MD Exclusive Interview: Dr Lalit Singh, ELSEVIER on Impact of Technology on Healthcare

In recent times Technology has indeed emerged as driving force for all major improvements in healthcare. In a country like ours, where policy makers struggle to take healthcare to each and every corner of the society, healthcare innovations and advancements in technology have emerged as a critical component for solving complex healthcare issues, whether dealing with issues of access, efficiency or even quality of care provided by healthcare professionals.

Medical Dialogues team interviewed Dr Lalit Singh, Director, Content & Product Strategy, Elsevier Health, to get his viewpoints  on the growth of healthcare industry and the role that technology can play facilitating the much needed growth in the Indian healthcare sector

Q) You talk about technology being a key enabler for hacking the growth in healthcare sector. Tell us more about how technology can be used to fill the existing gaps in Indian healthcare system.

Dr Lalit Singh –Healthcare is one of the most undeserved segments in India and, therefore, has huge potential for growth. Various estimates put different numbers to the growth potential, but irrespective of which estimate we follow, there is no doubt that if we are able to crack the code to provide adequate quality healthcare to all 1.3 Billion Indians, the sector will see immense growth.

The wide gap between demand and supply of healthcare services in our country has already attracted large private investment over last decade. But,we need a lot more investment in this sector to adequately fill in the gap. The real questions to me are - what should be the focus and nature of further investments in this sector, and if it is possible for us to bridge this gap only by building new hospitals and clinics?While we certainly need many more healthcare facilities and teaching institutions to make care accessible and educate more health workers, we need to also focus on efficiency and equitable distribution of the facilities and quality of delivered care. And it’s on this fundamental “value” argument, where I believe that technology will be the key enabler for hacking growth in healthcare industry!

Q) As you also have indicated above, taking healthcare to masses, particularly to rural areas and far off places in the country has become the Achilles’ heel of Indian Healthcare. What is holding us back on this front? Can technology help in closing this gap?

Dr Lalit Singh –We have been talking about universal healthcare coverage for all Indian citizens for many years now. While it’s a good aspiration to have as a nation, what we have not really seen coming from our policy makers is a concrete action plan to achieve this ideal state. A deep dissection of this issue of access to healthcare reveals that it’s a complex of some very fundamental problems, which need to be addressed in entirety. In my view, the key problems are inadequate and poorly maintained physical infrastructure, massive shortage of trained human resources, lack of real population health policy and initiatives.To top it all,there’s grossly inadequate allocation of funds for running the existing machinery in the public sector. Another dimension of this issue is an over-reliance on private sector to provide healthcare. Naturally, private sector healthcare is profit driven and has thrived in large cities and in tertiary care segment. These two factors combined have left a big gap in the area of primary and preventive care, especially in non-urban areas and far off places.

The finance minister announced some initiatives with far reaching consequences in the Budget 2017, the most significant ones of which include a higher allocation of funds for healthcare and national health mission, and a plan to increase the number of seats in medical schools at both MBBS and MD level. However, these initiatives will take at least 10 to 15 years to create meaningful impact, provided these measures are continued on a sustained basis. I believe technology can play a big role in improving the access to healthcare in the shorter run, besides being an essential complement tolonger-term interventions.

For example, think of a state-sponsored online self-symptom checker using individual patient’s clinical data, location specific environmental data and approved national guidelines – all of this coming to life using artificial intelligence. If we have such a simple online/ mobile tool for all citizens to help them make evidence-based decisions on if and how to seek medical opinion for their ailments inform them on the nearest health facilities about what kind of cases they can expect, we would have a different level of healthcare in our country. While people will have better and more timely access to care, there will be a reduction in workload and administrators will be able to plan their services and staffing much better and in advance, thereby improving both quality and efficiency of healthcare. At the same time, the policy makers will have much faster access to real life health indicators at both country and local levels and they will be able to roll out policy level interventions in a timely and more effective manner.

There are many similar use cases, where simple tools based on big data, artificial intelligence and the Internet of Things and delivered using a country’s vast mobile network to help improve access to healthcare for the masses.

Q) Another big issue is the severe shortage of healthcare manpower in our country. How, in your opinion, can technology be used to address this issue?

 Dr Lalit Singh –Actually the manpower issue in Indian healthcare has two dimensions –quantity as well as quality. Not only do we have a massive shortage of trained healthcare workers – doctors, nurses as well as paramedics, the quality of our healthcare resources is also not consistently good.

Not only do we not produce enough doctors and nurses to meet the current requirements of our country, a significant number of these qualified professionals leave the country every year, thereby leaving a big gap on the supply side. The government has, over the last two decades, taken many steps to boost the number of doctors and nurses in India, which includes starting new medical and nursing schools, upgrading older academic centers to admit a larger no of students, allowing specialty training for doctors in large hospitals and, very recently, allowing the private sector to start medical colleges. These are, no doubt, good initiatives and have resulted in doubling the number of MBBS quota and increased the number of specialist clinicians in the country. However, in the absence of proper regulations, due to the inadequate learning infrastructure in many new colleges and a lack of proper quality check, the overall quality of education and training has actually gone down. As a result many graduating students – both medical and nursing - don’t meet the required competency levels required to practice after graduation. Thus, the whole issue of manpower shortage can be seen as a combination of many factors - shortage of seats in colleges, inadequate teaching infrastructure in colleges, lack of quality standards in education, poor regulations and brain drain.

