Perspectives from ISB

Preeti Singh, Analyst, Max Institute of Healthcare Management, ISB Mohali

Point of Care (PoC) technologies refers to bringing care closer to the first point of contact in both temporal and organizational dimensions through use of technology. Over the years, health sector has seen interdisciplinary PoC technology innovations, such as smartphone health applications, biosensors, lab-on-a-chip, and wearable devices, across healthcare settings; from primary care, to home care, to emergency medical settings. Despite its growing demand, little is known about its relevance at the level of primary health care in rural settings. So, what is the need for point of care technologies in rural areas? How to address the needs of training and capacity building to use these technologies among primary health care workers? These were among the questions discussed at Health 2.0 conference hosted by Max Institute of Healthcare Management, ISB.
According to Sivan Menon, CTO GE Healthcare, in developing nations such as India, where health system faces multiple challenges in terms of physical and financial inaccessibility to healthcare, shortage of skilled manpower, and inequity in the distribution of skills,  technology interventions can overcome these challenges. However, he added, that not much has been done in rural sector in India on this front. His views were supported by Tanushree Chaudhary, Technical Officer AMTZ. According to Tanushree, although  government has provided basic health infrastructure in rural areas, the challenge of providing quality care remains pervasive. She emphasized that point of care is a medium which is not only affordable but requires minimal infrastructure, is well connecting, and provides real-time data. Where having a PoC technology in “rural setting” has received a fair bit of perceived value from experts, Guruprasad Seetharaiah, Director-Medical Screening Solutions Bosch Healthcare, argues that these devices are only screening solutions and should not be extended as a composite solution to higher levels of care.
Besides, the above mentioned advantages, PoC technology is also a comprehensive low-cost digital health solution. This is because PoC technology not only requires minimal infrastructure but can be easily used by frontline health workers with little or no college education. This has an added value addition as it empowers front line workers to act as a proxy for doctors in rural areas. But one must be careful in understanding that simply handing out these devices is not the solution. “As per previous experience, community health workers in public health system have been introduced with several new gadgets. Every time an innovation is introduced, these workers are being trained to use these devices. But there is no long terms hand holding by innovators. Innovators need to find out ways to go along with them and just give away the product”, said Tanushree Chaudhary.
With its core focus on providing clinically actionable information at or near the patient, PoC technologies have seen maximum proliferation and advancements in the space of diagnostics and imaging—PoC testing. Technology for PoC testing refers to the ability to acquire clinical parameters where the patient is, thereby allowing faster turnaround times (TAT). PoC testing has evolved quickly from the early tablet tests to dipsticks to the current range of all-in-one tests for broader spectrum of diseases. Some of the commonly known examples are glucose meters, blood pressure monitors, scales, coagulation meters, spirometers, and thermometers. With recent technology advancements, PoC testing is penetrating into broader spectrum of diseases. As an example, a device used to screen for cervical cancer screenings at primary healthcare settings was demonstrated at the conference. Ariel Berry, CEO of MobileODT, introduced to the audience a mobile medical-grade colposcope that uses Enhanced Visual Assessment (EVA) System. In addition to providing enhanced visualization, this device enables direct patient information input, image/video capture, image annotation, and green digital filter application. Deploying the Enhanced Visual Assessment (EVA) System at initial cervical cancer screenings can lead to a higher screening of suspected precancerous and cancerous lesions for women as compared to a Pap smear alone.
It is evident from the above example that the PoC testing ensures quicker test results i.e. faster turnaround times (TAT). It must be emphasized the PoC testing will only lead to an improvement in the clinical outcomes if the faster TAT is utilized efficiently by the healthcare delivery chain. Nonetheless, such products can revolutionize the health care especially in developing countries like India which suffers from massive resource gap.  In India, there is a deficiency of over 4 million health workers and to compound problems, nearly 60% of existing health workers practice in urban areas where only 30% of the population resides[1]. PoC testing devices are poised to grow by factors such as demographic and epidemiological transition leading to rising geriatric population and incidences of chronic diseases. With 70% of its people living in rural areas in India, often far from health care providers, it’s clear that there’s a lot of room for affordable health services to grow in India.