Life Line: Apollo’s digital disruption to delivery of healthcare in India
Digitization of healthcare in the developing world plays the role of plugging critical gaps in healthcare access, quality, and affordability. Apollo Hospitals is one of the first hospital chains in India to fully digitize its value chain, thereby transforming its traditional models of service delivery and operations, and driving last-mile delivery of critical healthcare services.
Indian healthcare is a US$ 100bn industry[i], yet India struggles to provide quality healthcare to massive sections of its population. 70% of India’s population lives in rural areas, which face a 60% shortage of doctors.[ii] Public hospitals, the primary source of care for rural low-income populations, are often dysfunctional; private hospitals promise better quality, but are unaffordable and inaccessible to populations outside major cities. With the penetration of smartphones, internet, and computers, hospitals in India are ushering an era of digital healthcare. Apollo Hospitals (2016 revenues: US$ 890mn[iii]), a chain of 64 hospitals across India (and abroad), is one of the first Indian hospital chains to fully digitize its entire value chain and offer integrated digital solutions to its patients.
Business Model
Apollo embraces IoT as a business tool rather than a technology initiative to provide effective inpatient care, post-discharge care, and preventive health services. Through its digital efforts, Apollo creates value for its existing patients and attracts new patients by offering improved access, quality service, speedy diagnosis and treatment, and better clinical outcomes. Key aspects of Apollo’s digital business model include:
Telemedicine: Apollo creates access to healthcare in remote areas by setting up a hub-and-spoke telemedicine model in which doctors in cities consult patients in far-off locations over the internet. With 115 telemedicine centers[iv], Apollo operates one of India’s largest telemedicine networks to ensure last-mile-delivery of critical healthcare services. To further extend its reach, Apollo is collaborating with the government to connect 60,000 frontline health workers across India to specialists.
Disease Management: Apollo uses IoT to empower patients to manage their health once they leave the hospital. For instance: SUGAR, a diabetes management initiative, enables constant monitoring of blood sugar levels using IoT-enabled technology that also creates personal health records, which patients can share with clinicians through the system to get expert advice on managing their sugar levels.[v]
Apollo Health Hiway: Apollo’s National Health Data Network connects 200,000 doctors to each other to map changing disease patterns, alert the medical community about emerging health problems, and make more informed decisions[vi].
Patient Mantra: When patients come in for tests, a patient tracking and monitoring system based on RFID and IoT enables the hospital to manage the flow of patients through various departments, saving patients time that was previously spent waiting for a procedure to take place, and allowing the facility to serve more patients each day, due to added efficiency.
Operating Model
Apollo is striving to connect medical equipment to information systems so that all devices can be connected to a larger network, which in turn is connected to a monitoring system. To reduce IT expenditure, Apollo’s Hospital Information System is on the private cloud and takes care of the entire supply chain and the medical administration, while also blending into the electronic medical records for doctors.[vii] Key elements of Apollo’s operating model include:
Remote ICU monitoring systems: Apollo’s e-ICU network virtually connects all of its ICUs such that a team of experts can constantly monitor critical patients in distant facilities, and suggest treatment procedures after assessing medical history and real-time heart rates of patients fighting for their lives.
RFID-IoT: Using an RFID-IoT-based patient tracking system, Apollo hospitals manage daily bottlenecks and maximize utilization across different departments by seamlessly moving ~250 patients through a series of upto 26 diagnostic procedures daily.[viii]
Unique Hospital Identification (UHID): UHID ensures patients across India have a single electronic instance of their health records, which can also be integrated into wearable medical devices. UHID combined with IoT substantially speeds up diagnosis and treatment since doctors can now access radiology and CT scan reports anywhere through tablets or smartphones and provide suggestions to the care teams.
Apollo Center of Excellence: Apollo’s IT-enabled quality-control platform monitors 25 quality parameters across hospitals to benchmark against global standards.[ix]
Medication Management System: An automated drug database provides electronic alerts for all drug-drug and drug-food interactions to improve safe administration.
Going Forward
Leverage Big Data and Predictive Analytics: Apollo already uses digital platforms to obtain patients feedback and must leverage big data to improve service delivery and drive innovation through predictive analytics.
