Reimagining the possible in the

Indian healthcare ecosystem with

emerging technologies

www.pwc.in
 State of healthcare in India........................................................................................................7
Disruptive technologies are shaping the future of healthcare................................................... 14

Table of contents
• Innovations in healthcare.................................................................................................... 14
• Relevant emerging technologies for the Indian healthcare ecosystem.................................. 16
• AI........................................................................................................................................ 17
• IoMT................................................................................................................................... 18
PwC’s Healthcare IT Survey 2018............................................................................................ 21
• Survey question 1: Current technologies that are being adopted amongst healthcare providers in
India................................................................................................................................... 21
• Survey question 2: Adoption of AI and IoMT use cases by healthcare
providers in India................................................................................................................22
• Survey question 3: Challenges for AI and IoMT adoption in the Indian healthcare ecosystem.26
• Survey question 4: Changes expected to drive adoption of AI and
IoMT amongst healthcare providers in India........................................................................30
Road ahead............................................................................................................................. 31
Bibliography............................................................................................................................33

2 Reimagining the possible in the Indian healthcare ecosystem with emerging technologies PwC 3
 Foreword Foreword
Healthcare is one of the fastest growing sectors in India and the Indian government Healthcare in India has always posed big questions around accessibility and
has aggressive plans to develop India further into a global healthcare hub, leveraging affordability for most of its population. On the one hand, it is largely financed through
its relatively lower priced treatment options. It presents a great opportunity for the out-of-pocket payments and remains unaffordable for a large part of the population.
growth of the entire health industry – medical devices, healthcare providers and On the other hand, access to the right doctors, facilities, treatment and medication in
pharmaceutical manufacturers. a timely manner is limited to a few metro cities and thus, large parts of the country
lack this acess. As the population ages and more people begin to need medical and
The government has initiated a fundamental change in its role from being a care social care, this dual problem is poised to assume mammoth proportions in the next
provider (hospitals) to also becoming an insurance provider, as is evident from the 20 years, unless we take significant measures to address it now with bold measures in
proposal in Union Budget 2018 of a health protection scheme of 5 lakh INR health policy and implementation.
insurance cover to 50 crore poor and vulnerable individuals, covering around 40% of
the Indian population. On the policy side, the Indian government has made a bold commitment to achieve
Universal Health Coverage (UHC) through Ayushman Bharat, which aims to
The gap between the required and current growth in healthcare infrastructure and provide affordable healthcare to the entire population and reduce their expenses on
care-providing staff in India cannot be addressed through an incremental and linear healthcare.
approach. Latest advancements in technology like artificial intelligence (AI), Internet
of things (IoT) and blockchain can enable the healthcare industry to adopt disruptive On the implementation side, improving healthcare infrastructure takes time and
technology-led service and business models, scale up for access and affordability, and money. Fortunately, technologies have evolved and converged significantly over
take the winning leap to make India a global healthcare hub. the last decade and shown promise to address these gaps in the Indian healthcare
infrastructure. Rapid developments in mobile technologies, cloud computing, digital
Technology adoption in healthcare is at a nascent stage in India. One of the first imaging, machine learning and 3D printing have paved the way for breakthroughs
steps towards this transformation will be to use technology as the lever to break the in the development and adoption of healthcare technologies – from telemedicine to
silos and for tight coupling of data with providers and caregivers, and to encourage nanotechnology, lab-grown 3D organs to Internet of medical things, and electronic
and enable an ecosystem of free data flow and interchange. Other steps will include health records to artificial intelligence.
adoption of IoT-enabled wearables to monitor health, AI-enabled predictive analytics
to predict diseases, mobile and IoT-enabled technologies to shift from hospital-based Just as mobile technology helped India leapfrog its landline infrastructure problems
care to technology-enabled home care, telemedicine and advanced imaging-enabled and catapulted it into the information technology age in the 1990s, technology-
technologies to address availability of specialist doctors in remote and rural areas, and enabled healthcare can provide cost-effective and scalable solutions to India’s
drone-enabled technologies to improve medicine availability. Sharing of health data healthcare problems and make it a global healthcare destination. Digitally enhanced
will bring in privacy concerns which need to be addressed through greater focus and healthcare, speciality operating models and disruptive technology-led healthcare
investments in cyber security. services are already making strides in patient satisfaction and provider revenues in
western economies.
In addition, we need to fund specialised domain research in medical fields like
robotics-led remote surgeries, basic medicine and provisions to incentivise the Globally, there are concerns around infringement of privacy of healthcare data and
participating resources for their time and effort to foster a culture of research hacking into connected medical systems, but the significant benefits of cost reduction,
and excellence. improved access, and better and timely treatment are leading to increased adoption at
both the healthcare provider and patient levels.
And all this needs to be done by taking a leaf out of the successful private-public
participation models in other countries and also other sectors in India to make the The key for Indian healthcare to taking a winning leap will be to reimagine the future
growth of technology-enabled healthcare more socially and economically inclusive with emerging technologies while finding a balance between:
and affordable.
1. Increasing care expectations of patients in a connected world and facelessness of
technology-driven healthcare

Arnab Basu 2. Constrained budgets and rising costs of healthcare

Partner and Technology 3. Complexity of new technologies and their ease of deployment, integration
Consulting Leader and security
Abhijit Majumdar
Executive Director and
Technology Strategy Leader
4 Reimagining the possible in the Indian healthcare ecosystem with emerging technologies PwC 5
 State of healthcare
in India

Healthcare in India is complex due to the multi-layered architecture of health system administration. There are various
considerations for this multi-layered hospital administration architecture.
These include whether it gets public (Central or state government) or private funding, what location it covers (rural or urban),
and what demography and prevalent diseases it covers.

Providers

Corporate hospitals

Government

Home care

Hospitals in tier 2 cities

Diagnostics

Enablers

Payers

Regulatory

Figure 1: Healthcare provider ecosystem in India

Historically, healthcare delivery in independent India has private sector that runs a majority of secondary, tertiary
been under the purview of the government. Although the and quaternary care facilities. Private facilities are also
government has secondary and tertiary care facilities, it is the majorly concentrated in and around tier 1 and tier 2 cities.

