Speakers: 
Mr. Rajiv Sikka (Group CIO, Medanta Hospitals)
Mr. Neeraj Lal (Chief Operating Officer,Apollo Hospital)
Mr. Bharat Gera (Strategic Advisor, BestDoc)

Moderator:
Midhun Subramanian (Head of Marketing, BestDoc)

MAKING THE INPATIENT JOURNEY MORE PATIENT-FRIENDLY WITH TECHNOLOGY

Midhun Subramanian: Good morning, good afternoon, good evening, wherever you may be, to this webinar session focusing on patient experience at hospitals organised by BestDoc. 

Today, I have with me three leaders – rather giants – from the Indian health care space with a combined industry experience of more than eight decades coming together to share their insights about in-patient experience, an area which has seen a renewed focus catalyzed by technological and operational innovation. And no better way to discuss this than with two distinguished guests coming respectively from the technology and operations expertise. 

Firstly, I would like to introduce Mr. Rajiv Sikka, the group CIO of Medanta. Mr. Sikka has been instrumental in taking Medanta to where it is right now, leading the digital strategy, both front-facing as well as backend transformation. Medanta has received national and international acclaim on how it managed the multiple COVID waves in north India. And this is in no small part due to the technological vision and execution strategies undertaken by Mr. Sikka and the team. Welcome sir.

Next I would like to introduce Mr. Neeraj Laal, the COO of Apollo Hospitals currently based in Gujarat. In 20 plus years of experience in healthcare management. Mr. Laal has been the driving force in scaling numerous hospital groups, including  Rainbow Children’s hospital, Medicover, Sunshine Global, and Shalby Hospitals focused on operational excellence and quality. Mr. Laal is also a key member of the ISQA international survey team for hospital accreditation as well as an internal auditor for NABH, NABL and a member of various national and international quality consorts. Welcome, Mr. Laal. 

Of course, we have our host for today. Mr. Bharat Gera, strategic advisor for BestDoc and a pioneer in digital transformation of healthcare. Mr. Gera has worked with hospitals across India, including most recently at KIMS hospitals Hyderabad as well as St. John’s National Academy of Health Sciences, Bangalore, and has designed and implemented multiple projects for digital healthcare. He is, as I would call the chief evangelist for patient experience technologies in India. And I would like Bharat to start off with the webinar. Over to you, sir. 

Bharat Gera: Thank you Midhun. Welcome Rajiv and Neeraj. He has put us on such a pedestal that now we’ll have to live up to the discussion about, you know, what can be done about patient experience. And to set the context. I think we are still talking in COVID times, and we’re still not completely out of the COVID times.

And although Midhun talked about the decades of experience we have, I think the last two years is equal to two decades of experience. And everybody has realized how important it is to have operational efficiency in hospitals when beds were not available during the COVID time. People have realized how difficult it is for people to spend unnecessary time at the hospitals.

At COVID time, nobody could enter the hospitals, right? So, it was difficult to manage without attendants, and hospitals found several technology solutions during this period. So, the digital transformation expert is not me certainly, it is COVID, I think, as we have all acknowledged.

I noticed when the pandemic began and I was doing a study for telemedicine in India. And I found one thing – and over the association with BestDoc also I found the same thing – that there are laggards who are not able to deliver a better experience in the hospitals, and there are people who are right in the front. 

And, the reason that happened is that even though all of them were supposed to do the same thing, post COVID or during COVID, some of them – a very large number of them could not actually cope with it. Because they didn’t have the previous experience of being digital enough or being prepared enough. Like they say preparation is half the battle won. I’m so glad that we have both of you on this talk. And being the beacons in the industry, not who did not start during COVID times, but started much earlier on improving patient experience and operational efficiency at the hospitals. I would really like to hear how you did it.

I am going to start with Neeraj on this one. Neeraj you’ve been at several locations and now you’re with Apollo. I would love to hear how you did this over the years? How did you improve operational efficiency and patient experience in hospitals? 

Neeraj Laal: Thank you for the question, Bharat. I think you are very right. This pandemic has changed the way we work in healthcare and healthcare had gone for a toss. And I think healthcare is the only company, which is working from hospital, unlike all the people who are working from home. So, I think it has changed the way we work. And now you can have all the doctors, magnets and stars – they are available on virtual platforms. So, because I have seen in this pandemic – I was with Medicover, I was with the Rainbow, and now finally for the last few months I am working for Apollo in Gujarat – I’ve seen telemedicine at Apollo started a long time back, but somehow it was not happening. 