Train doctors and patients: Apollo must proactively address the concerns of traditional health professionals who are resistant to IoTs by training them on the value of going digital to serve patients more effectively and efficiently. Similarly, Apollo should train and educate patients to seamlessly transition to digital interactions.
Prioritize m-health: Smartphone penetration in India is expected to grow to 520mn by 2020[x] and Apollo must bolster its m-health capabilities to tap into this market.
Build interoperable platforms: As Apollo strives for scale by working with other stakeholders such as the government, it will have to transition away from proprietary platforms to open platforms that can be freely shared, adopted and customized to local needs.
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ENDNOTES
[i] India, and Healthcare India. “Healthcare Industry In India, Indian Healthcare Sector, Services”. Ibef.org. N.p., 2016.
[ii] IndiaSpend, (2012). Rural India Faces 60% Shortage of Doctors. http://www.indiaspend.com/sectors/rural-india-faces-60-shortageof-doctors; Business Standard, (2011). 70% Indians live in rural areas: Census. http://www.business-standard.com/article/economy-policy/70- indians-live-in-rural-areas-census-111071500171_1.html.
[iii] Apollo Hospitals Group Annual Report 2015-2016, https://www.apollohospitals.com/apollo_pdf/annual-report-year-2016.pdf
[iv] Center for Health Market Innovations, Access Health International,. Apollo Telemedicine Networking Foundation (ATNF). 2011.
[v] Sethu, Kavya. “Current State Of Internet Of Things (Iot) In India – IOT League”. IOT League. N.p., 2015. Web.
[vi] “Apollo Hospitals Group Celebrates 25 Years Of Touching Lives”. Apollo Hospitals. N.p., 2009.
[vii] Economic Times,. “How Arvind Sivaramakrishnan Is Driving The Digital Agenda At Apollo Hospitals”. 2015.
[viii] “Patient Tracking Solution – ‘Patient Mantra’ For Apollo Hospitals – RTLS/RFID Based”. Icegen Computing.
[ix] “Commitment To Excellence | Indraprastha Apollo Hospital Delhi, India”. Apollohospdelhi.com.
[x] Ernst and Young,. Future Of Digital Content Consumption In India. 2016.
Rashi, this is such an encouraging post on healthcare access in India! Given that access to technology (and even electricity) is relatively limited in rural India, how does Apollo plan to ensure patients don’t get disconnected from this systems? I see a huge opportunity for them to work with local governments in improving infrastructure in villages that will ensure smooth delivery of healthcare to the last mile. Further, since education levels are dramatically low, I wonder how much of a barrier it is for Apollo to educate patients.
Additionally, are there any checks and balances in place on privacy data of patients? Do you think that the government should play a bigger role here? A big risk that I see here is Apollo forward-integrating into becoming a private insurance player for rural populations and using their medical data against them to drive up insurance premiums.
Great post Rashi. I have witnessed the ‘Patient Mantra’ system that you pointed out. Apollo is one of the few hospitals which has the highest in-patient utilisation rates. The RFID is a low-cost solution to manage the high-volume traffic that Apollo receives on a day-to-say basis. But my only concern is that how can they extend the patient monitoring to storing and using patient health data. Apollo still makes patient carry thousands of files and paperwork, which increases the cycle time of patient visits. Can this RFID approach enable doctors to have access to all patient records as the patient gets ready to seek advice? I may have missed out, but you’ve mentioned that UHID does the patient data storage, is it linked to RFID by any chance or these are two different systems that are not linked?
Thanks for the really interesting post, Rashi! Apollo has progressed the digitization of hospitals in India by leaps and bounds with their technology initiatives over the past few years. My concern with many of these initiatives is that they are heavily dependent on scale. While Apollo does have large hospital footprint- the key to a sustained competitive advantage will be the compatibility of its systems across all hospitals in the country, not just Apollo hospitals. UHID for instance, completely breaks down once a patient visits any other hospital, even if it is to treat a different condition. Moreover, there are a number of technology startups that are developing systems for patient data collection, remote monitoring and tele-medicine which can be used across hospitals in the country. If these startups are able to achieve scale, Apollo may need to switch over to these new systems and forgo much of the technology and IT infrastructure they’ve built in-house.