6 Reimagining the possible in the Indian healthcare ecosystem with emerging technologies PwC 7
 “
Also, there is great disparity in the availability of skilled resources between rural areas and urban areas, and more treatments are
taking place in private facilities as compared to public facilities in both urban and rural areas.
There is an increasing emphasis from the government to
Split of population and doctors Share of cases treated reduce drug prices and make medicines more affordable—for
example, some of the critical drugs for cancer treatment are
now 86% cheaper, whereas prices of diabetes drugs are down ‘The government’s move to provide a coverage of up
by 42%.2 Further, doctors are being encouraged to prescribe to 5 lakh INR to 10 crore poor families is the biggest
Share of cases treated generic drugs instead as much as possible.
Urban 34% scheme of its kind in the world and is in continuation
We are also observing tremendous efforts from the with the trend of the government being a payer
Urban government to change its role in Indian healthcare from rather than a provider in the secondary and tertiary
Percentage of
that of a provider to an insurer. With Union Budget 2017, care space. The National Health Protection Scheme
population
the government has pushed to make Aadhaar card a health will provide much-needed protection to the most
Rural 66% 78.8% 21.2% identifier for basic health services in the country. It was also a vulnerable section of our population and increase
critical step in identifying the beneficiaries of social healthcare productivity due to lower disability-adjusted life
insurance programmes being rolled out by the government. years (DALYS) lost.
Private In Union Budget 2018, the government has given a further The government has recognised the impact of medical
Public push to enhancing the healthcare system of the nation by inflation and increased the tax exemption for senior
Rural 33%
launching the Ayushman Bharat, which will provide insurance citizens from 60,000 to 1 lakh INR under section 80
cover to 10 crore families in India. This budget is also special DDB and medical insurance deduction under section
Percentage of because for the very first time, under the guidance of NITI 80 D from 30,000 to 50,000 INR. Also, the move
doctors 71.7% 28.3% Aayog, allocations to the tune of 3,073 crore INR have been to turn 1.5 lakh health sub-centres into wellness
set for creating a digital economy with emerging technologies centres will help in the early detection of disease,
Urban 67%
like artificial intelligence (AI), the Internet of things (IOT), reducing both mortality and morbidity. It will also
blockchain and 3D printing, which are necessary for building help change the current focus from treatment to
Rural a modern technology landscape in healthcare delivery. proactive prevention.’
If successfully implemented, this can reduce wait times
Figure 2: Split of population and doctors in India Figure 3: Share of cases treated in India and improve productivity greatly by minimising human
intervention in electronic medical records (EMRs)/enterprise
Source: PwC analysis, World Bank data (2017) resource planning (ERP)/hospital information systems (HISs). Dr. Rana Mehta
Healthcare Sector Leader, PwC India
Indian healthcare has made substantial progress, especially in the last decade. The government is trying to improve public health
delivery and huge ongoing investments are being made in infrastructure. Between 2000 and 2014, there was a 370% increase
in health expenditure.1

Statistics for Indian healthcare providers ecosystem (rural)

Sub - centres Primary healthcare (PHC) Community health center (CHC)

153655
25308 5396
146026 3346
23236

2005 2015 2005 2015 2005 2015

Doctors at PHC (in position) Surgeons, OB&GY, physicians and

paediatricians (in position)

27421
20308
4078
3550

2005 2015 2005 2015

Figure 4: Change in spread of providers across the care delivery ecosystem in rural India between 2005 and 2015

Source: Health & Family Welfare Statistics in India, Ministry of Health and Family Welfare (MoHFW), 2015

2
 apoor, R. (20 September 2017). A PPP approach to transform healthcare. The Hindu Business Line. Retrieved from https://www.thehindubusinessline.com/opinion/a-
K
1
PwC analysis and World Bank data ppp-approach-to-transform-healthcare/article9866487.ece (last accessed on 28 February 2018)
8 Reimagining the possible in the Indian healthcare ecosystem with emerging technologies PwC 9
 Despite the various initiatives undertaken by the government and private players, the Indian
healthcare ecosystem faces numerous challenges:

The Ministry of Health and Family Welfare (MoHFW) • There is a shortage of qualified doctors and nurses. On • We don’t have consistent quality in the healthcare sector
is also running several e-governance initiatives for the the infrastructure front as well, there is a need for across the nation—less than 2% of hospitals in India are
digitisation of the healthcare sector in India, and has set up exponential growth. accredited.3 There are also a large number of informal
a division called e-Health India. e-Health adds two more players and unqualified individuals acting as doctors.
goals to the triple aim of healthcare globally: World Health Organization (WHO) recommendations
• Government health expenditure is very low—in fact, it is
• Access the lowest out of all BRICS countries. However, this should
1
• Affordability improve once Budget 2018 is implemented.
• Quality 0.65
1.3%
• Lowering of disease burden India 4.6%
• Efficient monitoring of health entitlements to citizens

4.7%
Brazil
6.9%
Doctors per 1,000 population

2.5 3.2%
Russia
8.4%

e-Health
1.3
3.1%
China
12.6%
e-Health initiatives by the MoHFW, Government of India
South 4.3%
Nurses per 1,000 population Africa 14.0%
• National eHealth Authority (NeHA)
3.5
As percentage of GDP As percentage of budget
Envisioned as a regulatory and promotional organisation to strategise eHealth adoption and set the standards, policies and legal
framework for the health sector. Additionally, NeHA is responsible for setting up electronic health exchanges for interoperability Figure 6: Comparison of Indian government healthcare expenditure
and devising a certification framework for EHR products. vis-a-vis BRICS countries
1.3
Source: Lancet, World Bank
• Integrated Health Information Program (IHIP)
Hospital beds per 1,000 population • Private expenditure is very high in India. It currently
This programme intends to provide EHR to all the citizens of India and provide interoperability to existing EHR/EMRs on the stands at around 70% whereas for the UK, this figure stands
Integrated Health Information Platform. at 16.9%.
India WHO
• There is low penetration of insurance in India. At 62.4%,
• Electronic Health Record Standards for India out-of-pocket health expenditure is a very high share of
Figure 5: Comparison of key healthcare resources in India vis-a-vis the total healthcare expenditure in India. In the UK and
WHO recommendations
USA, this share stands at around 9.7% and 11% respectively.
EHR standards were first notified in September 2013 by the MoHFW and a revised version was later released on 31 December Source: PwC analysis, NSS 71st Round, 2014 • The Indian healthcare system is reactive. Patients
2016 after taking feedback. The MoHFW has also made standards like Systematized Nomenclature of Medicine – Clinical Terms
don’t act proactively and often visit a hospital only when
(SNOMED CT) available free for use in the country. • Healthcare facilities are not accessible uniformly across the disease has reached an advanced stage. This can be
India. In some places, patients might have to travel attributed to lack of awareness about diseases, care and
hundreds of kilometres to avail basic healthcare services. services available.
• mHealth
• Although government initiatives are in place, currently, they
are not mobilised effectively to optimise healthcare delivery
The government is working with organisations, both government and private, to provide in India.
intuitive and interactive modes of communication, treatment, data transmission, and
retrieval to doctors/hospitals and patients using mobile apps and websites.