The main concept of telemedicine is to reach far-flung areas. Like in Rainbow we got a pediatric subspecialist, pediatric neuro, pediatric nephro. And generally, if you travel tier two, tier three cities, you don’t have all these specialists. We have a general pediatrician. So what we have done through our telemedicine network, across the state of Karnataka, we have telemedicine facilities at key districts, where the children used to come to a general pediatrician clinic or a hospital. And our experts sitting at Bangalore in Marathahalli, Bannerghatta Road – they used to interact with the patients through pediatrician who is available at Shimoga, Dharwad and so on. 

So it made the life very easy for them. And once a month, they were travelling to these places. But I think now, because of this pandemic, I’ve seen the virtual consultation has gone from less than 5% to 45%. Now, most of the people – I always say PGI and AIIMS Delhi, they got OPD of 5,000 patients per day – people coming from far-off areas. But thanks to the pandemic, I think now filtering clinics are happening through this virtual consultation. So you’re not coming to the hospital, just for the sake of primary consultation. You are getting filtered out through this virtual consultation.

And, just in case you require a hospital visit, you can come. Like, say for example, at Medicover hospital, Hyderabad what we have done, patients were not coming after the first wave. So we have carved out our OPD on 50,000 sq ft,. 200 meters away from the main hospital. We created an OPD block where the patient can come. There is no ICU, there is no ward, so patients are fine. Health and wellness lounges are there and all the multi-specialty consultants are sitting on the different floor. So you come like a mall, you see a coffee house, there is a health and wellness gymnasium. Go and meet a doctor, get your nutrition checked by your nutritionist and go away. Just in case you require an indoor admission. There is a battery operated car, which is parked there. You sit in that battery operated car and go 200 meters away and get yourself admitted.

I think it has changed the way health care works. So now most of the hospitals – they are trying to do OPD block carving out from the main hospital. And for the sampling, we are not actually physically sending the sample. We have done, we have taken – we have done a trial drone. So from the top floor or the fifth floor, a sample has been parked there and it is flowing all 200 meters away, because you cannot, you have to take a legal license. We have done this. So it has changed the way we work. And all – it is looking like a health city, a battery operated car moving from one place to another place. And only for those people who actually require care in the hospital. So these are the few things which we have done. 

And as the discussion moves forward, I think I’ll share some more experience with childrens, women, because newborn vaccination is key. So what you will do? You cannot stop the newborn vaccination so everybody was calling when my child required a vaccination, what to do, and they are not coming to the hospital. So instead of all the people coming to the hospital, we have tied up with various clubhouses of the apartment in the Whitefield area of Bangalore. Our team of two people used to go to the clubhouses based on the appointment given to the parents. They come down, we give the vaccine and they go home. So all those things we have done, some through like vaccination. you’re talking about technology. We have done 40,000 vaccinations in a single day, and there’s no need for documentation – just a boarding pass. You come, your boarding pass is scanned, go inside the hall, get your vaccination and within five minutes you’re out. So these are the few things which we have done in the first wave of pandemic, second wave of pandemic, and third is on.

Bharat Gera: Fantastic. Thanks for sharing these really forward – and concrete examples of how you’ve improved patient experience. I really loved the way you brought in both the digital technology, and the physical. So its a phygital world going forward. And you’re already doing it. It’s exciting to hear that.  

Rajiv, I would like to go over to you and hear from you. You’ve done a lot during the last few years at Medanta and I’m sure earlier as well. But I’d just really love to hear about – Medanta is always known in the industry as the one who provides a five-star experience. So really would love to see how you achieve that. Love to hear that. Thank you.

Rajiv Sikka: A couple of points, and these may not be very structured – but I will go through this part. I came from a totally different backgrounds of healthcare and Medanta has been my first exposure in the Indian context. So when I joined, people asked me why don’t you come with the digital strategy for the hospital? I said, you know, I don’t understand digital, i don’t understand strategy, and digital strategy is definitely a bouncer for me. 

So let’s understand what the patient needs. And let’s list down in a typical whiteboarding exercise what are the typical, basic needs of the patient? So definitely we realised that, you know, their prescriptions, their lab reports, their radiology reports, their CDs – all of these are very important. And they need it – not just for a second opinion, but sometimes, you know, in case of an emergency when the patient is not around Medanta, they should have this ready for the actual clinical needs.

So, definitely each and every thing has changed. So, you know, within a year, every patient records are there on the mobile, which means they have a doctor portability, they have a hospital portability. And that’s what the basic essence of NDHM is that you don’t have to be a captive of the doctor. I think we’ll go a long way in this. 

You know, one thing which i realised and that’s coming from my mom and my dadima (grandmother) is that in this particular industry, trust is everything. This is a trust industry, this is not a clinical industry. It’s an art, you know, so that’s how trust gets developed. And why trust becomes important and at that time, I was not aware that you know why trust is important. But now I realise that if the patient is engaged, they will take their own calls, they will ask for more information, they will be more equipped to take some decisions in their own health and will be better satisfied and there are definitely better health outcomes. 