Technology can help us manage many of these factors. For example – standardized learning aids delivered to students when they need them and that are catered to their learning behavior and abilities can help them grasp concepts better. Tele-education obviates the need for having a minimum number of faculty members in all specialties in each campus, thereby addressing a key issue of shortage of qualified teachers in medicine. Virtual practice tools for key clinical skills will allow students to practice and learn the clinical skills more effectively and improve their clinical competence. Smart learning management systems allow teachers to effectively manage the students in their class – they can know which students need closer supervision for which subjects/ topics and can, therefore, address such individual learning needs of the students. In fact, many of such tools have already been adopted in the technical and management education in India, but not healthcare.

Q) How do you think can technology be used to make healthcare more affordable for masses?

Dr Lalit Singh –Healthcare, in its present form in our country, is actually a misnomer in many ways. It would be more appropriate to call it sick care, for a large majority of the system is actually dedicated to care for the sick instead of promoting health at a community level. Furthermore, since more than 80 percent of the care is delivered by the private sector, which primarily operates for profit making, and is paid for out-of-pocket, seeking care is always a costly affair for a large majority of our countrymen. Families have actually gone bankrupt when someone in the family fell sick and needed tertiary care.

It’s important to understand that the cost of healthcare is not just the price one pays for the services in a healthcare setup and buying medicines. There are many associated costs like travel cost, cost of keeping an attendant and coming back for follow up visits, which eventually add up to large sums of money. Similarly, lack of longitudinal health records often necessitates duplication of diagnostics, thus creating a huge burden on the healthcare systems and unnecessarily increasing the cost of care for patients. This means that even for people with health insurance, there are associated direct and indirect costs while seeking care.

Technology obviously has a big role to play in improving the affordability of care. Telemedicine is an excellent way to take healthcare to virtually everywhere without having to spend a large sum of money. It started with primary level care, but increasingly is expanding to secondary and even tertiary level care. The Internet of Things (IoT) will play a revolutionary role in improving affordability in the coming years. Combined with telemedicine and longitudinal health records, IoT will actually take healthcare to people, rather than needing people to come to the healthcare facilities. Not only will this obviate the need for patients to travel distances to seek care and for their family members to skip work, the overall expenditure on healthcare for the family will also come down. Eventually, the burden placed on health facilities will be reduced, and we will see more timely and better quality of care for patients who actually need admission and treatment at the hospitals.

Q) What do you think is the role of the Government in addressing these issues affecting Indian healthcare system? In your view, what should the Government be focusing on in next 5-10 year time frame.

Dr Lalit Singh – As I have already mentioned earlier, Indian healthcare is marred with multiple challenges with a long legacy. Halfhearted and misdirected efforts by successive governments have further complicated these issues rather than offering a solution to these problems. There have, however, been many encouraging initiatives for developing our healthcare systems in recent years. The role of government is gradually evolving from that of a dominant healthcare provider (essentially provider of ‘care of the sick in hospitals’) to one of envisioning and implementing preventive ‘population heath’ services.

I believe that, at a strategic and policy level, the key enablers of growth in this sector over the next decade will be the immediate roll out of long pending policy reforms such as the National Medical Commission Bill and Clinical Establishment Act. This is required to establish a stronger regulatory framework for medical education, pharmaceutical and clinical practice that focuses on quality and accreditation,as well as instituting a career oriented education and training system for health professionals. Another important area for the government to focus on is the building of a nationwide digital healthcare infrastructure to bring all service providers – both public and private - on the same platform, and developing a lifelong medical record system for all citizens. The national unique identity initiative of Aadhaar gives us the opportunity to realize this dream by having all Indian citizens on the same health platform. The government has already created the road map for an Indian Health Information Portal (IHIP), which combined with Aadhaar’sunique identification system, standardized digital health records and evidence-based clinical practice guidelines, can give India an opportunity to leapfrog many challenges and improve the quality and efficiency of the Indian healthcare system.

Q) Tell us about the role of Elsevier in addressing some of these issues?

Dr Lalit Singh –Elsevier is a global information analytics company and world leader in the education and clinical solutions space. We help institutions and professionals progress science, advance healthcare and improve performance for the benefit of humanity. We take pride in being the largest educator for nurses in the USA and in many other countries around the world. We harness the power of technological innovations in the fields of education and clinical skills training for doctors and nurses, and in improving the efficiency and quality of healthcare around the world.

Some of the notable examples of technology solutions from Elsevier in the field of healthcare include:

• Clinical Key – world’s leading clinical reference solution at the point of care


• Elsevier Care Planning – award winning interdisciplinary care planning solution for all levels of healthcare setups


• Elsevier Order Sets – evidence-based clinical order sets for clinicians,


• Clinical Skills – an award winning clinical skills learning and practice system with an in-built Learning Management System (LMS)


• Arezzo – an intelligent evidence-based clinical pathways solution, which can be used in many ways to improve access to healthcare and quality of care.

Similarly, Elsevier takes pride in being the most innovative education company in the field of medical education, both globally as well as in India. Clinical Learning is an indigenous teaching and learning solution for medical sciences and is being used in over 20 percent of all medical colleges in India. We have successfully proved that using Clinical Learning improves the learning outcomes for students and allows teachers to spend more time on actual teaching rather than preparing for lectures, thus helping improve both quality and efficiency of teaching. Sherpath is a personalized learning tool from Elsevier, which deploys smart adaptive technology to help students learn at their own pace for the best outcomes, while helping teachers identify learning gaps in students..