The healthcare industry, including Pharma, MedTech, and Providers, have been trying to improve the current state of patient care journey by using technology. However, doing so in siloes and not using innovations in an integrated fashion is holding us back. Starting from when a patient gets admitted to the hospital, gets the diagnosis done, receives treatment, and recovers, what if there was a holistic way to introducing smarts at each juncture in the journey to improve patient outcome while helping with the bottom line? What are those smarts, and how can they help? What is a practical way to implement and operationalize such smarts? How can various players in the healthcare industry collaborate effectively to bring smarts into patient care?

Contributor

• • Pravin Tiwari, Vice President, FPT Software

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Transcript

Sanjog Aul [00:00:19]:
Welcome listeners. This is Sanjog Aul, your host and the topic for conversation is Bringing Smarts into Patient Care. So here is the scenario. Companies from the healthcare industry, including Pharma, Med-Tech and the providers have been trying to improve the current state of patient care journey by using technology. Some are doing so in silos and others are not using innovations in an integrated fashion. The result is suboptimal patient experience, unwanted costs and struggle in meeting value based care outcomes. Starting from when a patient gets admitted to the hospital, gets the diagnosis done, receives treatment and recovers. What if there was a holistic way to introducing smarts at each juncture in this journey to improve patient outcome while helping with the bottom line? What are those smarts? How can they help? What is a practical way to implement and operationalize such smarts? How can various players in the healthcare industry collaborate effectively to bring smarts into patient care? To discuss this I have with me Pravin Tiwari.

Sanjog Aul [00:01:29]:
Pravin is the Vice President and Business Head for Healthcare America at FPT Software. FPT Software is a global IT services and outsourcing company headquartered in Hanoi, Vietnam. Hello Pravin, thank you for joining us.

Pravin Tiwar [00:01:45]:
Hi Sanjog, thanks for having me.

Sanjog Aul [00:01:48]:
So Pravin, what do you see as the top challenges that prevent companies from Pharma and Med-Tech industry and the healthcare providers from offering an optimal experience during the patient journey? I mean their journey starting from admission, to diagnosis, to treatment and finally to recovery.

Pravin Tiwar [00:02:07]:
Sanjog, if we talk about patient as a main focal point starting from his or her admission, diagnosis, treatment to recovery and health system, I would like to share some of my observation here. When I moved from San Diego to Chicago I had to go to the hospital for some treatment which was quite a challenge. It took a lot of time for hospital to admit me, get me a background history and to diagnose my problem. If there was a way to find my medical history quickly that would have saved a lot of time and I would have gotten immediate attention. It was purely due to lack of information exchange standard which slowed down the process. If a critical patient needs a prescription for a simple blood work, X ray, MRI or CT scan, waiting two days only adds to the anxiety or pain of the patient. Looking at the history of information available in the earmart doctors try to analyze the history before seeing the patient, understanding the symptom and evaluating the problem. Diagnosing is dependent on doctors experience and knowledge.

Pravin Tiwar [00:03:15]:
There is always a fear of human error that may result in the wrong diagnosis. Now for patient treatment, I am sure we have all read about COVID-19 patients who experience breathing challenges. They need a precise supply of air to breathe without having their lungs over expanding or deflating. Each COVID-19 patient requires post flight treatment which demands more nurses and trained officials to monitor and adjust the air supply periodically. Lastly, let us understand patient recovery. Once a patient leaves the hospital with a prescription and an understanding of discipline they need to follow, or if a patient leaves pharmacy with medicine or a prescribed device, for example a blood glucometer, they are completely disconnected from medical observation and thus the system has to rely on the information the patient provides or upon their return to hospital for a follow up. If a patient misses their dose they do not know the consequences it may cause and the challenges that may follow.

Pravin Tiwar [00:04:19]:
If someone has a bone injury and has been released to go home, his recovery progress is basically unknown till he comes back to the hospital for physical examination.

Sanjog Aul [00:04:32]:
Thanks Pravin with most organizations struggling with these challenges for decades, what would you like to propose as the way out?

Pravin Tiwar [00:04:43]:
You are right, these problems have been in existence. Although a lot of work has been done. We need to introduce smarts at each stage in the patient journey for better care. Imagine if there was a smart way for a patient to give all his information to the provider faster and easier. It can tremendously help them to go to any hospital at any time for their treatment and have access to doctors and treatments easily. How about if a patient is given a common ID that can be linked to their information including insurance with clients agreement providers can pull out all the details at click of a button. If the EMRs follow a common standard that can help connect the systems to provide push and pull the information faster. Doctors can help lower patients waiting time and the inconvenience they experience.