3
 wC analysis, NABH (http://www.nabh.co/frmViewAccreditedHosp.aspx), Open Government Data (https://data.gov.in/catalog/number-government-hospitals-and-
P
beds-rural-and-urban-areas) and Joint Commission International (https://www.jointcommissioninternational.org/about-jci/jci-accredited-organizations/?c=India)
10 Reimagining the possible in the Indian healthcare ecosystem with emerging technologies PwC 11
These challenges require the healthcare industry to cater to a lot more patients.
facilitated by the right push from the government in terms of providing insurance
coverage to the masses, Healthcare should become more accessible and affordable,
and the focus should shift from reactive to proactive diagnosis and treatment, and there
should be greater collaboration between various healthcare stakeholders.
The healthcare industry needs to move beyond linear growth such as adding new
hospitals and adding a fixed number of physicians every year, and instead look for ways
to disrupt the current operating model.

Uberisation of the healthcare industry is required to radically change the way

healthcare operates, and emerging technologies have the potential to positively impact
the healthcare ecosystem.
Emerging technologies can take up many of the responsibilities currently performed
by doctors, thus enabling doctors to spend more time on activities that require their
expertise. Emerging technologies can also monitor patients on a regular basis and assist
with the early diagnosis of serious conditions. This will enable patients and healthcare
providers to proactively seek treatment.
Emerging technologies can ensure collaboration between healthcare providers with
the right set of controls assigned to patients. Various aspects of Indian healthcare, such
as treatment guidelines and protocols and ownership and sharing of patient records,
need to be standardised. Most importantly, the costing of health services needs to be
made uniform with the agreement of all stakeholders and implemented across the
nation. Emerging technologies like blockchain look very promising in this regard.
Sharing of patient data can be made as simple as sharing a key, without any hassles of
managing availability or security of data. This will make it easier and faster for doctors
to understand medical history and for insurance providers to validate and expedite the
reimbursement process.

12 Reimagining the possible in the Indian healthcare ecosystem with emerging technologies PwC 13
 Disruptive technologies are shaping
the future of healthcare

Innovations in healthcare

Technology is the best way to achieve the vision of a connected From simple fitness and heart rate monitors to smart glasses Several other technologies are being used to empower Emerging technologies can be utilised to cater to the
healthcare ecosystem. Medical devices in hospitals/clinics, and smart clothing, there are several options for individuals healthcare providers with the tools to deliver better care or specific challenges faced in India:
mobile care applications, wearables and sensors are all to watch over their own health parameters in order to not only eliminate the current challenges. For example, augmented
different forms of technology that are transforming this lead a healthy life but also get expert opinion by simply sharing reality (AR) and virtual reality (VR), in addition to • Provide real-time patient information and assist with
ecosystem. These enable caregivers to perform their roles more these parameters with their caregivers. holograms are paving the way for precise surgeries with the symptom-based diagnosis which can save doctors’ time and
easily by automating the logging-on mechanism, automating help of 3D models of the patient which can be analysed enable them to consult more patients.
Digitisation of patient health records and EMRs has been
real-time updates of patient vitals and providing insights into one of the crucial steps which made such a transformation in detailed by surgeons prior to performing the actual
• Provide consultations and conduct surgeries remotely, thus
early detection of diseases. possible. Several vendors are trying to digitise the ways we complex surgery.
bringing healthcare to remote areas with no access to basic
Technologies help to collect, store and share critical patient manage or share electronic records, payments, insurance, and AR is being used in medical education, where it has the healthcare facilities.
data. By adding an analytics layer to this, caregivers document these aspects. potential to reduce the count of actual dissections, and
can provide a much better analysis of the condition and • Enable the patient and healthcare providers to take
There have been various proofs of concept of blockchain greatly help in the study of human anatomy, histology and
recommendations to the patient. AI can assist caregivers in the proactive measures based on an analysis of vitals captured
applications in the healthcare industry that are theorised to embryology. This is especially beneficial today when the need
early detection of diseases based on certain triggers in vitals. remotely using wearable medical devices.
bring together sharing of this information in a secure manner. for doctors has vastly increased.
Even outside the hospitals, wearables and smart sensors can All these use cases will enable seamless access to historical • Provide critical home care with the same level of care and
3D printing is also becoming popular in this industry due to
help track patient history or any threat to an individual, which and real-time patient data to authorised users, eliminate cleanliness that is provided in the ICU along with remote
its wide variety of applications. From precise casts to accurate
may be beneficial, especially to those who are at a higher risk, the need for intermediaries, reduce costs, and save time. monitoring of a patient’s vitals.
replacement of bionic parts, it has found many uses in curing
such as those with diabetes or a history of heart attacks.
physical injuries. Bionic parts include not just accurate ears or • Decentralise patient health records using blockchain
teeth, but also tissues and organs made from the patient’s own technology to maintain a single source of truth and provide
Disruptive technologies in healthcare cells to reduce the risk of rejection of organ transplants. control to patients regarding who can access their records.
Also, 3D printing of complex vascular organs and anatomical
Less invasive diagnostics models has increased the accuracy of surgical process and
training. Even in pharmaceutical processes, it is helping
Patient-facing mobile apps in personalised drug dosing, drug delivery and drug
release profiles.
Remote monitoring solutions With the future of healthcare focused on personalised care,
the adoption of chatbots and AI assistants in this field is
Digital platform integration beneficial as these help in reducing the workload of doctors
and ensuring convenience for patients, in addition to helping
Surgical robotics tools in therapy and 24x7 support for patients across the globe.