So what we realised is that in a typical hospital interaction, a patient has more than 100 touch points cover both digital and physical. They start not even – when the patient has yet to reach the hospitals. What it means is that they will figure it out, what this doctor is, what kind of accreditation this hospital has, what kind of treatment this hospital provides, what kind of infrastructure this hospital has? This is the fact I was somewhere outside of the country for an operational tour. Someone told me that God knows what kind of hospital Medanta would be or any hospital in a developing nation like India would be. And so, you know, it kind of hurt me. 

So we decided – you said, Bharat, that it’s a five star experience. And then somebody asked me whether the basics would be there or not. So we decided that we’ll put a 360 3D view of Medanta on the website, which means right from the Google maps, you download, you go down, you figure out how the lobby is, how my CT rooms look, how my OT looks like, how my seat looks, how my cafe looks like. We have put a lot of videos on websites. The journey of a plate from the kitchen to bedside. We put a video showing the importance of laundry in any typical hospital, you know, and it’s such a popular video.They get super hits. So what we realised is that these are the basic stuff to bring the trust and the journey never ended. 

COVID definitely accelerated this, but these were already there in Medanta. Obviously those got further calibrated on the contactless or remote or digital. For me, COVID is contactless, which for me is remote, and remote for me is nothing but digital. So these are like quite synonymous for me. And right from apartment booking to asking for a bill payment mechanism, to get a receipt, to get a prescription – everything is on this digital world. That’s one part of the OPD journey. And I will take a pause here and we’ll discuss more such experiences as we move forward. 

Bharat Gera: Superb. Thank you, Rajiv. I think what I really liked was the a 100 touch points you spoke about. We’ve got some of those identified in the IP patient journey here on the slide that Midhun has shared. It’s really the way to do it what you said – you know, identify all the touch points, see where the moments of truth lie in those touchpoints, and try to see how much it can be made an excellent patient experience. 

Somewhere I read that if you’re trying to do six sigma in any industry, you need to look at not just your core activities, which is the provision of healthcare, the curative part of it. But 80% of.where the inefficiencies lie are in the non-core activities, which is like moving the patient from one place to the other, which you both spoke about. And I loved the battery operated cars taking them. I know what a nightmare it is when somebody has to be admitted and they’re waiting in between the OPD and taking them away from the OPD area. Brilliant, brilliant way to do it. 

So now the 80% as I was saying which – Rajiv also spoke about you also spoke about one thing, which my friend Ambarish Giliyar often mentions in his LinkedIn post, which is about – you know, if you have to get this right, you have to do three Es – experience engagement, and empowerment. Rajiv from his personal background shared that as well that you need to build that trust, and the trust will come when you get the patient more engaged and you’re empowering them and then providing them of course, a great experience as well.

Now, what I have seen is that in spite of all the best efforts that people make in hospitals, there’s  still a lot of vast area for improvement. I may make, you know, may be a little bit of a controversial statement, but I think a lot of the hospitals – am not sure about Medanta and Apollo, a lot of hospitals I’ve come across have the so-called VIP category. And my thing is in this time and age, there’s no VIP category. Every patient is a VIP. Every customer has to be a VIP. It also – I mean, it sort of admits that we can’t do really well for all the others. That’s one thing I find strange in today’s time in hospitals. And the other thing is that these are really tricky problems and I’m really fortunate in this forum to have a leader from technology and from the operations side at the table. I wanted to put this across so many times there are these sticky problems, like, you know, the queues that happen in pharmacy or the time it takes to make a lab procedure done, especially the radiology I’ve seen a lot of times, you know, the long waiting periods for radiology investigations. 

These are sticky problems we see across when we speak to hospitals, and of course the inpatient part where I just, you know, when I work in hospitals, I just go and talk to patients. And several times I’ve heard things like everything was ok but when nurses were called for some help there was always delay at least 8-10 minutes. I could not get the bedpan in time. So these are quality indicators, and sometimes there is a gap between how technology sees it and what operation sees it as. So this time, I’d like to start with Rajiv. What gaps have you seen and how have you overcome those challenges?

Rajiv Sikka: Sure. And I will not disagree with you that basically to do that there are definitely gaps in each and every operation because the scale is vast. And what we’ve realised is that the scale at which Medanta operates, we also have roughly more than 3000 OPDs per day which is a huge number by all means, and someone calls us a private AIIMS. 