Pravin Tiwar [00:05:35]:
Let us take example of patient’s MRI and the CT scan images that are available. What if there was a smart tool to apply and segment the image to analyze and provide right information? We have seen hundreds of patients that are admitted with COVID-19 symptoms and they need ventilators to survive. Imagine if this was managed using smart tool automatically. This would eliminate the issue of shortages of nurses and trained staff. It can help to manage large amount of patients and provide better treatment. I’m talking about the smart system adjusting the oxygen supply based on oxygen level in the blood and the lung’s capacity. I meant to say if this would be personalized for each patient, you will agree it can greatly reduce the monitoring needs and increase survival rate. Another example would be how a patient with lung cancer could be better treated using the SMART system.

Pravin Tiwar [00:06:33]:
If a patient breathes and moves while on the treatment table, which in turn also moves the nodules. I’m talking about cancer infection spot here. The chances of radiation hitting the non infected area is high. What if the machine is smart enough to change immediately based on the movement and still treat only the infected areas? This personalized treatment of cancer to a specific area would help avoid unnecessary exposure to radiation and be very precise. We will all agree that patients usually recover faster at home and often want to avoid going to the hospital. Although doctors would like to treat more patients and see more challenges. So if there are ways patient can be remotely monitored and managed using SMART system, not only will it be good for the patient but also the doctors. Doctors can see the progress without the patients coming to the hospital and in case of an exception, doctors can contact and check the status.

Pravin Tiwar [00:07:35]:
Also, patients are happy avoiding the hospital while still being closely monitored.

Sanjog Aul [00:07:42]:
Pravin, your idea about introducing smarts into patient care is definitely fascinating but sounds utopian. What are the main pillars of this SMARTs paradigm which would make it practical to implement and effective for a given organization and other partner entities in the ecosystem?

Pravin Tiwar [00:08:02]:
SMART is a new and holistic way of looking at improving the patient’s journey. Some of the elements of this SMART approach are already being used in some form but not fully. I would like to describe the fundamental blocks of SMART. Firstly, digitalization. What I mean here is a paperless process or operations. Implementing EMR is moving away from paper to digital. Connectivity between the system integration, interoperability to pull or push the information is other important part. Now when you have data, why not make the best use of it? Finding insight into the data, the trend and the pattern from it is another tenant.

Pravin Tiwar [00:08:46]:
Prediction and proaction. React with information and or create report last. Even though very ambitious at this stage, Virtualization. This is about creating virtual image in computer for simulation of issues and experimenting with treatment and its outcome. What we call the digital twin of the human body. As I said, in some shape or form these are available or being used in every organization. Some are more advanced while others are still at an early stage.

Pravin Tiwar [00:09:19]:
But in order to create real value with tangible outcomes, outpatient care in today’s world, this needs to be accelerated efficiently and cost effectively. I’m assuming all the providers have EMR capability to store and capture information. However, if a patient’s information can be smartly and seamlessly pulled into the system from various sources, this will be an advantage for both the patients and providers. In addition, if the DICOM and HL standardization is implemented for interoperability, it is of great importance. It can help connect EMR to radiology, ultrasound, MRI systems which can expedite the flow of information for example from lab to doctor. Historical data insight is good, but implementing SMART system to analyze the EMR data and provide more details and insight for doctor regarding the patient will be more helpful. Artificial Intelligence application is another example. If applied on top of the data lake for smart analysis, it can help in the prediction of diagnosis.

Pravin Tiwar [00:10:29]:
Smart segmentation and disease detection on captured images can help doctors in accurately and quickly diagnosing the problem for better treatment. Even this is helped in pre-operation process. Treatment plans can be created using Artificial Intelligence tools. What’s interesting is the virtual simulation. Imagine a system where you can replicate the real information of the body and the events happening in the body, plan a treatment, apply the treatment and get its possible outcome on the system before using it on the actual human body. Smart device to monitor muscular skeleton movement can be useful for an orthopedic patient who have had knee replacement and are recovering. It can help doctors remotely monitor the joint movement, analyze the data received to monitor the progress, and map the recovery plan.

Sanjog Aul [00:11:23]:
Let’s take a quick break listeners. When we come back, let’s dig in a little deeper to see if there is any proof of the patient’s SMART concept working in the real world, the value IT created when implemented, and if it can genuinely deliver as promised. Please stay tuned. We’ll be right back.

Sanjog Aul [00:12:38]:
Welcome back. So Pravin, is any proof of the patient smarts concept you explained working in the real world? What value did it create when implemented? And how do we know if this proposed approach to patient care can genuinely deliver as promised?

Pravin Tiwar [00:12:58]:
Absolutely. Smarts have been implemented and proven beneficial in the healthcare ecosystem. There is a large hospital chain with 80 sites and 200 clinics which was working in silos and needed to create a connected ecosystem for a better customer experience and ease of operations, keeping the existing investment intact. Not only did we provide recommendations, but also helped implement the integration system like connecting the EMR system to radiology, picture archiving systems and lab information systems. Also connectivity to external agencies like government and insurance. Thus had an easy access to information like case orders, history, lab results and helped the clinic to spend less time on computer or documentation and more time with the patient. Like I mentioned earlier, one of the medtech companies that manufactures MRI machines wanted to provide more value to its customer talking about doctor here, than just the image output.