Ancillary services

Connected devices for home use

3D printing

AI

Smaller implants
Figure 7: Disruptive technologies in healthcare

Source: PwC Health Research Institute clinician survey, 2015

14 Reimagining the possible in the Indian healthcare ecosystem with emerging technologies PwC 15
 In this paper, we will look closely
at applications of Artificial
Intelligence (AI) and the Internet
of Medical Things (IoMT), their
adoption in India and challenges
that the Indian healthcare
ecosystem faces in terms of the
adoption of these emerging
Relevant emerging technologies for the Indian healthcare ecosystem technologies.

As per PwC’s 2017 Global Digital IQ Survey, the Indian organisations surveyed seem to be making significant investments in AI,
IoT and robotics. The investment focus is likely to shift to blockchain in the coming years.

PwC’s Global Digital IQ Survey

AI
In India, investments are happening in IOT and AI: Globally, healthcare executives rate AI as most disruptive tech in the Artificial Intelligence(AI) can be defined as the capability of devices to learn on their own without an explicit program and act on
industry, followed by IoT: the information gathered cognitively. AI leaders are working tirelessly to enhance the applicability of AI in health sciences. There
is a huge effort to put AI to good use at the very core of the healthcare industry, at the point of care delivery.

Some of the most remarkable developments are:

• Identifying patients at risk of developing a condition, face and the medication they’re taking using a visual
64% 31% deteriorating due to lifestyle, environmental, genomic, recognition system but also confirm ingestion.
or other factors, utilising system dynamics driven pattern • Clinical trials are traditionally time consuming. It might
recognition. PwC’s Bodylogical™ uses machine learning take more than a decade to create a drug and therefore
algorithms to digitally represent the physiology of the huge investments to the tune of billions of dollars are
of the Indian executives interviewed say of the global healthcare executives interviewed rate
AI as the most disruptive tech in the industry human body, thereby enabling simulations to predict the sometimes necessary. AI is drastically expediting clinical
they are investing in IoT
likely progression of chronic diseases in the future based trials from years to—in some cases—days, consequently
on choices made today. These simulations help hospitals, leading to huge savings in expenses.
IoT 64% AI 31%
insurance providers, pharmaceutical providers, and Another start-up in the US discovered a potential
researchers to better understand choices and therapeutics candidate drug to reduce Ebola infectivity, cutting
AI 42% IoT 27% and their implications for patient’s health outcomes and down months and years of analysis to a single day.
impact on associated costs. With advances in AI, tissue sample analysis, which
Robotics 27% 3D printing 17%
• AI can also help clinicians take a comprehensive approach traditionally took a year of a pathologist’s time, can
towards disease management, better coordinate care now be performed in a single day. Since lower costs
plans and help patients to better manage and comply with are incurred on drug discovery, in the long run,
VR 16% Robotics 12% their treatment programmes. An application has been pharmaceuticals can be expected to pass on the benefits
built by a start-up in the US, with these very objectives in to the end user either voluntarily or by law, thus making
mind. This application can not only identify the patient’s healthcare accessible to more people.
3D printing 10% AR 8%

AR 10%
PwC’s Bodylogical
Blockchain 3%

Bodylogical™ is a patent-pending scientific model that is bringing an entirely new level of precision to health and enabling
Blockchain 7% VR 1% organisations to double down on value. By simulating the interplay of actions and reactions inside each of our bodies,
Bodylogical™ creates a deeper, more personal view into something not possible before: the unique requirements of our
Drones 3% Drones 0% individual bodies when something changes to affect our health. Bodylogical™ helps organisations deliver on two sides of
value simultaneously:
Figure 8: PwC’s Global Digital IQ Survey Improving health outcomes and lowering healthcare costs.

Source: PwC’s Global Digital IQ Survey, February 2017

Pharmaceutical and life Population health managers Devices from digital

PwC’s 2017 Global Digital IQ Survey sciences organisations and employers health providers

can now create new and can make better healthcare can now give consumers more
We’ve been conducting Digital IQ research since 2007, and 2017 marked our eighth survey of business and IT
quantifiably more effective investments by knowing what power to do more with their
executives globally.
therapies faster, get therapies interventions will quantifiably health by providing more
The 2017 edition was fielded September through November 2016 and included 2,216 respondents from 53 countries. to the right people, and focus reduce chronic disease for actionable and personally
Respondents were evenly divided between IT and business leaders. Reflective of the distribution of respondents their investments on drugs and specific, targeted populations – calibrated information.
globally, 62% work in organisations with revenues of 1 billion USD or greater and 38% have revenues between 500 technologies that indicate the down to the individual level.
million USD and 1 billion USD. highest probability of success.

16 Reimagining the possible in the Indian healthcare ecosystem with emerging technologies PwC 17
IoMT

Internet of Medical Things (IoMT) refers to the worldwide movements of people/assets in hospital premises, and assisting IoMT devices have also found application in ensuring that The administration of one of the leading US-based paediatric
network of interconnected medical devices and applications. with real-time information on queues to suggest appointment medicines are stored at the correct temperature. A leading hospitals identified that patients were facing difficulties with
The healthcare sector stands to gain a lot from this technology rescheduling, etc. global telecom network provider and a medical devices start- indoor navigation and this would often lead to increased
as IoMT has found applications in clinical as well as non- up collaborated to develop a medicine packaging equipped stress. The hospital created a mobile application which would
clinical scenarios. On the clinical side, IoMT is being used A university hospital in the US was facing challenges in terms with sensors to monitor temperature, light and movement, utilise the location of a patient’s family member and guide
to monitor a patient’s vitals (temperature, blood oxygen of locating IV pumps and nurses had to wait up to two hours and report the same via the former’s global SIM as and when them from one point to another within the hospital. The
saturation, blood pressure, respiration, ECG/EEG/EMG, etc.) before receiving a pump. Some nurses even resorted to hiding either is approaching a threshold. A healthcare start-up in application also allowed the hospital administration to update
and raise timely alarms. It is also being used for continuous IV pumps, which led to an overall reduction of IV pump the US has developed smart wireless pill bottles to track information such as faulty elevators so that people were not
monitoring of vitals and assisting physicians with intuitive utilisation. The hospital administration implemented a radio- adherence by patients and report the same to physicians. directed to these areas.
dashboards instead of them manually operating ICU devices/ frequency identification (RFID) based system to quickly
patient monitors to check for recent spikes in vitals or relying track IV pumps which increased utilisation from
on information noted manually by nurses at regular intervals. 45% to 70% and also reduced the waiting time from eight to
IoMT device categories
IoMT and AI together have the potential to enhance the clinical twelve minutes.
decision-making process and change the reactive approach of A leading medical centre in the US collaborated with a
healthcare delivery to a proactive approach. technology company to implement RFID-based hand hygiene
On the non-clinical front, IoMT has found value in terms of compliance equipment. All hand sanitiser dispensers were
asset tracking, tracking physicians’ adherence to hygiene equipped to read RFID tags of physicians/staff and the
IoMT
standards, connecting ambulances to the hospital information data was analysed to check for individual and overall hand
system, enhancing operational efficiency by tracking hygiene compliance.

