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Dr. Vinod Agarwal runs a public healthcare clinic (PHC) in Meerut district, a semi-urban community, which is located 45 miles north-east of New Delhi. It is spread across 1,000 square miles and has a population of 3.5 million people of which 2.2 million (63%) live in semi-urban/ rural communities around Meerut city. There are 14 PHCs in Meerut district similar to the one administered by Dr. Agarwal and these serve the communities around Meerut. Dr. Agarwal’s tools of trade are a thermometer, a stethoscope and a blood pressure monitor. He has used these instruments for the past 35 years, ever since he graduated from the med school. By various accounts, India has 765 thousand general physicians (GP) or population-to-GP ratio of 1,700, however, this ratio varies significantly across the urban and rural areas. In metropolitan areas, the ratio is closer to 400 and in some of the rural areas the ratio exceeds 10,000. However, one thing remains common throughout the country – the same tools of trades may be found with all the 765 thousand GPs.

In 2005, I met with Futurist Dr. Jay Hellman in Bethesda, MD. He described to me the concept of Virtual Adjacency, which defines inter-dependency between transportation and communications. Until, Scotty beams us up, we will have to depend on transportation and communications infrastructure for our daily living.

To date, the healthcare delivery remains heavily dependent on transportation infrastructure and as a result affordable healthcare remains a utopian dream. This dependence has created access barrier for the 3.3 billion people living in rural and remote communities across the world because healthcare delivery today requires patient, doctor and healthcare equipment to be physically co-located. When it comes to delivery of quality healthcare in non-urban communities, there are several challenges – a) Availability of trained healthcare professionals (after many years of education and training, most healthcare professionals gravitate towards higher paying jobs in urban centers); b) Availability of good equipment (due to high cost of healthcare equipment, hospitals and clinics tend to invest in urban areas where the CAPEX recovery is faster); and c) Cost of travel for people in remote areas (cost of transportation, time and lost wages).

It turns out that until recently, we have been focusing on the wrong problem. For a number of years, telecom equipment vendors and network providers have been working to provide faster and cheaper communication links. In order to deliver quality healthcare at affordable prices, we need applications not just cheaper and faster pipes. We need network-connected sensors, cloud based storage and data analytics to allow the doctors in urban centers to evaluate patients in far away places without having to step out of their office. In other words, delivery of affordable healthcare requires reduced dependency on transportation and increased application of communications to create virtual adjacency between patients, diagnostics tools and doctors. How do we do that? What diagnostics tools are required? How do we make these tools easy to use? What is the role of data analytics? How to take advantage of cloud based services to reduce the cost of healthcare delivery? How to protect patient data? Solutions are required for a large number of inter-dependent problems that intersect medicine, health technologies, healthcare policies, information technologies, business model, investment and other areas. The only way to address these complex problems is to solve a small set of problems at a local scale, test the solution within the limitations of existing transportation and communications infrastructures, learn from these experiments to create solutions that are scalable and sustainable.

The innovation in healthcare technologies over the past few years, particularly in network connected devices, has created a vibrant ecosystem that is ready to deliver affordable healthcare through virtual adjacency. We are at an inflection point to bring sea change in healthcare delivery. Since early April, patients’s of Dr. Agarwal’s have seen him using a high-tech gizmo – a network connected ECG. This device saves each ECG scan on a cloud based server, it performs basic interpretation of the ECG signal to check the heart rate and identify various arrhythmias and is capable of sending the scan to a cardiologist anywhere in the world at the touch of a button. Thank you, Dr. Hellman – Virtual Adjacency has finally arrived in Meerut to deliver quality healthcare to this semi-urban population. Soon, some of 3.3 billion people in remote and rural communities in the world will reap its benefit as well.

This is the story of affordable healthcare, Made in India.