Need For A Robust ABDM Healthcare Network Enabling Cancer Care Without Walls By Manish Sharma @Msharmas

The idea of expecting a doctor/physician to be responsible for keeping a patient’s health records up to date throughout his/her care journey, is obviously not preferred these days. Neither is the practice scalable nor does it allow adoption and application of recent and new technologies.

In healthcare, information about a patient/citizen is created from the moment the citizen interacts with a hospital, clinical, etc or avails of a service online. Every subsequent activity adds recency, relevancy, context of care linkage to the citizen information in that hospital’s information system. The information is filled in by any hospital employee who encounters a patient, i.e., the hospital’s front desk staff/registration person, nurse, doctor, surgeon, anesthetist, pharmacist, pathologist, radiologist, radiation oncologist, surgical oncologist, cardiologist, and many more clinicians across the continuum of care of the citizens’ journey in that facility.

In a facility it is a process of progressive elaboration that ensures the completeness of a patient record over a period of time. The scenario in a distributed network needs a healthcare network to support enable the filling of the patient/ citizen in a collaborative and participatory manner. 

The recent pandemic has created a very clear inflection point in the history of HealthTech adoption in India:, 

BC and AC.

BC – Before COVID

AC – After COVID

Before COVID, health tech companies had to develop ROI sheets to justify the use of technology in healthcare to improve efficiency in care. It was a long gestation process. 

After COVID, while we still have to do that, with added information, how fast can one enable the digital first adoption of technologies to deliver an enhanced, safe, and continued care for the citizens in the healthcare ecosystem. The expectations of the consumers from the healthcare ecosystem have changed drastically. Overnight, the need for digital first approaches to healthcare have become even more embedded in the behavioral shift of the consumers. What was ok to get done in 2005 in ten years, is expected to be done in one tenth the time in 2020 or less. 

Mobile Applications like CoWIN have brought front and center the ability for the system to share live status of bed availability in hospitals in the shortest period of time. An idea that used to be the holy grail of emergency medicine professionals who wanted live feeds to be shared with the Ambulance Operators to reduce the Door-to-Balloon time for cardiac emergency cases. Today, not only has bed availability status been shown to be readily accessible using a healthcare network ecosystem, but we also observed breaking down of the data silos and walls to bring in the hands of the consumer, appointment availability for vaccination at a center closest to home. Apps like CoWIN manifested the benefits of a strong well-connected healthcare network that could not have been more adequately showcased at a national level.

The After COVID scenario, world-wide, is being transformed to ‘Healthcare without Walls’. 

We at KARKINOS Healthcare are relentlessly working towards enabling ‘Cancer Care without Walls’ driven by a motto to leave no patient behind and to deliver quality service to every care receiver under our ambit. 

In the Before COVID Scenario, a Cancer patient diagnosed with TB was treated as a TB patient for many years. No one did a differential diagnosis for cancer, invariably the patient died because of incorrect diagnosis and treatment. In such instances, all that was required was to do a differential diagnosis using an AI based conversational agent to check for the signs and symptoms for lung cancer. Early stage, early detection could have helped the patient. But that is not the case in a Before COVID scenario.

In a post pandemic world, an ABDM based care context linkage would have alerted the patient’s treating doctor regarding a positive differential diagnosis for lung cancer and the patient could have been referred to an oncologist for treatment.

In the above scenario, the most important aspect to consider is the availability of a “ABDM Health Network” that collaborates to keep the patient record “complete” with context and with relevancy and recency of the patient healthcare information.

ABDM can be that Health Network that makes care collaboration possible between all the partners in the connected network. Where portions and relevant and recent snippets of patient information is published on the network as and when it happens. An XRay or MRI may not be ordered if there is an XRay or MRI result for the patient already available for the same care context as the patient is presenting in the most recent visit to the doctor.  

If needed the patient can still be advised for the MRI or any diagnostic service if the recency is no longer valid for the care context.

Relevancy can be dictated by the clinician and the information when available is there for all the network connected clinicians, health tech apps, HMIS, LMIS systems in the connected network ecosystem.

I recall reading about the successful implementation of the mother and child welfare programs across India using the ASHA Workers in the primary healthcare setting to improve the child mortality rates. The information was captured by multiple care team members across a period of time, and it ensured the outcomes for pregnancy improved by maintaining a relevant and recency of care records for pregnant mothers. The information updates were kept recent and updated with constant supervision of the doctors at all levels.

Cancer Care is collaborative in nature. Multi-disciplinary tumor boards are a norm and multi-speciality involvement ensures information about a patient/citizen is recent and relevant to the context of care. The problem arises when there are gaps in the information about a patient. And these generally happen when the patient is away from the hospital (which is the maximum amount of time) and that is when the medication adherence information, mental health information, and care coordination information needs to be added to the healthcare record for the patient. While it may not be urgent care, its is an urgent need to have recent and relevant patient information from all possible sources in the network.