Non-clinical
Clinical

Wearables Implants Equipment Location-based Sensors for

trackers legacy devices

On the basis of their applications, IoMT devices can be split into two major types—clinical and non-clinical—which
can be further classified into five device types.

18 Reimagining the possible in the Indian healthcare ecosystem with emerging technologies PwC 19
 PwC’s Healthcare IT
Survey 2018

In order to understand the adoption of AI and IoMT in the

Indian healthcare ecosystem, the challenges being faced
and expectations of the industry, PwC interviewed senior
executives from leading healthcare providers in India.

The survey involved discussions on four topics:

Survey question 1: Current technologies
1. Current technologies that are being adopted amongst that are being adopted amongst healthcare
healthcare providers in India providers in India
2. Adoption of AI and IoMT use cases by healthcare providers
in India Technology adoption has been higher in private
institutes as compared to public institutes. Most
3. Challenges for AI and IoMT adoption in the Indian private healthcare providers, at least the ones in
healthcare ecosystem tier 1 and tier 2 cities, have adopted foundational
4. Changes expected to drive adoption of AI and technologies such as hospital information systems
IoMT amongst healthcare providers in India (HIS), enterprise resource planning (ERP) software,
appointment booking software, RFID asset tracking
and the integration of pharmacies with HIS to bring
Clinical Non-clinical in operational efficiencies and provide good customer
experience.
1. Wearables 1. Equipment With the release of EHR standards for India,
They include biosensors for monitoring blood pressure, private healthcare providers have now shifted their
It includes bedside monitors, smarts beds, community kiosks,
heart rhythm, respiratory rate, blood oxygen saturation, focus to EHR adoption. As for emerging technologies,
medication dispensers and medicine adherence trackers.
temperature, eye pressure, glucose level, brain waves, sleep while private healthcare providers in India recognise
These can be used in a hospital or for home care.
metrics, etc. These can be used for monitoring inpatients and the potential of these technologies, they are
for remotely monitoring patients after they are discharged 2. Location-based trackers still weighing their options and the adoption has
from hospitals or under home care. been limited.
They include sensors or RFID tags used for tracking patient
2. Implants movement. The data is used to improve operational efficiency,
track critical equipment and identify whether a patient has
They include ingestible or implantable sensors used for fallen and not recovered, etc.
tumour detection, tracking genomic signals, drug tailoring and
inflammation detection. 3. Sensors for legacy devices

They include sensors that are used to simply transmit the data
captured by legacy biomedical devices. These devices are
costly and sometimes do not offer connectivity options. The
sensors thus enhance their utilisation by connecting them to
the enterprise applications.

20 Reimagining the possible in the Indian healthcare ecosystem with emerging technologies PwC 21
Survey question 2: Adoption of AI and IoMT
use cases by healthcare providers in India

There is a shared enthusiasm regarding the potential of AI Care delivery

and IoMT. Most multi-specialty hospitals are evaluating AI,
with some level of scepticism, by working with tech start-ups.
Most large-scale hospitals have adopted IoMT in some shape or
the other.
1. Breast cancer screening (AI) 3. Radiology inferences (AI)
Adoption of AI and IoMT among Indian healthcare providers is
higher for driving care delivery and customer experience In India, around 50% of women who are diagnosed with breast India is home to a quarter of tuberculosis cases across the
than improving operational excellence. While IoMT has been cancer die within half a decade. The fatality is alarmingly world. This increases the disease burden of the nation. A lot of
used to collect and present patient vitals to assist physicians with high specially when compared to developed countries or these cases are recorded in underserved rural areas, making
real-time information, Indian healthcare providers can utilise even China.4 This severe situation can be changed if cancer is detection and treatment difficult.
emerging technologies to explore use cases such as asset tracking, detected early. A leading hospital in Delhi-NCR, in association with the
identifying defects in assets and tracking patient waiting times There is a lack of facilities and specialised radiographers. Government of Haryana, is involved in a project where a
to enhance queueing mechanisms in order to improve operational The cost of screening is also very high, rendering it to be mobile van goes from village to village performing digital
efficiency. unaffordable for most of the population in India. chest x-rays to be processed later by AI. The hospital is
AI-based cancer screening software using machine intelligence working with a machine learning company, which has an
There is some level of confusion on what AI is. Further, AI is also
over thermographic images has given rise to a low-cost, easy accuracy of around 85%.
associated with rule-based programmes being marketed as AI.
to operate, portable solution to detect breast cancer that too The hospital claimed to have detected 244 positively
There are several use cases of emerging technologies being piloted at a much earlier stage in comparison to traditional diagnostic diagnosed patients, out of the suspected 618, within the
across the three pillars of healthcare delivery in India. These methods, thus providing a great level of improvement in first three months of running the initiative. This is remarkable
technologies will help solve some of the biggest challenges in survival rates. Also, the screening method is non-contact, progress towards the eradication of tuberculosis, considering
Indian healthcare. painless and free of radiations, making it easier for women that more than 10 people are saved from contracting this
of all age groups to undergo frequent screening. dreaded disease through sputum for each pulmonary
tuberculosis diagnosis.
2. Preliminary symptom-based diagnosis (AI)
4. Cancer treatment options (AI)
The lack of healthcare infrastructure is one of the major
challenges in the Indian healthcare ecosystem. A majority of As far as cancer treatment is concerned, there is no single
Summary of currently implemented use cases of AI and IoMT in India physicians spend their time consulting patients about not- solution for all sorts of variations found in diagnosis. For each
very-complicated common diagnosis. Patients also have to new cancer case, physicians have to look for the best suited
spend a great amount of time to travel to clinics/hospitals and treatment plan; this is a very intensive process, and with a
Care delivery then wait in queues to see a doctor. limited number of specialists available in India, this
Refers to the core purpose becomes a bigger challenge.
Care delivery of a hospital to treat Based on the symptoms a patient might be having and
patients with utmost care comparing them with a library of symptoms, AI is helping A leading hospital chain in India has created a system which
• Breast cancer screening from doctors, nurses and can generate a detailed report in around less than thirty
physicians save time for medical cases which might require
• Preliminary symptom-based other staff.
diagnosis immediate attention. This also makes the best of the minutes. This report outlines the most relevant treatment
Remote patient • Radiology inferences Smart physicians available to the larger population without any plan options for the patient based on his/her cancer
monitoring • Cancer treatment options ambulance geographical barriers. diagnosis and medical history. The platform uses advanced AI
and covers around 60 different types of cancer.
This hospital also provides these reports for remotely
located patients with an option to avail video consultation with
an oncologist, further breaking geographical barriers for
cancer treatment.
Customer Operational
experience excellence
Customer experience Operational excellence
Refers to the initiatives • Patient appointment • ICU vitals monitoring Refers to the initiatives taken at
taken in a hospital so as to scheduling • Transmit data from legacy a hospital to enhance its logistic
create an impression of • Indoor navigation bio medical devices efficiency and automating
more friendly facilities for typical detail-intensive tasks like
patients /caretakers. periodic data capture at a
hospital facility.