So, now what happens is that typical activities are done, and these are some of the best practices we picked up from the other industry verticals. We started doing a very strong digital survey. We said that we will try to be away from the paper surveys because God knows who’s filling it and you know, whether it is full or half. So at the end of each encounter or visit or interaction, you know, a automatic link goes to the guy. And we realized that there are two major problems which are coming up in the complaints, and one is the discharge part, which everybody knows is a major, major challenge. And the second is food, both in terms of the TAT as well as in terms of quality – sorry, if somebody has asked for hot food. There were the two major challenges. There were challenges in other areas also, and some we were able to very easily able to do it. 

The third biggest example was that we have a 15-floor hospital, 21 lac sq ft area, and the billing area is in the lower basement – lower ground. Which means that those on the 15th floor had to to come all the way to the ground – 16 floors down and do the payment. And so sometimes, you know, the patient’s attendant is relatively old and they can’t go each time to get payments done. So there was a simple request, can’t we get a link to pay? We all know that this is very simple. This doesn’t need any tech. Only thing is that all those will be treated as advances, and to be integrated into the pending accounts. So that was very simple tech. So I keep on saying, tech is never complex, its usage and its applicability is more important. So this was like a 2-day job, integrated into the billing, and get it done. 

So let’s go back to the discharge. Now what happens is that the Dr. Saab is on the round and in the morning at 9 o’clock, he says that I will discharge the patients. And so patients all bags set, and by 9.30 am they expect that I will go and do the final billing and I will get discharged. So in this particular case, as we know that there are multiple departments who are involved right for the, you know, labs and radiology whose tests are still pending or medicines to be written, or TPA information has to be sent. So what we did is that we requested doctors and doctor teams that on the mobile app – for a doctor, or for a doctor team, they just have to announce discharge. And so at nine o’clock, he says – at the click of a button, he announces discharge – so each and every workflow gets triggered. What we have is a live dashboard in each department head, including housekeeping. He knows that that this particular bed has to be vacated, expected time is this, because we have major things and everything. Nursing department is aware, the clinical pharmacy department is aware, what medicine has to be returned. So there is a dashboard and everybody is fully aware. 

And at 230, our Medical Director asks  for whichever areas are in red or are in yellow because its an automatic calculation of the dashboard and then questions are asked. We realised that if questions are asked, things will fall in place within one week or two weeks. And now we have been able to reduce cash patient discharge to the expected TAT, which is not very, very wonderful. Yes, it is bed inventory, but if you ask me and ask any one at Medanta, it is about patient satisfaction. Mainly we don’t have, you know, mainly we don’t have a paucity of cash beds, but we do have, you know, this patient dissatisfaction, which is the highest ever because of bed discharge.

This is one part. It’s a simple dashboard and each and every point – so I’ll give you an example. The major problem used to be that somebody is taking a discharge summary to the billing counter and the nurse says that I have given the discharge summary and the billing counter says we have never received it. So, no trust on anybody – we trust in only tech, like, you know, people trust in God and we trust in tech. 

So, in this particular case, the guy who is taking the discharge summary, there is a barcode. He has to – from the nursing counter, the GDA  has to scan it, so it gets recorded that I have started at 11:10 from the nursing counter. Then he goes to the billing counter, he scans it one more time, and there is a barcode reader there. So I know that at 11.10, he started and at 11.18 he has delivered that discharge summary. 

So all the manual calculations, movements have been – same thing with the pharmacy returns – the guy takes it from the pharmacy, nursing unit and delivers it to the main store. Both the movements are tracked through the barcode reader. There is nothing high-tech, it is a very very simple tech. Today roughly 250 off discharges are completely automated and each and every milestone is fully automated. 

So this is an assistance to ops because – ops, you know, is struggling with this when the GDA started and when the GDA – so I thought i will share all these examples. Same is with the food. We have roughly 2,800 items that get delivered in the room. And as soon as someone orders it, it gets logged through a ticket in the system. And as soon as the plate leaves from the kitchen, again the scanning happens. He has to scan it, and the journey is cracked. I can’t comment on the quality of the food, but I can definitely comment on the serviceability of the food. So that’s what we did in some of the basic, basic experiences for the patients.

Bharat Gera: I love the way Rajiv makes it – or keep it simple and stupid principle. Don’t complexify it because then you’re going to run into more obstacles and a very smart way of handling the problems that are there typically in the healthcare industry, especially the tracking part you spoke about. 

I want Neeraj to step in now and share where does he see the gaps when he’s working with a technology team or you know when you face those gaps, how did you address them?