Oncology care is an apt use case for the need of a network where each connected node adds to the information about a patient and each node provides better outcome-driven care instead of repeating activities that may increase the financial burden for the patient.

Imagine the following benefits of a connected healthcare network: *listing a few here

  • pharmacy vendor connected to the network and is able to provide constant refills for a patient’s medications. 
  • An oncology drug vendor connected to the network is able to provide just-in-time drugs for chemotherapy at a facility nearest to home. 
  • A mental health professional is able to provide assistance to the citizes in need for palliative care or patient undergoing chemotherapy
  • Discovery of healthcare services is a constant endeavour of the consumer, a connected healthcare network enables that automatically via a UHI construct and allows the consumer to decide where to get their treatment
  • Second opinions and referrals in the network can be seamless and most importantly with context for the clinicians involved in the process
  • Home Healthcare get enabled with the citizens choosing to get care at home instead of spending an inordinate amount of time managing the hospital workflows
  • Alternative medications with similar outcomes can be dispensed to reduce the financial burden of the patient in close consultation with the clinicians
  • For emergency scenarios, another often quoted scenario is the ability for the treating physician to enable a break the glass scenario to understand the current status of a patient’s/ person’s health

Many more scenarios and workflows can be enabled by a network-enabled healthcare ecosystem that keeps the information recent and relevant.

The network keeps the information accurate and relevant and most importantly recent.

The travel app that I use for my flight bookings has my most recent COVID vaccination certificate and not my HealthApp, travel context has allowed for the network to keep that information relevant, recent and updated on the network to ease the travel for the citizen.

Similarly, ABDM will be the network that allows the Citizen to Navigate through the Healthcare Ecosystem to find closest to home a care facility, and with the doctor always having the recent, relevant and most updated information regarding the citizen/patient once they are connected on the network.

ABDM for India ensures the network keeps the most recent and relevant information just the same way UPI Network keeps the most recent and relevant information regarding the bank balance for a citizen.

The ABDM – UHI will allow for the patient information to be accessed by all healthcare providers in providing a higher degree of care that has the right context about the citizen, with an updated accurate and structured data regarding the citizen. The network enables efficiency of care for the citizen. It helps each connected node to provide better care where the patient is, instead of the patient having to travel across the state lines for expensive treatments. The network enables collaborative care, participative care, the network enables care without walls. Not just the doctor. 

Expecting the doctors to fill in all the information about a patient is impossible in the indian context. Clinicians don’t use systems if the burden of entering clinical information is solely their responsibility. Allow them to sign off on important information for the patient instead of making them fill all the information. It is not a problem of only user experience in health tech systems, it is just simply the paucity of time. We all have come across the physician burnout stories from across the globe. We need not repeat that process here.

One of the important aspects of PMJAY is to focus on outcomes and these outcomes measures are being worked at a national level by enabling 1600 hospitals to be digitised with automation and relevant digital transformation interventions (HIMS, LIMS). A HCX, Health Claims Exchange is being rolled out with the Insurance Regulator to ensure cashless claims settled for the PMJAY beneficiaries. Focus is on outcomes and citizens. Focus is on Network instead of Platforms.

HealthTech Platforms, Apps, Companies therefore can join the healthcare network to further improve the efficiency, relevancy, recency of patient/ citizen care delivery.

For instance, Karkinos Healthcare was one of the 40+ companies who have cleared the certification milestones are connecting on the network to provide much better outcomes to their customers on their respective platforms. e.g. Travel Companies connected on the network to provide recent vaccination certificates for safer and seamless travel experience.

At Karkinos Healthcare, we are working to connect on the network to ensure scenarios like citizens being diagnosed for TB instead of lung cancer therefore enabling early detection and much better outcomes for our citizens in our care.

For Karkinos, in the after COVID world, Cancer Care without Walls is an idea we have been pursuing since July 2020, it’s an idea that is pertinent in the current time ripe enough to be executed bringing care to our citizens instead of asking the citizens to go somewhere for care. We are working towards closing the care gap for citizens in our care. This is being done by enabling knowledge driven care pathways that help in keeping the knowledge and delivery separate allowing for a wider reach (accessibility) and delivery of protocols that have been curated and controlled by training of the karemitras with the sole purpose of taking appropriate care to the citizen. As mentioned in his article about cancer care without walls, Dr.Moni highlighted the need of a community as a cancer care center

Similarly, ABDM Health Network is an idea whose time is now for enabling care delivery for the citizen and by the citizen, therefore truly democratizing care delivery. Going by the focus of the World Cancer Day, such a network will help in delivering the theme for the world cancer day, Close the Care Gap, the ABDM Healthcare Network has the ability to Close the Care Gap by keeping the information recent and relevant


The views, thoughts, and opinions expressed in the text belong solely to the author, and not necessarily to the author’s employer, organization, committee or other group or individual.

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