7 April, 2021

Majority of people pay attention to health when they really get sick. Care givers in a hospital set-up attend to such patients generally with a two pronged strategy; (i) perform clinical examination and order some diagnostic tests to understand the underlying cause of the ailment and (ii) prescribe a few medicines to take care of the health till the time the laboratory, radiology or pathology produces a detailed report. Doctor may then either continue the course of treatment or alter it based on the new knowledge acquired through these diagnostic reports. Barring a few chronic diseases, this episode is closed leaving clinical record to be retained and referred when the patient is brought to the same hospital again. This entire paradigm is tantamount to Health Repair instead of Health Care.

Emergence of innovative technologies is rapidly changing the entire ecosystem. People are seen wearing devices like fitbit, Goqii etc. These devices measure their daily steps walked, quality & quantity of sleep etc. and prompt them to record their water consumption, dietary consumption and many other activities to monitor their lifestyle. Several Smartphone apps are now able to measure and monitor various vital health parameters. Bluetooth enabled devices connected with smartphones now facilitate monitoring of such parameters without any active human intervention. ECG, Blood Pressure, Pulse, Oxygen Saturation etc. could be monitored through such devices. These devices are getting miniaturized and increasingly affordable. This trend is set to accelerate.

Connected Care

Hospitals are investing in technologies that bring patients under remote monitoring by tapping into the data collected by such wearable devices and generate alerts when certain parameters become abnormal requiring active clinical intervention. For example, in the event of detecting a heart attack, ambulance equipped with lifesaving facilities could be scrambled to patient’s location and active treatment can start there itself under remote guidance of an expert sitting inside the hospital.

This concept of data capturing, sending to central repository, processing and signaling alerts form part of concept called Internet of

Medical Things (IoMT)

Imaging Systems are also being endowed with communication capabilities so that medical images can be directly sent to a central imaging repository (a Picture Archival & Communications System, PACS). The PACS allows for easier handling of medical images and makes them available to a physician on demand, and remotely.

Smart hospitals are going to be part of an integrated, interconnected ecosystem that includes government data platforms, population health agencies, payers as well as other providers. Data sharing among entities (to the extent permissible by law) is crucial to ensure that patients receive high quality healthcare efficiently and conveniently.

Robotic Telepresence

Hospitals have been using Robotic Process Automation (RPA) for some time now, but these areas have mostly been limited to operational aspects only. However, robotics holds promise in several key patient care areas. One such emerging area is Robotic Telepresence. One of the complaints about a conventional hospital setup is the painfully long wait time. In emerging countries, and in rural locales, the wait time for even a basic check-up or a follow-up could be hours. The loss of productivity, patient and physician frustration, and operational chaos in the hospital during this time can all be alleviated using robotic telepresence systems. These systems connect the patients with the physicians virtually. A physician need not be present in a hospital or clinical setting for periodic checkups; similarly, a patient can videoconference physicians at predetermined times. This will help improve hospital efficiency.

Clinical Decision Support System (CDSS)

Errors are not uncommon in healthcare delivery setup. Medication errors, surgical site errors, hospital acquired infections etc. are unfortunate realities. There are several stakeholders in a care delivery system including doctors, nurses, paramedics, phlebotomists, pharmacists, dieticians etc. and care delivery workflow passes through several stations and several individuals. Any communication gap at any stage could cause undesired effect on the outcome. Electronic health record systems are increasingly being used to minimize or eliminate this communication gap ensuring necessary and sufficient data capture and avoidance of verbal instructions.

Information systems are becoming increasingly smart as a myriad of data is collected through wearable devices (vital parameters), investigation reports are available with trends of results (e.g. CBC, LFT, Lipid Profile, KFT, TFT etc.) and once aggregated for several thousands of patients, it is becoming easy to pinpoint the exact health condition of the patient. IT is bringing research at the doorstep of clinicians. Concerned research papers pop-up based on the specific health condition and point the clinician to the latest protocols being followed as best practice. Advanced diagnostics e.g. Next Generation Sequencing (NGS) further helps selecting precision medicines and personalized medicines. Doses are calculated based on the approved formulae and in case of a prescription above or below tolerance range, system generates an alert of overdose or under-dose. Equipped with predictive analytics, these CDSS systems are becoming increasingly productive and will enhance clinical outcomes significantly in terms of speed and accuracy of clinical decisions.

AI Enabled Diagnostics

Deep neural networks can help diagnose a range of diseases by image analysis, and research suggests that the AI now has a diagnostic accuracy rate to that of human physicians. Using advanced Machine Learning algorithms, CT and MRI images can now be analyzed to detect cancer cells using texture analysis to the level of accuracy that could otherwise come from microscopic examination of the tissues after biopsy. AI is bringing Radiology and Pathology to a much greater convergence. Future of the diagnostics seems progressing very much on this line.

Breaking New Frontiers

Use of Robots in ICU and Operation Theatres is being contemplated and is even being experimented. As early as 2015, surgeons affiliated with Florida Hospital Nicholson Center (Celebration, Fla.) used a surgical robot system to simulate telesurgeries. The team successfully performed surgeries on a simulator that was located in Texas- more than 1200 miles away. A surgical team at St. Joseph’s Hospital Hamilton in Ontario, has a better story to tell; it has operated on actual patients located hundreds of miles away, performing biopsies and minor surgical procedures through remote control of surgical robots.
While hurdles in the wide-scale adoption of telesurgery had been attributed to technical uncertainties that could affect real-time control and patient safety, these pilot studies have shown that the biggest hurdle today is psychological.

The Road Ahead

Hospitals have long been reluctant to adopt emerging technologies and practices, primarily due to the high investment involved. However, with the cost of technology falling sharply, and fast developing digital connectivity, hospitals will now be forced to embrace new technologies. Besides helping patients, these changes will benefit the hospitals themselves by digitizing asset tracking, personnel management and scheduling for better operational efficiency.
In the distant future, patients may well end up not going to hospitals, instead having all services performed from a distance. That could be the future of hospitals!

Dr. A.K. Dewan
Director – Surgical Oncology


Mr. J.P. Dwivedi
Chief Information Officer


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