Neeraj Lal: Okay. I was just seeing the slides while Rajiv was talking, you know, the feedback, which patient gives. See a small thing, like we have a nurse call management system. So I don’t know why the name is nurse call management system, because the poor girl has to be called for anything and everything in the hospital. For example: My AC is not working, I’m not getting food on time. If you see these feedback also, they’re not talking about clinical services, they’re talking about the supportive services. So what we have done in Bangalore in one of the hospitals, instead of a nurse call bell system, we have installed a four-point care. So we have a housekeeping button on it.

It is a wifi device, which we use to give to the patients –   housekeeping, maintenance, F&B, as well as the nurse. So if I’m in that patient bed and I require food which is not coming, or I may require some maintenance part of it, or a bed sheet or a cushion. So instead of calling a nurse, I press the housekeeping button. Automatically the alarm goes to a housekeeping supervisor of that floor with a defined TAT. They have mentioned the TAT within 5 minutes, within 10 minutes, within 8 minutes, and he needed to revert back to the patient room with closure. He can come to the room and close the call. And once it is satisfied, then only you can close it.

And if he’s not attending the phone call, this message goes to the CEO or the manager of that unit. So at the end of the day, we can manage how many calls are raised from the patient room and how many have been closed. And we have seen two things happen. Major thing. One patient’s satisfaction has gone highest because now we are maintaining TATs and if you’re not doing it, escalation is going to a manager or a CEO or a unit head of the hospital. 

Secondly, a poor staff nurse, 33% of time was saved because we have used these four buttons. We have categorised. We have done a traffic man’s job. You go, there you go there. Everything doesn’t go to a nurse. And it changed the way we work. And I presented in the budget that there is no shortage of staff nurses. Because if a doctor comes she has to accompany, patient requiring medications she has to accompany. So with this four point call system, which is small wifi device. One startup company – small two, three young boys came and he made it for us and we have installed it. And regarding the cost of it, we are billing just 110 rupees per patient for his entire stay and he’s so happy. 

Secondly, when I was working in a pediatric hospital, it was very, very difficult for the children to wait for the consultation while the doctor is busy in consultation – very, very difficult for parents.

So what we have done, we have installed a floor mounting game device on the waiting area of the pediatric OPD. So, while they’re waiting for the doctor to consult, there is a device on the top floor on the rooftop and some games are there on the floor. So, the children used to play football, then they hit the football, it is all virtual game. So children became so engaged with those games and parents had to literally take them out. Your turn has come, and we have to go in. 

So it is so nice. So I’ve seen in one of the meetings when I was talking to these apartments – resident  welfare association said his children’s say Papa, we need to go to that hospital because there are games there. And generally, you know, if you bring the children to the hospital, it is a nightmare for parents. So small things I’m not talking about, like you’re talking about this patient care, a health checkup – Apollo drive health checkup in a big way. We say Apollo ProHealth checkup. Earlier it was a master checkup now its Apollo ProHealth checkup. 

So in the city of Ahmedabad what we have done is big big corporates go for a health checkup. I think everybody can go for a health checkup wherever you want, but how it is managed and how it is linked to your profile. So what we have done in the last few months, whichever health check up we have done – Torrent or any pharmaceutical companies, we have created a AI dashboard for them.

So after the health checkups, we send that AI dashboard to them. So what we say, 600 employees screen – it is in the form of a bar graph. So what do we send 601 employees get health checkup, 80% having NCDs, 37% had more than one comorbidity, 23% with NCD in the age of 46 to 60, hypertension and so on. And that HR manager and the CMO of that corporate is so happy, because a health checkup is what, you send the file and they don’t know what to do with that file report. So we have given our AI-based summary and a health mentor is attached to each of the employees. So when I get to know that out of so many employees that many NCD’s, that many have hypertension, there’s many comorbid conditions, so you can take a call accordingly. And since then we are getting health checkups from that corporate on a continuous basis. So we are empowering the corporates, we are asking – we are making the journey of patients, may be children, may be adults, so they are thinking more about how to access that facility and use the technology.

So few things, what we have done, and it is working like in one of the hospitals in Medicover, which I think even Rajiv was sharing, you know, there is everywhere you have to punch in and punch out. And it is very, very difficult for the doctors to ask them to punch because he’s only available omnipresent in the hospital for 24 hours.

Punching is not, it is very, very important to be a base AI based camera. So whenever you’re coming, you’re not supposed to punch in. You have to just see the cameras and go away and it also check your happiness index.

So for example, in the morning, Bharat is coming to the hospital and he is 75% happy.

While he is going out, we have seen it is 47% happiness. Then you may get a call from a HR manager that you came in the morning with 76% happiness and you are going with just 45. What happened? The day was not good? Something like that. And, you know, cameras, which have been put up in the OPD, you know, a patient is waiting.

