MediAngels: #hesawards 2013 Winner Changing Global Healthcare Award
Pioneer: Dr Arbinder Singhal
Awarded for: Changing Global Healthcare
What is there to be done if you are a patient suffering from a little-known chronic disease in an area where the healthcare system may be at a crossroads? What if the nearest specialist doctor required to treat a condition you suffered from was over 200 miles away? Both of the aforementioned questions are challenges facing the healthcare system in India today.
Dr. Arbinder Singhal, a paediatric urologist based in Mumbai chats to us about the vision and need behind MediAngels, an India-based eHospital initiative that has been running for two years. The online platform aims to facilitate the consulting of expert doctors from the comfort of the patient’s home, thereby eliminating the need to travel and queue.
Vision Behind MediAngels
MediAngels is an eHospital service provider co-founded by Dr. Singhal that works by providing patients with fast, quality health consultation from experts in different therapy areas around the world. Patients typically scan or upload photographs of medical tests in advance, which are examined by MediAngels’ healthcare professionals before these can make a decision. The website also provides video consultations.
Dr. Singhal sums up his vision as wanting to offer more affordable, dependable health information and services to a larger segment of the population, especially given how fragmented infrastructure can be in India. Although MediAngels seeks to cater to a global audience, at the moment, around 93% of its users are based in India and the project started out as a means of offering patients the opportunity to seek second opinions. The project is also mainly promoted in India.
Dr. Singhal explains that although a lot of complications have traditionally arisen from vulnerable patients having to travel in order to get an accurate diagnosis and/or treatment, technological innovation is on the rise in India. Mobile phones have become very pervasive, with a large number of the population owning multiple devices. This is understandable, as the infrastructure needed to use landline telephones on a large scale is absent due to the country’s geography. Therefore, mobiles have also become Indians’ preferred method of accessing the internet. This is positive, as it allows the population to access a wealth of health information. However, a difficult diagnosis is a difficult diagnosis and it remains challenging to find what Dr. Singhal terms as ‘super specialist’ doctors in a timely and efficient manner.
“In the long haul, it takes a long time to become a specialist doctor, and a super specialist doctor typically requires 11 or 12 years of training. In most countries, and especially in most of India, 90% of ‘super-specialist’ doctors are present in only 5% of Indian geography. A lot of patients who live in peripheral towns, or smaller cities, have to travel 300 – 500 kilometres to see a cancer specialist, or a paediatric specialist, so someone like a paediatric cardiologist”, Dr. Singhal tells us.
Specialist doctors are hard to find, especially bearing in mind that there are around 20-30 paediatric cardiologists throughout the whole of India, Singhal says. Conscious of the large number of emails he received from patients and parents seeking a second opinion or a more accurate diagnosis for their child, Dr. Singhal came up with the idea of uploading all of these questions to a digital platform where groups of doctors would be available to carry out immediate consultations and answer questions. A large proportion of these enquiries came from families who were anxious about their child not having been diagnosed on time or correctly, and seeking a specialists’ opinion.
Arbinder Singhal gives us a good example of a situation he observed that has made him sceptical of some local healthcare procedures and determined to encourage patients to seek a second opinion. The case he tells us about revolves around a child in a small town in Punjab who had suffered a myocardic infarction and travelled hundreds of miles to see a doctor.
“Here, you travel about 100 miles to reach a hospital… Even in that hospital, the doctors recommended a bypass, but I wasn’t very sure of the ethics of the doctor who recommended the bypass. That’s why I got all the results scanned and I sent them to somebody I know, a medical scientist …who said a bypass isn’t going to help him. So I suddenly realise that I know who the best doctor is but the ‘common man’ on the street, do they know who the right doctor is?” asks Singhal.
In the cases of very niche diagnoses, determining the right person to treat a case is difficult and missing the opportunity to do so may lead to inferior quality of treatment, explains Arbinder Singhal.
The website also gives patients the opportunity to find out more about a certain specialist’s history, a privilege that is rarely available to patients who visit doctors in person at their nearest hospital. This provides peace of mind to the family and reassures them that they are being seen by someone with years of experience in their field who keeps up to date with recent medical developments.
Shifting Healthcare Paradigms: Success Stories
The MediAngels team believes in harnessing technology to solve outpatient problems and are also using US examples of similar initiatives to learn from. Although operating as a private medical consulting firm, MediAngels is a project with a vision to change the way healthcare is delivered in India and across the globe, and Dr. Singhal firmly believes such an initiative can operate profitably whilst making tremendous improvements to healthcare. At the same time, it serves as yet another example of technology changing healthcare, especially in the context of delivering value to patients who may find themselves in a very complicated scenario in terms of diagnosis.
“In the last two years we have seen about 7500 patients online (…) and we have analysed the way we have been able to actually change health outcomes. Almost 20% of these consultations came in for a surgical diagnosis …and in around 32% of cases, surgery was not needed”, claims Dr. Singhal, adding that these patients were then sent to the right specialist based on their symptoms and needs.
In other cases, patients who are seen in person by Dr. Singhal realise that they need not have gone to the doctor in the first place – in some cases, patients travel hundreds of miles to show their doctors various medical tests carried out locally, and MediAngels service eliminates the need to do that, saving patients both time and money.
“Maybe even 50-60% of the total work of the outpatient clinic can be facilitated using technology. We are doing so many other things using technology, but healthcare somehow remained indifferent to the advances of technology. The patient goes to the doctor, waits for two or three hours, and sometimes doesn’t even have all their questions answered”, says the MediAngels co-founder.
Serving the US Market and Lessons Learned
Dr Singhal sees potential in branching out to serve more US-based patients. In the US, he explains, the majority of the population has ceased being wary of using internet-based services in almost all areas of their everyday lives, whereas in India there is still a cautiousness associated with this, especially keeping in mind the much lower internet penetration rate.
The MediAngels success story is not without its lessons, however, and Dr. Singhal stresses the importance of piloting such initiatives on a smaller scale at first, or perhaps in a single specialty therapy area such as children’s cardiology. The learnings can then be applied when implementing a wider scale version of the project. We also talked about the importance of publicising initial efforts to get the initiative off the ground in a genuine way, as it is easier to attract funding if the right amount of money is raised at the right time.
Another challenge MediAngels founders have dealt with in the past was striking the right balance when recruiting specialist doctors to work on the project. As well-known doctors with over 20 years of experience can be quite pricey to recruit, assessing the initial risk before delving into expanding the panel of specialists present on the website can seem like a daunting task. However, Dr. Singhal maintains that the company ethos does not allow them to skimp on medical expertise, noting that the company is well aware that a senior expert is not only more dependable ultimately, but also makes sense from a business perspective. Accurate diagnoses and treatment will ultimately save the eHospital money in the long haul, allowing them to do bigger and better things in the future.