Created on 2019-10-02 13:30
Published on 2019-10-02 13:38
This week, India celebrated one year anniversary of Ayushman Bharat, the world’s largest and most ambitious social health protection scheme, with the goal to cover 500 million people in India. This is a comprehensive program covering hospitalization, drugs and diagnostics with protection of up to INR 5L per family (USD 7000). In addition to the insurance cover, the plan also envisages 150,000 health and wellness centres around the country to diagnose and contain non-communicable diseases.
And tomorrow, India will host the India Economic Forum in Delhi, supported by the World Economic Forum. Prof Klaus Schwab, Founder and Executive Chairman of the World Economic Forum, propounded the idea of the Fourth Industrial Revolution in his book. He is convinced that we are at the beginning of a revolution that is fundamentally changing the way we live, work and relate to one another.
The Fourth Industrial Revolution is, fundamentally different from previous industrial revolutions. It is characterized by a range of new technologies that are fusing the physical, digital and biological worlds, impacting all disciplines, economies and industries, and rapidly changing sectors, making some redundant while creating new ones. The Fourth Industrial revolution is going to alter fundamentally our education system, how we work and ultimately how we live.
These two events, happening in the same week, also point to a massive transformation happening, led by technology in a critical area of the healthcare sector – Diagnostics. Before we delve into Diagnostics 4.0 and implication on Ayushman Bharat, let us look at the historical context of Diagnostics.
History of Diagnostics (Diagnostics 1.0 to Diagnostics 4.0)
Diagnostics 1.0
Age of Observation and Deduction (Pre-19th century)
As medical students we were drilled the importance of inspection, palpation, percussion, auscultation along with history of the patient to make accurate diagnosis. Thousands of years of medical practice, starting with the Egyptian/Babylonian doctors all the way to the middle Ages, when doctors used various methods to diagnose illnesses. This period was largely based on observation and deduction. The key transformation and start of Diagnostics1.0 started with development of key technologies like Microscopy, Stethoscopy and the Thermometer. Diagnostics as we know begin to emerge as a key contributor to treatment based on these technologies which now aided the doctors to look beyond what they could do with their own senses.
Diagnostics 2.0
Age of Visualization (Late 19th century to Mid-20th century)
Wilhelm Roentgen paved the way for the second phase of diagnostics by developing the X-ray machine, which was converted into a key diagnostics tool my scientist Marie Curie. The subsequent years led to an incredible phase where imaging developed in multiple areas, moving from X-rays to Computerized Automated Tomography, Magnetic Resonance Imaging and to later technologies like Positron Emission Tomography Scans.
Diagnostics 3.0
Age of Automation (Mid-20th Century onwards)
The last few decades have been driven by computer technology and miniaturization of diagnostics technology. Tests which were done manually or were done in a hospital setting now are routinely done in a standard laboratory setting at incredible speeds. In many cases diagnostics have now moved into our homes, with point of care diagnostics. The focus has been faster, cheaper, and smaller.
This age also unfurled the genomics based approach to diagnostics which hold much promise and the early signs are very encouraging.
Diagnostics 4.0
Age of Prediction (21st Century and beyond)
The real shift in diagnostics is happening as we speak. Artificial intelligence, big data and personalized genomics will move the field from diagnosing illnesses to predicting illnesses, much before they manifest themselves as symptoms.
This will lead us to the brave new world of diagnostics, the world of Diagnostics4.0 where predictive diagnosis will help not only help improve quality of life but also have a significant impact on the cost of healthcare, that every country is suffering from today.
Coming back to Ayushman Bharat, the two components of the program – health protection via insurance and the Health & Wellness centres will have to embrace Diagnostics 4.0 as a critical component for their success. Using data from multiple sources (both existing and the newly established health and wellness centres), coupled with technologies like Population genomics, Artificial intelligence and Robotics, we will be able to launch predictive diagnosis at unimaginable scale and speed. The faster we can predict, the better the economics on both the health insurance program and the success of the health and wellness program.
However, this will need a different approach than we are used to in public health infrastructure development. Diagnostics 4.0 is less about physical infrastructure or plugging the gaps in human resources as has been the strategy in the past. Diagnostics4.0 is as much about building the ecosystems, fostering collaboration and inviting new players to the sector as much as investment in data quality, open standards and innovative technology. This requires government bodies like the National Health Authority, Private sectors players, Diagnostics Startups, Artificial Intelligence and other experts to address the opportunity together. We need better and rapid test beds to validate new tools and technologies which will bring people and organisations from different sectors together to co-create new ways for prediction – ensuring we enjoy the benefits of Diagnostics 4.0.
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About the Author
Ashwin Naik is passionate about healthcare access and an advocate for strong primary health as the backbone of healthcare systems worldwide. He consults with organisations around the world, as the founding partner of We Scale Impact. He is also a Resident Fellow at Ashoka, a pioneering network of social entrepreneurs worldwide. In addition he co-founded Vaatsalya (India’s first rural hospitals network) and Seraniti (India’s first integrated mental health organization). He also leads DisruptHealth, a health focused ecosystem enabler based in Pune and is actively involved in the sector as an adviser and angel investor.
He is the author of two books – The Healthcare Gamechangers, which profiles innovations around the world which have the potential to change the way healthcare is delivered, and #ChangeStartsYoung, a book about young change-makers who are starting as early as 11 years young.