So we see a sad face in the AI camera, our customer care manager approach to that patient who is waiting at the OPD. I understand you’re not very happy. You are sad. How can I help you? So if you use all these technologies, you know, patient feel, oh, somebody’s watching me for a call. And he said, “ I’m waiting for the doctor, there is a billing, which is, I’m not happy with, you know, all those things we can track and check the patient moods and their happiness index by using technology. I think it can change the way we work in healthcare. 

Bharat Gera: Amazing examples. And I love the way that you work with startup companies. And as you know, I’m associated with startup companies, including BestDoc trying to do similar things and others as well. I think the technology innovation that hospitals need increasingly is coming from young startups which are very nimble and able to deliver what you need. In that light I wanted to bring up you know, what’s, what are we heading for? and I’m taking a 10 year perspective on this, or at least now eight years, two years have already gone.

So I’m looking at 2030, you know, as the timeframe and what seems to be happening here is that with the national health authority and the ABDM and the unified health interface we are headed towards a much stronger ecosystem than ever was. And like Rajiv was talking about, you were talking about, you know, we can make life much easier for patients to move between facilities and go from one hospital to the other from one lab to the other. People are saying that this is like the UPI moment. We are at the beginning of the UPI moment in healthcare, which coincidentally it’s the same team and they’ve called it  UHI and we’re heading for the UHI moment, which will fructify over the coming years.

So that is one trend I see for the future, which is very specific to India, but then globally, the trend is towards consumerization of healthcare where the customer is asking for convenience, transparency, and also being able to you know,  be able to discover of course, and, and able to be involved in the decisions.. They are not letting somebody tell them what to do. If you take the surgery market, for example, Pristine has been creating waves in it because, you know, they’re like you just spoke about, you know, mentor for every patient. I think that’s where we’re going, where the level of service requirement pre hospitalization, post hospitalization during hospitalization, there’s going to be much more involvement of the patient as a customer. So both these trends will sort of merge in the coming years is what I feel.

And I’d like to hear from both of you on how you’re preparing for it. And what do you see as your role in the ecosystem in health care as it is going to fall into place? So maybe we can start with Neeraj again, this time on this one.

Neeraj Lal: Okay. This technology is coming and I think pandemic is the biggest enzyme to change the thing we do. I think I’ll give you an example.

Now, most of the time, if you see any hospital planner, 10 years down the line, you know, ICU beds, it’s generally 15 to 20% of the total bed what you have, say, for example, if you are giving a hundred, but it has 15 to 20 beds. Now, if you see 30, 40% bed in any hospital are ICU beds, so I think we don’t require a hospital for any small time thing.

We require a hospital for critical care for a procedure or a surgery, this Pristine model or so many companies, they have come with a different kind of model. What they’re talking about, they require a hospital only for an operation or a surgery or critical care. And I think COVID has exposed the entire hospitals. See, we are looking at bed with a ventilator and oxygen visit in shortage. So if we make hospitals in the way, it is more critical care beds, or it is much, much better. Secondly, from the OPD point of view, see the challenges. So like Apollo, what we have done, we have done a care suit persona. 

So what is to talk about so much data generated while a patient is coming for an outpatient. So what we have done challenges with paper-based prespiction, you know, we cannot track the investigation, which is ordered by a consultant admission surgery, procedure advice. We cannot track medicine order we don’t know. So I, as a CEO, as operating head, my responsibility is P&L also apart from patient care.

So while the doctor talks to the patient, He write the prescription. And I think the prescription of a doctor can be read by the doctor himself or herself or a pharmacist only. It is very, very, very, very difficult. So we have started the CSR, which is a care suit persona in this we have linked our appointment system or HIMS to this.

So whenever a patient is going inside, the patient consultation room, doctor spends most time by talking to the patient. Hear them out, what is happening. So a video will come, which we’ll talk about, you know, what is happening in the body, what can be done and not. So it is template driven and it can be modified with minimum   clicks and whenever he’s ordering a pathology or radiology or a procedure, it is stored somewhere so that whenever he comes, the patient is coming, he’s not coming with a prescription. Then a care manager will assist him, take them to the pathology, and bring them to the radiology for various tests. And while he’s going out, most of the time pharmacies outside the hospital, he can take his back from the pharmacy, just pay them and go away.And there he’s not supposed to show the prescription, standing in a queue and all. With that e-prescription we can able to track when the next pathology can be done, When next procedure is planned. 

So OP to IP conversion I think if you see, you know, it is not happening in most of the hospitals. So we used to take care through the CSP platform where we are tracking the entire OPD-based prescription and it makes the patient journey very smooth. So whenever he enters the doctor you must have seen, he is coming up big. Polybag. A few days back the Governor of Gujarat came to our hospital to show what ENT surgeon and I saw the medical officer, which is attached to him. He’s bringing five bags: CT scan, MRI reports and all.So I was just talking to him.

