(Lightly edited for readability)
Speakers: Abhinav, Sunaina Bihani, Giridhara Babu, Subhra Priyadarshini
00:02 Support announcement: This episode is produced with support from DBT Wellcome Trust India Alliance
00:27 Subhra Priyadarshini: Hello and welcome to the Nature India podcast!
How many times in the recent past Have you WhatsApp-ed your blood test reports to your doctor and got their advice on the go? Or downloaded your reports from a pathology lab's website using their app?
In this episode of the Nature India podcast series "Our mobile world", we are going to specifically talk about how these tiny devices have completely changed the field of healthcare and medicine. I am your host Subhra Priyadarshini.
The use of mobile phones in the healthcare sector started in a big way, somewhere around 2010. And every day, more utilities are being added in medical diagnostics, disease surveillance, health monitoring, or point of care diagnosis. Nowadays, most medical test results, from simple to complex, are checked by doctors on mobile phones. It saves a lot of time in taking life saving decisions.
01:36 (Doctor giving medical advice to patient in Tamil)
01:56 Subhra Priyadarshini: That was an Indian surgeon traveling in Australia, advising his patient in Tamil Nadu in India on blood parameters and other health indicators uploaded on a mobile phone app.
There are apps, for instance, that can do a quick ECG to check your heart health Abhinav, who heads a start-up called Cardea, with his team, created a mobile ECG whose results can be shared with doctors on a mobile phone.
02:26 Abhinav: Now, when it comes to monitoring your heart, ECG is the first go to product because that gives you a non-invasive way to look at your heart. And that was the vision with which we started working. We wanted to work on ECG devices. It's been more than a decade, we started working first with a single lead ECG. And we brought it on the mobile phone. In fact, we are credited to be the world's first people to actually do this over a smartphone. Now the problem that happened here is that even though we were doing a single lead ECG, and when we showed the results, the doctors said that, hey, it's good, it's useful. But even ECG itself is just the tip of the iceberg. So if you're looking at ECG, you need to give us a complete 12 leads ECG for us to make certain diagnostics of any heart ailments. And that is when we realized that single lead, 3 lead or 6 leads, really sucks lead. Even though they are easy to use, it is not really solving the complete purpose, it is not completely solving the requirement. That is when we started working on a full 12 leads ECG device where you can get a simultaneous high definition 12 leads ECG on your smartphone. And that is what atom ECG is all about, which stands for accurate tele ECG on mobile, and it is being used in over 250 hospitals right now in India and in Africa. We are still in early stages and what I will say medical devices takes a lot of time. But our ultimate aim is to come up with a medical product that can reach every home. We already have a working prototype of nearly four electrodes system, which gives the exact 12 lead ECG simultaneously on your smartphone. And it is so easy to use. Any layman can put it on their body and they can record a full 12 lead ECG and take it forward.
04:20 Subhra Priyadarshini: Sitting in the comfort of your home, you can complete the entire health care cycle from consultation to diagnosis to treatment and then follow up. Sunaina Bihani, who is the managing director of a healthcare service company Pulse Diagnostics in Kolkata, says the time between diagnosis and treatment is way shorter today making a crucial difference in patient outcomes, especially in emergency situations.
04: 51 Sunaina Bihani: Patients don't need to come to the center Once the sample is given, they can just wait at the operation theatre or they can wait in the doctor's chambers, and they can get their results on their mobile device, saving a lot of time in rural or remote areas where healthcare facilities are scarce or poorly equipped. Mobile diagnostics is good for healthcare professionals because they are able to provide informed and effective treatment plans.
05:30 Subhra Priyadarshini: Have you also noticed how mobile phones now enable real time monitoring of disease outbreaks by collecting data on symptoms, locations, demographic information. This information helps researchers track the spread of diseases like dengue, malaria, or COVID-19, helping with early detection and response. We spoke to epidemiologist Giridhara Babu at the Public Health Foundation of India on this kind of health surveillance enabled by the mobile phone.
06:06 Giridhara Babu: There has been again a lot of transformation in the way we collect data, we analyze data and we use the data. And in each of these aspects, mobile phones are very useful. So as you would know, surveillance is data collection for action. So the action is related to the actions that we take the public health level and also at the individual level. So how do we collect the data? Mobile phones help in reporting symptoms, it gives locations, it will give demographic information and delivery real time so that you can actually find out when the diseases occur and how we can control. It also gives more information on public health level in terms of how many such cases occur in a geographical area, and which are the locations that we need to focus. That kind of information for public health action also can come from the real time. And we have seen during COVID-19, contact tracing, and also some kind of prediction analysis. All of this has been done by using mobile phones only. So there is a greater need for integrating the technology in appropriate healthcare.
07:22 Subhra Priyadarshini: The pandemic really enabled public health professionals to look at use of mobile phones quite differently for things like contact tracing and helping power public health actions.
07:36 Giridhara Babu: Actually, during COVID-19, we have seen how there has been an explosion, I would say, of technological ideas for public health management. There are several apps that were introduced during COVID-19. Just to take few examples, if you can look at contact tracing, right? So in mobile phones, you can track where people are and from where they came. And based on this, and how many people were in close proximity to a confirmed case could be found out and through that even people could estimate the secondary attack rate and how people were transmitting the disease from one area to another. So contact tracing was one area where mobile phones were used extensively during the COVID-19.
