditional system, particularly in a country where nearly 80 percent of the population pays for healthcare out of pocket. “MediAngels provides transparency that is lacking in other parts of the healthcare system,” says Singal. “The consumer has absolute power to decide which doctor they want to see.” He claims the service will be of use to both patients and insurance companies by steering patients away from receiving unnecessary or inappropriate care.
Despite the country’s low insurance penetration, insurance companies have recognized the value in connecting patients to healthcare outside of expensive hospitals. Practo and Lybrate have already begun partnership talks with some insurance providers. Lybrate’s Saurabh Arora says insurance is waking up to the importance of mHealth services because of the potential cost savings.
Virtual consultations are likely just the beginning for mHealth. Smartphone applications could, perhaps in just the next few years, integrate patient medical records with individual data from implantable or wearable medical equipment, such as pacemakers, cochlear implants, and insulin pumps. Others could act as high-definition cameras and microphones that allow patients to record the sound of their lungs and heartbeat. “There are just so many aspects of healthcare that technology hasn’t touched,” says Arora. “Moving forward, these sectors will be utilizing technologies more effectively.”
Security remains a big concern in mHealth. Aside from the general risks of health data falling into the wrong hands, stolen biometric data could in theory be used to allow hackers to break into secure systems that rely on fingerprints, eye scans and other physical characteristics. Yet India currently lacks a strict and comprehensive patient data-privacy legal framework comparable to the U.S.’s HIPAA regulations. The Indian government is in the process of setting up its National E-Health Authority to set and enforce privacy and security standards regarding electronic health data. Those standards could eventually create friction for the development and spread of mHealth applications in India. Moreover, there are no specific laws which govern activities of doctors providing medical guidance through mHealth. Medical providers who handle diagnosis, treatment and prescription over the phone are still bound by the same legal framework that can result in charges of liability, negligence, and malpractice.
In spite of these challenges, mHealth seems to mostly face enormous opportunities. Some of them may be outside of healthcare proper: Pharmacies and the growing field of mobile prescriptions also remain uncharted and highly promising territory. Saurabh Arora of Lybrate explains that “Pharmacists do not sign off on prescriptions; nothing is digitized.” He sees promise in mobile apps, like his own, that enable easier and more accountable patient-doctor-pharmacist interactions.
Mobile healthcare may yet prove to be the best tool yet to empower patients and deliver care to underserved regions. If so, India could be setting the stage for the next big leap in healthcare quality, access and value.
— Ali Greatsinger
Ali Greatsinger is the senior editor at GHCi.