So instead of that, if he just walks like that, and there’s a UHID number where our doctor clicks, like what the government of India is planning to do EntireCT scan and MRI and pathology and radiology can be seen, and then e-prescription is generated so that we can track the entire patient journey in OP or IP. So we are attempting to do that. 

Bharat Gera: I noticed that our Apollo is one of the 27 organizations that have been certified by the national health authority on the NHA platform. So that’s really a big achievement. So going forward, we will be seeing a possibility, you know, there’s a very simple thing I’ve asked people, you know, what can we take in first.  As a patient what I find is that the.  in fact , if I go from one branch to another branch of the same hospital chain, I have to go and register again. 

At least let’s solve that problem. Why do you want the patient to pay for registration each time one ID across all the hospitals should work without this registration. It’s a very low hanging fruit problem, but it’s not a huge problem, but 200 rupees across. 20 million people is going to be a lot. 

Neeraj Lal: It’s a pain also while you go everywhere, they ask your name, your address and all — it is just wastage of time. 

Bharat Gera: Yeah. I’ve been pushing the hospital industry to adopt their allied health ID just for this one reason that you’ll make the patients and your effort less by doing.

Rajiv, love to hear your take on this, how are things going with the ABDM at Medanta and,   you know, how are you approaching this whole consumerization wave?

Rajiv Sikka: Sure, So I think it’s very clear that in last 75 years in the journey of independent India, each and every policy maker has talked about healthcare as inclusive, affordable, accessible, and this has not changed.This is the basic ingredient, which is constant for each and every policy we have come in the healthcare field.

Now why it is important is that this is also a reflection of consuming. See what happens when the patient moves, as you know, we don’t want them to have it from one location because those tests should be available to, you know, to the new hospital, to the other hospital on a click of a button.

The other part of what we started doing is that we see we have a legacy product, which is not getting integrated, my 99.9% hope is that within this month of March, we already did this thing with the national health priority. Hopefully we’ll be going to live with this  month. So that’s for us. You know, since we don’t have the legacy of bronculate and our all the hospitals are relatively newer hospitals they came in the last five years. So I started from scratch for all of these hospitals, which means that I had the liberty of thinking over their integration. So we have one patient ID which is used and it gets linked to other platforms within 30 minutes. 

So now what happens is that, you know, when you think we are not in the public health, but we have a sound opinion that, if this NDHM you know, this particular patient repository with respect to the disease spectral reported properly. What we have is a demographic platform and we have a disease spectral. Just imagine that, you know, you will allocate a budget. So your budget allocation, your policy, definitions, your enforcement of all of these policies towards the disease management will be very, very focused than sort of generic and you will be working on that very besides data, that you know, this belt in Punjab is Cancer prone for this particluar area, this belt in Jharkhand is having lung issues because of the coal mine. That, according to me, should be the next phase of NDHM and all the hospitals.

And just imagine, you know, if I know that this particular belt is cancer prone, better to put more cancer focused infrastructure in that area, better to put respiratory focus in that area, so that the ultimate aim will be happening in the form of consumerism as a private phase of concern.  So that’s my thought process and that’s what we are also now getting integrated with NDHM national health issue. 

Bharat Gera: So you brought out the socioeconomic indicators of health as being very important for population health and how ABDM will play a big role in making that album. And also you spoke about how you are almost there to go live for the ABDM platform as well. Wonderful and that’s what was expected out of the leadership, you know the leaders in the background in healthcare in India and I’m glad you’re keeping all this in mind for the future. I think a lot of other hospitals will learn from the thought you shared in the seminar.

I have just one last concluding point, which I wanted both of you to summarize all the discussion as well. I have personally believed for quite some time that the ones who can change this healthcare delivery in India. We’ll be the incumbents, that is people who are already in healthcare and not necessarily the digital health players who are emerging, who have no background in healthcare.

People have spoken about disruption of healthcare for these kinds of companies for some time, but we’ve seen it not, not really succeed. I feel that trust and the phygital nature of what needs to be done in health care doesn’t allow only a digital only kind of player to play to make the success and to really improve things. And I believe it’s organizations like Apollo, Narayana, KIMS hospitals which I’m associated with and Medanta, and Max and Fortis. And including the other 10,000 smaller hospitals that are there. I think all of them can play a big role if technology interlinks them, they will be able to provide an overall great experience across the ecosystem, not just in their own hospital. 

Those are my concluding thoughts, but I’d love to hear from both of you on the concluding thoughts. Rajiv, if you could go first just to make a take away from what we discussed so far.