Figure 9: Summary of currently implemented use cases of AI and IoMT in India

Source: PwC’s Healthcare IT Survey 2018

4
 hakraberty, S. (24 April 2017). This startup uses AI to detect breast cancer from the cloud. Retrieved from https://www.techinasia.com/startup-patented-ai-tech-
C
breast-cancer-screening (last accessed on 28 February 2018)
22 Reimagining the possible in the Indian healthcare ecosystem with emerging technologies PwC 23
 Care delivery and
Operational excellence
operational excellence

1. Smart ambulance (IoMT) 1. ICU vitals monitoring (IoMT)

Previously, ambulances were used merely for transporting a In an ICU, it is of utmost importance to record patient vitals
patient and giving necessary care during transit. The lack of on a regular basis and present them to physicians as and when
automated transmission of patients’ vitals on a regular basis they visit the patient. Generally, a nurse manually records
hindered analysis by senior physicians and also didn’t provide patient vitals at regular intervals. However, this leads to risks
enough information to the healthcare providers to prepare for of missing out on certain spikes in vitals in between the nurse’s
the treatment by calling specialist doctors, arranging medical rounds. Along with nurses, physicians manually operate
equipment, etc. bedside patient monitors too.
Some leading hospital chains in India have now implemented A leading hospital in India has been running a pilot programme
IoMT sensors in ambulances to track patients’ vitals and share for the last two years on 10 ICU beds, whereby IoMT sensors
them in real time with the healthcare ecosystem attached to bedside patient monitors detect spikes in vitals on a
so that physicians can analyse the vitals and make the continuous basis, trigger alarms when approaching a threshold
necessary preparations for treatment before the patient and keep the data ready in the form of insightful dashboards
reaches the hospital. for physician visits.
IoMT has thus helped improve operational efficiency and The dashboards generated using data captured through Care delivery and customer
enabled healthcare providers to provide better care. IoMT sensors not only provide an accurate analysis of the Customer experience
changes in vitals, but also save physicians the trouble of
experience
manually operating bedside patient monitors to see spikes in
the last few hours.

1. Remote monitoring (IoMT) 1. Patient appointment scheduling (AI)

2. Transmit data from legacy biomedical
devices (IoMT) For some illnesses, it is preferable for patients to stay at home Traditionally, patients used to make appointments with
and receive the care that only their families can provide. physicians by visiting clinic/hospital registration desks or by
Legacy biomedical devices are costly and do not offer flexibility
However, it is also of utmost importance for patients to receive making a call, which would be processed by a receptionist.
in terms of connectivity. While some offer Wi-Fi, others only
the necessary medical care and cleanliness that healthcare Human intelligence was used to match patient demands
provide wired connections.
service providers offer. with physician supply. Today, with multiple channels of
A leading hospital in India has utilised IoMT sensors to capture interaction between hospitals and patients (web/mobile apps/
Critical care at home is picking up in India with dozens of
data from such legacy biomedical devices used in ICUs and call/text messages), it’s getting increasingly complicated to
companies providing ICU facilities and critical care treatments
share the same with a smart hub. Since the IoMT sensors schedule patient visits.
at home. While the home provides a convenient environment
are only used for transmitting data, the reliability of vital
for the patient and family members, the service provider Chatbots are helping hospitals schedule their patients better
parameters transmitted is unquestionable.
ensures that the patient’s vitals are continually recorded using by analysing the data gathered at all points of interaction
The smart hubs provide insightful and configurable digital IoMT devices; the vitals are then transmitted to physicians at in combination with patient’s medical history and past
charts to physicians who now don’t have to manually operate their treating hospital. interaction data.
the biomedical devices to identify irregular patterns in vitals or
Physicians thus have continuous access to the patient’s vitals Chatbots also provide great opportunities to enhance and
rely on data captured manually by nurses at regular intervals.
and can instruct the attending nurse at the patient’s home personalise the patient-caretaker experience.
IoMT sensors also assist with automated alarms in case a
to adjust the dosage, if required, basis the vitals reported
threshold is reached. IoMT sensors thus assist in making legacy
remotely. Remote monitoring also assists in triggering
biomedical devices more user friendly.
automated alarms to physicians, ambulance service providers
2. Indoor navigation (IoMT)
and patient’s family members in cases of emergency.
It is not always easy to navigate from one point to another
Remote monitoring has also found application in rural areas within a hospital and most of the time we have to seek
where access to hospitals/clinics is limited. Physicians visit directions from hospital staff.
rural areas with mobile monitoring devices that either attach
A leading hospital in India has implemented IoMT-based
to a mobile to transmit data or transmit data to a mobile
location awareness technology. Patients have to download a
device through communication protocols such as Bluetooth
mobile application which connects to beacons placed all
Low Energy. Patient data is transmitted to physicians sitting
across the hospital.
miles away and, if needed, tele-consultations are arranged
with specialists. The beacons detect a patient’s location and guide them from
Point A to Point B by giving detailed turn-by-turn navigation.
This same technology also has the potential of locating assets
placed in the hospital.
24 Reimagining the possible in the Indian healthcare ecosystem with emerging technologies PwC 25
Survey question 3: Challenges for
AI and IoMT adoption in the Indian
healthcare ecosystem • Absence of a healthcare regulatory body
Medical Device Rules, 2017
PwC 27
There are a number of barriers that There is no healthcare regulatory body in India. In the The MoHFW notified the Medical Devices Rules, 2017,
are limiting the adoption of emerging absence of adequate regulations, there is concern among on 31 January 2017. The new rules have been framed in
technologies such as AI and IoMT in the healthcare providers regarding the reliability of medical conformity with the Global Harmonisation Task Force
Indian healthcare ecosystem. devices and thus practitioners prefer to use traditional (GHTF) framework and conform to the best international
medical devices. Although the Medical Devices practices. Only 15 categories of medical devices are, at
Rules, 2017, became effective on 1 January 2018, present, regulated as drugs. This indicates that the current
their effectiveness is yet to be seen. regulatory practices in India are not fully equipped to
meet the requirements of the medical devices sector in
the country. The new rules seek to remove regulatory
• Low collaboration between various bottlenecks with regard to the Make in India initiative and
stakeholders facilitate ease of doing business while ensuring
Challenges for AI and IoMT adoption better availability of better medical devices for patient care
and safety.
Although the Government of India has set up standards
Medical devices are to be categorised into four classes based
for sharing statistics among healthcare providers, the
on associated risks. Manufacturers of medical devices will be
sharing of clinical data between healthcare required to meet risk proportionate regulatory requirements
stakeholders still seems a farfetched goal in that have been specified in the rules and are based on best
India. In some cases, the sharing of information international practices.
within the same entity is not seamless as some big
hospital chains in India are using different HISs across Class A, low risk Class B, low to moderate risk
different locations.
• Manufacturing licences will be • Licensed by state licensing
granted without prior audit of a authorities
Absence of healthcare regulatory body* #
• Unaffordability manufacturing site, based on
self-certification
• Post-approval audit for
Low collaboration between various conformance with QMS
While there are some big players in the AI and IoMT
stakeholders*
space that provide quality solutions and reliability in • Licenced by state licensing
terms of their longevity, their solutions are not Authorities

