Data core to digital strategy, training surgeons on VR: Medanta’s Sahni and Sikka

Some of India's biggest multi-speciality hospital chains are increasingly using emerging technologies such as artificial intelligence (AI), machine learning (ML) and Internet of Things (IoT) to make healthcare delivery better. Gurugram-based Medanta, founded by noted heart surgeon Naresh Trehan and Sunil Sachdeva in 2009, is one of those hospitals.

For Medanta, patient data is core to its digital strategy of harnessing emerging technologies, though it's clear that these technologies cannot automate the doctor out of existence. In a conversation with TechCircle, CEO Pankaj Sahni and IT head Rajeev Sikka explain how Medanta is adapting to emerging technologies for faster and better decisions. Edited excerpts:

What has been the hospital’s approach towards emerging technologies?

Sahni: We started our digital journey early and we are using these new technologies (AI, machine learning or ML, Big Data, analytics) in hundreds of different ways. To understand in what areas we are applying these technologies internally, you must understand the healthcare delivery ecosystem. It starts with the condition of the patient and early detection of ailments followed by treatment or surgery and then comes post-operative care, etc.

Take treatment, for example. We are using medical technologies in diagnostics, conducting robotic surgeries and for clinical support. We are also using ML in bits and pieces in several aspects. Our hospital uses IoT for post-surgery care. Then there are apps for doctors and use of telemedicine. We are also using virtual reality (VR) in a very effective way.

But these technologies cannot replace a doctor. They have all been put in place to assist them in making faster and more informed decisions.

What is core to this approach, and how do you plan to implement it?

Sahni: As with most digital initiatives, data are core to our strategy. India doesn’t have a planned strategy to store accurate electronic medical records (EMRs) of patients. What we are trying to do is to keep EMR at the centre of our strategy to provide the best medical care possible. The more data a doctor has, the easier it is to treat a patient. The journey of our EMR strategy begins right from the preventive side to post-treatment care.

For example, take an overweight person who is borderline diabetic. If there is a device that can continuously send data about the person’s diet, blood reports, etc., the doctors can understand what is going wrong and can simply call them for a visit. 

Another use case is to keep track of patients who miss appointments. Better, imagine a Fitbit-like or Apple Watch-like device relaying all the required data. For post-surgery care, a patient can be monitored remotely as well. We are already working with device partners.

How do apps fit into the EMR strategy?

Sikka: Medanta has an EMR app, which is in production for over six quarters now. It has been used by doctors, nurses, clinical pharmacists and doctors’ coordinators. It has made life easier when it comes to accessing patient’s EMR and taking decisions based on real-time patient information in line with AAA (any time, any device and any place).

The app has helped clinicians make more-informed decisions based on complete patient history, which includes investigation reports, medication, progress and referral notes, and much more. We are now upgrading the app. Now, practitioners and clinicians would be able to view even run-time patient vitals from the ICU (intensive care unit) on the app. 

You said you are using virtual reality (VR). How?

Sikka: An important critical success factor for any surgery is pre-operative planning, all the more in neurosurgery since a neurosurgeon has to manoeuvre through a complex 3D space. Traditionally, neurosurgeons relied on non-intuitive 2D images and mentally reconstructed 3D equivalent befoe the surgery. At times, this is not precise enough for a complex surgery.

With the advancement of biomedical devices, computing power enhancement and better image-recognition algorithms, different images (CT, MRI, angiography, etc.) can be fused for interactive and immersive environment, leading to the foundation of VR and augmented reality (AR) in neuroscience.

Our neuroscience team has developed a VR- and AR-based solution for cost-effective and immersive training for patient planning tools. The solution was developed for four categories -- surgery observation, instruments training, virtual surgery and certified assessment modules. Not only is it cost-effective but also customisable with respect to patient models, surgical scenarios and other parameters.

What is the hospital’s IoT strategy?

