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Point of Care Healthcare Technology in India – Challenges and Journey Ahead: A clinician’s perspective

By Dr. T. Sunder

This article initially addresses the current healthcare scenario in India and current POC technologies available. It then looks at how these POCT may be “fit” in the Indian Healthcare model. The various challenges in adopting POCT are discussed along with possible solutions.

Point of Care Technology (POCT) refers to the ability to acquire clinical parameters where the patient is, thereby allowing faster results. It is evident that POCT only ensures quicker test results i.e. faster turnaround times (TAT). How the faster TATs are utilized by the healthcare delivery chain dictates the improvements in patient outcomes. Hence, it is must be emphasized that POCT by itself does not lead to better clinical outcomes. While technological advances pertaining to POCT, in the last two decades, have been impressive, its relevance in developing countries needs to be seen in the perspective of the available healthcare infrastructure of these countries.

Indian Health Statistics and Indian Healthcare System

The population of India is 1.21 billion (Census 2011) with 68.84% of people living in rural areas and 31.16% in urban locations.[1] In terms of healthcare personnel, it is estimated that that there is only 0.6 doctor per 1000 population.

Health Status Indicators

In terms of Health care indices, while there has been significant achievements in terms of life expectancy at birth which has increased from 36 years in 1951 to 64 years in 2011 and the Infant Mortality Rate (IMR) has dropped from 146 in 1951 to 50 in 2009, there is still room for improvement – India lags behind many other countries. Of note, the Maternal Mortality Rate (MMR) is still high at 254 maternal deaths per 100000, compared to fewer than 10 in some developed economies such as UK and Japan. [2]

Dual Major threats

In India, it is anticipated that both communicable and non-communicable diseases (NCD) will continue to rise and be major Public Health Concerns. NCD such as cardiovascular diseases, chronic Respiratory disease, Cancer, and Accidents, account for more than half of the deaths in our country. [3]

Point of Care Technology

Geographically speaking, POCT can be delivered in various settings:

  • Remote location
  • Physicians’ consulting office
  • Hospital Based in Emergency Room, Operation Theatres, ICU.

POCT also can be used for:

  • Therapeutic Aid: Treatment of diseases like diabetes, myocardial infarction.
  • Preventive measures: Targeted Screening in high risk groups. e.g., checking for diabetes in patients with positive family history
  • Surveillance measures: Monitoring blood sugars, INR check after heart valve surgery, etc.

POCT in conjunction with EHR (Electronic Health Record) has been shown to reduce mortality. Hence, POCT & EHR along with Telemedicine will go a long way in providing Healthcare to patients in remote locations.

Healthcare Delivery Chain

This comprises the numerous personnel/technologies involved in the delivery of healthcare. Traditionally healthcare involved direct contact between the physician and patient.

Figure 1: Traditional Healthcare

Figure 1: Traditional Healthcare

However with the advent of modern technology and POCT, quality healthcare can be delivered at rural/remote locations, too.

Figure 2: Modern Healthcare

Figure 2: Modern Healthcare

Challenges in implementing POCT in India and Possible Solutions

• Patient factors
Literacy and Economic status: Often illiteracy compounds problems in healthcare delivery. This in combination with poverty remains the main issue. “Universal Health Coverage by 2020” by the Government of India addresses this issue and projects are currently underway based on recommendations of the High Level Expert Group.[4]

• Healthcare staff
Where there are insufficient doctors, Community Health Workers (CHW) may be “empowered” to undertake some tasks i.e. Task Shifting. They may be trained to perform minor procedures/POCT and report to a central unit manned by a physician. The acceptance of any procedure is usually better when vouched for by CHW. Eg. Maternal Health: CHW can visit antenatal patients of their villages and a small POCT kit – which measures Hemoglobin, urine dipstick for protein and an inexpensive electronic BP apparatus will go a long way in reducing MMR – which is still high in our country.

• Infrastructure
In addition to the prevalent system of Subcentres, Primary Health Centres, Community Health Centres and Hospitals, various small kiosks or booths can be set up with telemedicine facilities and networking capabilities to enable connection with doctors at central units. In the long run, these attempts would provide huge savings in terms of transportation costs avoided.

• Physician Factors
Physicians across the globe, in general, have been very slow and gradual in adoption of technology in their workflow. Reluctance to change existing practice, time-restraints, “unfriendly” software, software designed by non-medical experts and those not tailored to individual physician needs, are some of the main causes in the failure of universal adoption of technology by the medical fraternity. Physician motivations by incentive and disincentive schemes, demonstration of improved health care are steps that are urgently needed.

• Technology Factors
Currently, hospitals across the globe have their own EHR and HIS (Hospital Information Systems). These systems, while they work very well as standalone products, seldom communicate with one another. This emphasizes the need for individual patient records which are cross-compatible across all platforms.

• Overwhelming Need for Data
There is a need for Indian Data – beyond the currently available crude demographic data. Burdens of Disease in India are largely estimates based on pilot studies and the accurate burden may be much higher. Accurate data allows accurate needs-assessment and this has an impact in budgeting for health care by the healthcare policy makers and also for allotting appropriate personnel.

Conclusion

While there have been significant improvements in health in our country, there is plenty more to be accomplished. The high penetration of mobile phone technology in our country (over 900 million mobile phone subscribers) [5] can be used in promoting mHealth – by means of which POCT results may be transmitted using mobile phone technology.

For Further Reading

1. “Family Welfare Statistics in India, 2011,” Statistics Division, Ministry of Health and Family Welfare, Government of India.

2. “World Health Statistics Report 2010,” World Health Organization

3. “NCDs Policy Brief – INDIA,” The World Bank, South Asia Human Development, Health, Nutrition and Population, February 2011.

4. ” Report on Universal Health Coverage for India by the High Level Expert Group, November 2011,” Public Health Foundation of India

5. TRAI – Telecommunication Regulatory Authority of India, January 2012.

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January 2013 Contributors

Nitish V. ThakorNitish V. Thakor is a Professor of Biomedical Engineering at Johns Hopkins University, Baltimore, USA, as well as the Director of the newly formed institute for neurotechnology, SiNAPSE, at the National University of Singapore. Read more

Atam DhawanAtam Dhawan, Ph.D. obtained his B.Eng. and M. Eng. degrees in Electrical Engineering from the University of Roorkee, Roorkee, India... Read more

Clifford DacsoClifford Dacso, MD, MPH, MBA is Professor of Molecular and Cell Biology and Medicine at Baylor College of Medicine, John S. Dunn Sr. Research Chair in General... Read more

Ritu KamalRitu Kamal works at Stanford Biodesign Program, Stanford, CA, as a Global Research Project Manager. She has previously worked at Roche Diagnostics as a Scientist and was a 2010... Read more

Christine KuriharaChristine Kurihara is Manager of Special Projects, for the Stanford Biodesign Program, Stanford, CA. In this capacity, she oversees IT, web and infrastructure projects for the program. Read more

Dr. Anurag MairalDr. Anurag Mairal is the Director, Global Exchange Programs, Stanford University, Stanford, CA. In this role, he is responsible for developing an extensive network... Read more

Dr. T. SunderDr. T. Sunder is a Senior Consultant Cardiothoracic and Transplant Surgeon in Apollo Hospitals, Chennai, India with over 20 years' experience in Cardiothoracic Surgery... Read more