Unaffordability*#
well-priced.
Oncology consultations using world-renowned AI Class C, moderate to high risk Class D, high risk
software can cost tens of thousands of rupees, whereas
in-person consultations with leading oncologists can be • Licensed by central licensing • Licensed by central
Privacy and security of data*# authorities licensing authorities
sought by paying a small percentage of that amount.
While IoMT sensors, actuators, etc., are not very
Unavailability of relevant data*
costly, IoMT solutions provided by big players and • A system of ‘third party conformity assessment and
IoMT platforms cannot be afforded by most healthcare certification’ through notified bodies is envisaged.
providers in India. In order to avoid heavy costs, some of The notified bodies will be accredited by the National
these healthcare providers have experimented Accreditation Board for Certification Bodies (NABCB).
by developing use cases and getting them implemented
Interoperability# • Quality management system (QMS) will need to be
by smaller technology partners instead of procuring aligned with ISO 13485.
solutions from big players in the emerging
technology space. • Imported medical devices will continue to be regulated
by the Central Drugs Standard Control Organization
(CDSCO).
• New devices will also be regulated by CDSCO.
* Challenge for AI adoption # Challenge for IoMT adoption Technological challenges
• No requirement for the periodic renewal of licences.
• Manufacturing and import licences will remain valid till
Figure 10: Challenges for AI and IoMT adoption in the Indian healthcare ecosystem they are suspended or cancelled or surrendered.
• The entire licensing application process is to be
Source: PwC’s Healthcare IT Survey 2018
processed through an online electronic platform with
predefined timelines fo most activities.

26 Reimagining the possible in the Indian healthcare ecosystem with emerging technologies PwC 27
• Privacy and security of data

Based on our interactions with CxOs of leading healthcare

providers, it was identified that privacy and security
of healthcare data is a major concern in the absence of
adequate laws. Many medical devices in the healthcare
ecosystem run on public networks and there are no
regulations for ensuring secure management of such data.
There is concern and confusion regarding legal
aspects tracking patient location.
India needs stronger regulations in the form of the
Healthcare Data Privacy and Security Act
(HDPSA), which is being drafted by the Union Health
Ministry. Hopefully, this will address the concerns of
the industry and provide a clear path to the adoption of
emerging technologies.

• Unavailability of
relevant data

Artificial intelligence

Machine
learning algorithm

Labelled data

To develop highly accurate AI predictions, a gigantic amount of labelled

data* is required to train the underlying models. Further, this data
needs to have parameters similar to the one for which it needs to make
predictions.
The lack of India-specific clinical data was a shared concern from the
CxO community. Further, the cost of collecting and testing this data
(e.g. collecting genome data) is enormous.

* Data with known outcomes for input parameters

IoMT solutions available in the market are mostly

proprietary targeted solutions that are developed to
tailor a particular client’s requirement, with an emphasis
on reducing the cost and not with an intent of sharing
information with external players in the future.
Therefore, most of the current implementations
use different protocols which result in the lack of
standardisation of communication protocols. This leads
to interoperability issues between various IoMT devices/
solutions available in the market.
28 Reimagining the possible in the Indian healthcare ecosystem with emerging technologies PwC 29
 Road ahead

Survey question 4: Changes expected to

drive adoption of AI and IoMT amongst What steps can be taken to drive adoption of AI and IoMT by
healthcare providers in India healthcare providers in India?

Collective efforts by the government and

industry stakeholders are necessary in order to
increase the adoption of emerging technologies
such as AI and IoMT. Stronger and clearer
regulations are expected from the HDPSA. Public
and private institutes should collaboratively work
towards collecting and sharing India-specific Collection Budget for emerging
patient data so that emerging technologies can be of data technologies
utilised to their full potential. The government
should incentivise the adoption of emerging Stronger Incentives Emerging technologies
technologies. regulations adoption framework

Stronger regulations
Currently, there is no healthcare regulatory body in India. Data
privacy and security is a concern in the absence of the HDPSA,
which is still being drafted by the Union Health Ministry.
Further, the effectiveness of the Medical Devices Rules, 2017, is
yet to be seen.
The government needs to form a legal framework which
should be imposed stringently but with a caveat that laws
should be formed in a participative manner, taking industry
perspective in consideration along with accommodations for
geographical conditions, resource availability and public-
private partnership administration model.