Pravin Tiwar [00:13:59]:
It is not easy to detect the nodules, especially since some are difficult to distinguish between benign and malignant. With the help of our scientists, we created an algorithm to detect small nodules that are often missed by normal eyes and thus helping detect the lung cancer at an early stage. This even helped doctor reduce oversight, ultimately helping eliminate human error. Another example is manual drawing and analyzing of cephalometric tracing which is very time consuming and contains human error risk. We developed a computer aided detection and analysis system that incorporates Artificial Intelligence to provide accurate cephalometric analytic results within few seconds. It is frequently used by dentists, orthodontists and surgeons as a treatment all plastic surgery planning tools. We have done some similar things for muscles and fat detection, Artificial Intelligence, powered aesthetic surgery recommendation system, blood vein segmentation, bone segmentation and much more.

Pravin Tiwar [00:15:01]:
Proton beam treatment is commonly used for cancer treatments with a pinpoint accuracy and minimum side effects. As mentioned earlier in the discussion about challenges, this medtech company was having difficulty in positioning it correctly when the patient is moving. We have helped build the software that is used to perform image processing using an algorithm to detect the cancer tumor movement according to the patient’s breathing. This technique increases the accuracy of radiation. Even while moved, ventilators often need attention. To ensure the right amount of oxygen is supplied to the patient, we have built a software to adjust the supply according to the oxygen content in the blood and the lungs pressure of the patient, thus avoiding frequent attention by the nurses and the staff yet still providing the right treatment. This has helped manage large patients that were admitted in the hospital during COVID-19 smarts implemented has greatly helped pharma companies in many aspects. One example is of a medication adherence platform that we built. Patients are now using this technology to get alerts for when to take the medicine and ensuring to keep them on track.

Pravin Tiwar [00:16:14]:
This is even helping pharma to understand patient consumptions, to know the time for the refill and even helping them to cross.

Sanjog Aul [00:16:24]:
Based on how you described, introducing patient smarts at each juncture in the patient’s healthcare journey with a holistic approach is definitely going to take significant time, effort and very possibly outside help. So what capabilities will a healthcare organization need to develop or acquire by working with a partner to make it a reality? And if a healthcare organization invites FPT as a partner specifically in which areas can you help?

Pravin Tiwar [00:16:59]:
That’s an important question. I’m glad you asked. Healthcare organizations need to reset their thinking and develop the ability to reimagine what what the patient’s journey be like. If SMARTs are introduced and how it can be continuously evolved, they should be able to evaluate the current versus available platforms. Technology is changing at a fast speed and adaption is slow. This is important so that one preserves any existing investments or innovate using what’s in the bag while being able to pick the appropriate tools and platform that allow them to build a cohesive and maintainable technology stack. If there is any technical debt that would cause unnecessary costs and risks, removing them all is a prerequisite to starting the journey or at least plan related remediation upfront. Besides, organizations should be able to determine the required talent pool that understands the software development in regulated environments and can manage the technology stack.

Pravin Tiwar [00:18:01]:
Talent pool is scarce and based on the current and impeding needs, with the right plan the organization can develop a sourcing strategy. One of our customers started their journey with Google Cloud and was looking for right partners with skills to adapt and contribute. As there were not many company with a lot of skills in the space, they gave a minimum viable product to three potential partners and selected us based on our speed, best outcome, best cost and proving the quick understanding of the new technology. Being able to assess and benchmark data engineering and analytic capability so they don’t lose out on the opportunity to fully utilize the power of data and enable patient smarts to deliver the business outcome. Educating the users and buyers to adopt changes related to patient smarts and allow healthcare organization to meet their value based care agendas as a business and for the community. This may need a setup of the back office for future field support so that they can see the value of what they did as a healthcare company in uplifting their experience. If FPT is selected as a partner, most importantly, we would be able to help the organization in its digital transformation life cycle across the value chain that I was explaining. This includes right from solution ideation, strategy alignment, business architecture, program execution, technical engineering services, data analytics, artificial intelligence to all the way to operational and maintenance support.

Pravin Tiwar [00:19:40]:
In our recent surveys with our customer they have described three reason or attributes for why they selected FPT as a partner. These are speed, flexibility or adaptability and finally the cost. My hope is that healthcare organizations take a holistic approach to introducing the smart for the patient journey we discussed today, starting from admission to recovery and the delivery of value based care promised while improving their bottom line.

Sanjog Aul [00:20:13]:
Once again thank you Pravin for sharing your insights about how we can make a quantum leap toward our value based and patient care centric goals by bringing SMARTs into each step of the patient’s journey.

Pravin Tiwar [00:20:25]:
Thank you Sanjog and listeners.

Sanjog Aul [00:20:29]:
I invite you to find related conversations on our website @ciotalknetwork.com.