Rajiv Sikka: You know, there are three things according to me. I’m not talking about 10 years down the line or five years for one or two years down the line, because they’ve all been, all that is how things have passed in the last few years. Mobile will definitely play an important mobile Mobility will play an important role in  many things to come. But we realized that it is not possible for any hospital to accommodate all the possible patients, not just in India we have seen this trend worldwide.

So care away from the hospital is definitely going to play an important role. And you rightly said hospitals have realized that we have all the requisite infrastructure, knowledge process, skill and for us to move is better instead of any digital company starting to open a hospital. So that mindset is already then most of the hospitals and that’s why I say that mobility is going to play an important role in days to come.Secondly according to me it is very important in this case and that’s my personal experience of doing things in the last three days that done is better than perfection.

You know, don’t wait for perfection. I sincerely share this examples and this is probably my best accomplishment in 3 decades of tech experience. On a Saturday we were told that govt of India had announced that we will start treating patients at home asymptomatic and symptomatic patients and we were with the civil surgeon’s office and nobody knew what to do but this was Saturday afternoon and Monday morning, we were up and running, you know, with a platform where a patient would get enrolled. You know, they pay remotely, they get all the complete schedule of their appointment, interventions, they record their vitals in a particular platform, and up or below threshold alert goes to nurse and beyond alert goes to doctor. 

So much confidence in a very simple HTML based technology and it started functioning like anything. So what I’m saying is that, you know, in a typical environment, I could have perfected this system for months and months before launching it. So this is learning that do it and make things happen and you’re able to reach the maximum number of patients away from the hospital.

Bharat Gera: Thank you Rajiv. I loved the word done, get that thing is much better than being perfect. Totally agree with you on that. 

Neeraj, concluding remarks from your side please.

Neeraj Lal: Yeah, I think he’s very right. I think hospitals are not only meant for waiting for the patient to come in. What he’s talking about there’s no formal government order here in Gujarat, but what we have done is all the big corporates who have employees strength up to 5,000, 10,000, like Gautam Adani group, Torrent, ONGC. So what we have done, we have created the digital team, a few staff, nurses, and medical officers there, digital nurses and digital medical officers.

So we have an empanel with them. We have empaneled with them whenever any of your employees are getting symptoms or they’re not well, so no need to come to hospitals, take an appointment from the team they’ll see you and accordingly a medicine is prescribed and it will come to your home. If you require a certain pathology, our phlebotanists will come and do their need full. And once in a day, our doctor will see. So I have seen that 10% of the people are on home health care.

Not only because of COVID, whatever is happening to you, their boss, their mother, their father, their grandfather, who is very difficult for them to move. And whenever they feel, whenever our doctor feels they require hospitalization, an ambulance will go and bring these people back home. Since I’m a part of a quality council of India, as well as I require to visit other countries.

We don’t have a generic center, we don’t have a pediatric center. I think it is one of the biggest hospitals in the world, a mother and child hospital, but unfortunately in our country, we don’t have one. So therefore I think care is going home. 

So we started a campaign. And through this campaign, we said, don’t come to the hospital, come only when our care team says you require a hospitalisation. So I think it is a buzzword. I think hospitals should not be overcrowded with the patients and you are getting business also because we are the private sector. We have to take care of business. 

So now eight corporates I’ve seen in the last few months are on the panel of home healthcare and I think 30, 40 patients are on that care team and are out of them. And their patient engagement is there while they are not in the hospital. So I think it is a way forward and we should move forward. 

Bharat Gera: Excellent. I think it reminds me of the statement The patient will see you now. Absolutely a wonderful discussion. Thank you so much, both Rajiv and Neeraj for making this happen. And, you know, continue to exchange thoughts on this and once we get the responses, we will also share with you about what is the response of people. And if they have any further questions, we’ll come back to you. Thank you Midhun. Over to you. 

Midhun Subramanian: Thanks. Thanks. Once again, a really interesting session, especially with many of the best practices and examples. Really great to see. I mean, and I’ve been working in various areas, other industries as well, always, they used to say us. Healthcare was one of the laggards in terms of digital adoption, but see today, right? I mean, what we are seeing, especially in two years, or even in the past few quarters. It’s amazing, right? The speed at which we have adopted these technologies. I’m sure like now we can really see that healthcare has gone live. In terms of digital transformation and synergizing that with operational excellence.

Bharat Gera: After the seminar, I’m going to cut down my process of innovation, no longer vision, 2030 at least come down to 2025 because there’s so much being done at such a rapid pace by leaders.

Neeraj Lal: I think we are making a budget now, most of the budget for the marketing is the digital way. So you spend more on digital, but it is a good sign, but you are very right from 2030 to 2025. 

Midhun Subramanian: Okay. Once again, thank you so much. And thanks once again.