Collection of data
Despite the enormous costs related to the collection and ‘We are seeing the emergence of non-profit organisations like
testing of clinical data such as genome data, some start- Ramesh Nimmagadda Cancer Foundation (RNCF) that has
ups have started collecting India-specific data and plan created a software platform called OncoCollect which is being
on extrapolating it for it to become relevant for AI. Once used by organisations spread across India. OncoCollect can
a significant amount of relevant data is available, a team be used to collect, collaborate (AWS cloud based) and analyse
of physicians, IT staff and data scientists will have to patient data.’ – JP Dwivedi, CIO, Rajiv Gandhi Cancer Institute
collectively develop algorithms for AI software. and Research Centre
Sharing of clinical data and discussions among various
stakeholders should be promoted in order to collaboratively
draw insights from the captured data. Emerging
technologies such as blockchain can play a big role in
achieving this goal.

30 Reimagining the possible in the Indian healthcare ecosystem with emerging technologies PwC 31
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Figure 11: PwC’s framework for emerging technologies adoption

32 Reimagining the possible in the Indian healthcare ecosystem with emerging technologies PwC 33
Notes Notes

34 Reimagining the possible in the Indian healthcare ecosystem with emerging technologies PwC 35
About BCC&I About PwC’s Healthcare practice

The Bengal Chamber of Commerce and Industry, India’s oldest institution of its kind, traces its origins to 1833. The Chamber has PwC India’s Healthcare team offers Advisory services in the diagnostic players, insurance providers and private equity
played a pioneering role as a helmsman, steering the evolution of Commerce and Industry in India. The Chamber reviewed and healthcare sector covering multiple domains such as strategy, players on projects both in India and overseas.
commented upon some of the most critical legislations in the country. business planning, market scan, commercial due diligence, Our Social Sector Advisory Services, a division within
The Bengal Chamber has managed to remain both young and relevant simply because it is quick to recognise and value the only feasibility study, operations improvement, cost reduction, the GRID practice, also works with several government
constant in time – change. health IT, digital and technology, internal audit and PPPs. (national and state) departments, IFIs, private players in
The Healthcare Advisory team of 30 members combines over the social sector on health and nutrition, education and
In healthcare also include a B2B Meet with IT companies to discuss the 40 years of operational experience in setting up and managing skill development, livelihood, governance, local community
latest offerings relevant to the healthcare sector, a Medico hospitals, and over 120 years of healthcare consulting development based in urban and rural areas, and women
In keeping with this practice, the Chamber has pioneered a Legal Workshop involving doctors, lawyers and hospital experience. This enables the team to deliver granular strategy and child development. All these sectors and sub-sectors are
number of initiatives and programmes in new directions in the administrators to learn and share the experiences on and market and operational insights of the highest quality. multi-dimensional in nature and are intricately interconnected
past which have brought cutting-edge offerings in healthcare medico-legal issues and guidelines, a Blood Donation Camp, The team works with leading healthcare providers, medical through various aspects including grassroots community
services to the common man and included lectures on health a Seminar on Deceased Organ Donation as a gesture of our technology providers, central and state governments, development.
issues by leading and iconic personalities in health like responsibility to society. The Committee also celebrates
doctors, entrepreneurs and policymakers. Doctor’s Day in a unique way by organising a panel Discussion
The Health Committee also organises an annual Health Quiz, and quiz with doctors.
which has made a niche for itself in the corporate community
of the city. Technology
The Bengal Chamber’s Health Committee has been playing The Chamber has a vibrant IT Committee comprising all
an important role in addressing the critical aspects in leading developers, consultants and corporates. The focus
the field of healthcare in the state and has been catalytic has always been to communicate and create a bridge between
in bringing about significant corporate consciousness in technology users and developers on how applications can
healthcare management. It has organised health expos, panel make enterprise planning and manufacturing processes
discussions, and lectures on health issues by leading and simpler, faster and less complicated – achieving all this at a
iconic personalities in health from the fraternities of doctors, lower cost. Most importantly, as a catalyst, service provider,
entrepreneurs and policymakers. The Chamber’s National initiator of sector-specific activities, facilitator of business
Health Debate, which has been addressed by national and and spokesperson for the state government, the Chamber
international personalities, also deserves a special mention. envisions itself to be the most valued partner of our members
The Committee also organises a quiz on health and lifestyle to in promoting and facilitating sustainable growth.
create awareness on healthy living. The Committee’s activities

Our signature programme is Business IT Conclave, the eighth edition of which was held on 24 May 2017 on ‘Bridging Automation
and Society’. The presentations shared by speakers, photographs, and YouTube links of videos are available on our website:
http://www.bengalchamber.com/events-gallery-business-it-conclave.html The archive of earlier editions is also available here.
The Conclave brings together stakeholders of IT to discuss, brainstorm, and share best practices of the latest happenings in the
realm of technology.

Contact persons

• Ms. Angana Guha Roy Chowdhury (+91 9830251019, [email protected] ), Deputy Director, The Bengal Chamber
• Ms. Sarbani Sett (+91-9831430781, [email protected]), Senior Executive, The Bengal Chamber
• Ms. Dia Sen (+91 8017053773, [email protected]), Junior Executive The Bengal Chamber

Reimaginingthe
36 Reimagining thepossible
possiblein in
thethe Indian
Indian healthcare
healthcare ecosystem
ecosystem withwith emerging
emerging technologies
technologies PwC 37
PwC
About PwC

At PwC, our purpose is to build trust in society and solve important problems. We’re a network of firms in 158 countries
with more than 2,36,000 people who are committed to delivering quality in assurance, advisory and tax services. Find
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© 2018 PwC. All rights reserved

Contacts

Arnab Basu Dr. Rana Mehta Abhijit Majumdar

Partner Partner Executive Director
Technology Consulting Leader Healthcare Consulting Leader Technology Strategy Leader
[email protected] [email protected] [email protected]
Mob: + 919830706904 Mob: +919910511577 Mob: +919819854482

Sayantan Chatterjee Abhishek Tejpal Singh Jashanjot Singh Sekhon

Associate Director Senior Consultant Senior Consultant
Technology Consulting Technology Consulting Technology Consulting
[email protected] [email protected] [email protected]
Mob: +91 9971 915 709 Mob: +919769281004 Mob: +919971998067
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