Sahni: All IoT strategies are about data and for us any data that answers the following three 'Vs' is a potential case of Big Data. The first V is volume. Under this comes data from millions of patients’ visits to our facility throughout the year across various specialities. In Medanta, we are collecting 2 GB of data per day per bed covering over 20,000 data points.

The second V is variety. Under this, data are collected from multiple devices in a vendor-agnostic, data-centric, structured data model. Data are structured, partially structured and unstructured in the form of EMR, digital imaging and communications in medicine, images and videos, lab reports, biomedical devices, self-reported results, live-streaming of surgeries, etc.

The third V is velocity. Under this comes data generated from medical devices. These devices generate data that translate into multiple instances (many graphical charts for the same set of data, for example) in a minute and need to be monitored/processed/analysed.

Despite a 24-hour dedicated one-nurse-to-one-patient ratio, it is difficult to gather, process and analyse data in real time. At times, it is prone to error. For intensive critical care, it is essential to monitor various vital signs (pulse, blood pressure, glucose, etc.) almost on a per-second basis. 

While we have the capabilities with biomedical devices to capture data accurately, human ability to record and analyse the correlation between multi-dimension parameters remains a constraint. Therefore, it is logical to automate by allowing devices to record and display information independently. We are capturing this information using Hadoop Distributed File System platform.

This way, a clinician can get complete, accurate and contextual information about the patient. This information can be part of EMR and, finally, clinicians can know patient vitals one hour or “n” number of hours back and, hopefully, with advancement of AI, they would know how vitals would be in the next one hour.

How do you use tech for post-surgery care?

Sikka: This connects us to telemedicine, as it is one of the strongest use cases for post-discharge and post-surgical follow-up. Let’s take the example of a liver transplant. The post-surgical care, regular compliance with medication, and frequent diagnostic tests help a liver transplant surgeon figure out the likely development of the disease and measure the success of the 14-20 hours of effort put in by his team for the surgery. 

Medanta is building a liver transplant app to ensure ease of follow-ups, strict post-procedure compliance monitoring and to keep constant check on any deviation in the clinical parameters of the patients without raising the cost of treatment. The app should go into production by August-end.

The app will enable patients to update their lab results, get a medicine-adherence plan, get alerts on upcoming lab tests, report any medical event that paused their clinical progress and allow doctors to understand if there is any deviation on the path to recovery. They can also take a quick video or phone consultation via this app in case the need arises.

To enable the doctors to track all their patients, all the patient data will be made available to them via the doctors’ version of the app. They can view all the records, including the parameters of the patients during the stay in the hospital and all diagnostic reports in a graphical representation showing the medical progress. 

How are you using telemedicine?

Sikka: Medanta launched its mobile- and web-based telemedicine platform called Medanta eClinic for doctors as well as for patients. A patient can now download the eClinic app on a smartphone and search our doctors by name, speciality, ailment, procedure or treatment. Patients can book their sessions online for video, phone or email consultations.

With the option to upload all types of files, they can share their relevant reports, prescriptions and health records to take an opinion from our doctors. In line with the principle of digital hospital, patients can also access their previous lab reports, diagnostics, prescriptions, and get summaries from the comfort of their home.

Our doctors can view their appointments for the day, check the previous records of the patients and fill recommendations online. Technologies like speech-to-text conversion help in completing the recommendations faster. 

In order to ensure continuity of care, consultation records are stored in the hospital information system (HIS), too. This means, irrespective of consultation mode (virtual or in person or in remote camp), the doctor can have a 360-degree view of the patient medical records for all visits to the hospital. 

For doctors working in teams, the option of case assignment to team member for assessment is available before one releases the recommendations. This platform can also be leveraged for recording prescriptions in outreach OPD (out-patient department) or camp, thereby ensuring the availability of consultation record in HIS for any future reference.

The app has been downloaded 15,000 times and has processed over 20,000 appointments with over 5,000 telemedicine consultations only.