But if you look at it in terms of real time updates, the applications don't need any smartphones or any applications. But if you have a mobile phone in the remotest area, even if it is a basic phone and if there's one rare case that is reported and the health worker reports that directly to the headquarters, we can actually avert large outbreaks if this is in real time and if this is a disease of public health importance. So instead of looking at, you know, vertical diseases like COVID-19, dengue, malaria, I think, this is the time to integrate all these solutions because each disease cannot have a separate app.
So health service disease surveillance, what we say, is for tracking all the diseases in real time, that should be integrated into something very usable, simple and very easy for healthcare worker and community. And once we have these integrated solutions, I think the integrated surveillance will then power public health actions. There are multiple examples including geotagging, ensuring that early detection is done also in terms of the International spread, what we can prevent it terms of international spread for any rare diseases, this is of public health importance.
09:49 Subhra Priyadarshini: Most mobile phones come with built-in sensors that can be used for tracking vital signs of your body, your physical activity and your sleep pattern. Researchers can leverage this data for studies related to public health and epidemiology, like Giridhara Babu just told us. One good example in India is the mSehat app that the government uses to conduct maternal and child health surveys. The app basically facilitates the collection of survey data and health information, enabling real time monitoring of maternal and child health indicators across different regions in India. That's the big picture, the health policy level thing. But even in our daily lives, we all use the mobile phone for health monitoring and lifestyle interventions.
10:40 Sunaina Bihani: So think of your smartphone as a mini health monitoring device that's with you around the clock. We all can't even move anywhere without our mobile today. We can forget our wallet at home, can forget our keys at home, but we'll never forget our phone. With the right apps, you can track everything from your heartbeat and blood pressure, I'm sure most of us must be using an iWatch, I'm sure you must be using one too, to monitor your heart rate or monitor, your exercise levels, how many calories you have burned every day. So you see this has two-fold benefits, you get a detailed real time understanding of your health, which helps in taking proactive steps towards well-being. And it also helps our doctors take a decision and get valuable data. The data collected from countless individuals like you, like me, can be used by medical researchers to understand population wide health trends and behaviors. This could mean studying the impact of certain lifestyle or heart related problems in different areas in different types of people. Since we are feeding in so much data on our mobile of our height, weight, what's our BP, what we are eating, it really helps put in all this data together and do much more with it. So if you see our smartphones are just not an instrument of personal health, but a contributor to the broader public health discourse.
12:18 Subhra Priyadarshini: And telemedicine or remote consultations with healthcare providers is something we've all warmed up to, and so has the healthcare industry, thanks to the mobile phones.
12:29 Abhinav: So mobile phones enable healthcare providers to conduct remote consultation with patients, even in rural or remote areas, right? So through audio with video or text based communication, doctors can diagnose and treat patients without requiring in-person visits. Now I can give you an example, eSanjeevani, a flagship programme of the Ministry of Health and Family Welfare, Government of India, is now the world's largest telemedicine service provider. In fact, it has served over 114 million patients. In the private sector, companies like Practo, Amfine, Doc app are a few other examples.
13:01 Sunaina Bihani: Imagine needing a medical test and not having to travel to a lab or hospital to get it done. I'm sure you must have also faced this a lot of times when you just don't feel like going to the centre. And you just want to call somebody and check on them and say can you please come and take my blood test at home? That's the magic of point of care diagnosis made possible by mobile technology. From checking blood glucose levels for diabetics to monitoring heart rate rhythms with mobile ECG devices, the possibilities are numerous. So the advancement is especially significant in remote areas where traditional healthcare facilities may be limited or non existent. We see now it's possible for healthcare professionals to deliver diagnostic services to these areas, thanks to portable mobile technologies. So your mobile phone while being a tool for communication and entertainment is also a potential lifesaver, enabling immediate data-driven medical decisions wherever you are.
14:07 Subhra Priyadarshini: There's a bunch of Indian healthcare companies and startups now investing in point of care diagnosis.
14:13 Abhinav: There are many other companies which offer tests such as pulse oximeter temperature, blood glucose, urine tests, and now it is very much possible to add more and more such tests all on the smartphone. Companies such as Google and GE pharmacy, Netmeds, they offer services where you can actually place an order for medicines and they get delivered at your doorstep. And additionally, you can see there are service based companies such as Portea, Here on Call etc, where you can actually get nurses and healthcare providers all through a mobile app. So in a way mobile phones have literally revolutionized the healthcare delivery in every segment, including the resource poor countries.
14:49 Subhra Priyadarshini: That is crucial for most countries in the Global South. In this series, "Our mobile world", we are examining through the lens of science and research, the many ways in which mobile phones influence our daily lives. Healthcare and medicine have turned out to be one of the most prominent beneficiaries, as we heard, of these handheld devices.
Up next are more examples of how our lives are intertwined with these devices in ways we don't even begin to imagine. Stay tuned and subscribe to the Nature India podcast on your favourite podcast platform. This is your host Subhra Priyadarshini.
15:46 Support announcement: This episode is produced with support from the DBT Wellcome Trust India Alliance.