Data Collection

Medical researchers are building India’s first map of infectious diseases, one patient at a time

The heat map – which goes online this month with dengue data from Karnataka – will help fill information gaps.

These days, doctors at the Hosanagara Taluk Hospital in Karnataka are asking patients who come in with a fever a few extra questions. If a patient tests positive for dengue, the doctors visit his or her home and inspect the surrounding area for signs of the mosquito-borne virus. The patient’s village along with his immunisation record and other relevant information then goes into a national database. This database is slowly growing with information on infectious diseases across the country and the people suffering from them.

This is all part of a project to study infectious diseases in India, their causes, prevention and cure, and – in a first – to build an interactive heat map of these diseases. A heat map is the representation of data in the form of a map or diagram, with different colours indicating the intensity of the subject they represent.

Epidemiologists, bioinformatics experts, virologists, entomologists, biotechnologists, scientists, social scientists, software experts and students from various institutions across India have come together for the project.

As a first step, data about dengue in the taluks (sub-districts) of Karnataka will be shared on the map, which will go online this month. Dengue is an under-reported disease in India. The map will have information about the density of patients in a particular area, its demography, socio-economic status, immunisation and climatic data, clinical classification of the four types of dengue virus that cause infection, the medicines sold for dengue in that area, and other viruses found there. The map is roughly modelled on the infectious diseases heat map of the United States.

Interactive heat map

Sudhir Krishna, professor with the Cellular Organisation and Signalling group at the National Centre of Biological Sciences in Bengaluru, brought the project team together. “We have created a consortium that is working towards building a digital heat map for India in infectious disease,” he said. “The current focus point for a variety of reasons is dengue and using a sub-set of Karnataka taluks, we do have a first graphic created by the Manipal Virus Centre.”

The team intends to update the map regularly and make it interactive to allow users to post data on it. There will be around four levels of filters that will verify such data. “We want the map to be a one-stop resource for all infectious diseases in India,” said Krishna. “Of course, we may expand our vision later and add non-infectious diseases such as cancer and others.

Data on influenza that will go on the heat map. Image credit: Manipal University
Data on influenza that will go on the heat map. Image credit: Manipal University

Dr G Arunkumar, professor and head of the Manipal Centre for Virus Research that is part of the heat map project, said, “We have no structured public health system in India. As of now, whatever evidence and data we have, it is not user-friendly to policymakers.”

According to him, the heat map will help address many problems – the overuse of antibiotics, disease cases not being properly documented, and the wilful blindness of health departments.

“By actually seeing data in the heat map, denial among policymakers and health department officials will come down and [this] will lead to policy changes,” he said. “We may be able to identify hotspots in the areas affected by disease and implement prevention strategies.”

The group is also exploring using next-generation sequencing technology to identify viruses, study the processes by which they have evolved to be able to infect humans, and build a virus data map. “We are involving the Postgraduate Institute of Medical Education and Research at Chandigarh for a fungi database and another institution for a bacteria database,” said Arunkumar. “We are also interested in the molecular epidemiology of bacteria. For example, how did shigella become resistant to drugs in some villages?”

Shigella is a group of bacteria that causes a diarrhoea-like infection called shigellosis, and spreads through contaminated food. The infection is treated with fluoroquinones and cephalosporins, two classes of antibiotics. In recent years, medical researchers have documented cases of shigella infection in villages of Karnataka’s Gulbarga district that are resistant to treatment with these antibiotics.

Meanwhile, Dr Guruprasad Madigeshi, a virologist at the Translational Health Science and Technology Institute, will start mapping the characteristics of viruses causing diseases in India. “In addition, we will also study the properties of antibodies against dengue,” said Madigeshi.

Dr Satish Rao from Medical College, Kolar is also part of the project and interested in developing dengue biomarkers – entities in the blood of infected patients that help in diagnosis. “Data in an excel sheet is not interesting and people don’t read it,” he said. “However, everyone will be interested in looking at an interactive map that will let us know more about dengue, influenza, malaria and so on. This health heat map will have big data mapped out in a graphical way for it to be interesting to lay people as well as experts in the area.”

The team is collecting data from state-run primary health centres as well as private institutions. According to Arunkumar, 27 sites in 13 districts in 10 states will be covered. “Samples reach Manipal within 24 hours to 48 hours through special courier service,” he said. “The idea is to empower the local hospital to test and evaluate the disease.”

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Most of these tech enabled solutions have emerged as hospitals look for better ways to enhance patient experience – one of the top criteria in evaluating hospital performance. Patient experience accounts for 25% of a hospital’s Value-Based Purchasing (VBP) score as per the US government’s Centres for Medicare and Mediaid Services (CMS) programme. As a Mckinsey report says, hospitals need to break down a patient’s journey into various aspects, clinical and non-clinical, and seek ways of improving every touch point in the journey. As hospitals also need to focus on delivering quality healthcare, they are increasingly collaborating with entrepreneurs who offer such patient centric solutions or encouraging innovative intrapreneurship within the organization.

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Getting the best from collaborations

Speakers such as Dr Naresh Trehan, Chairman and Managing Director - Medanta Hospitals, and Meena Ganesh, CEO and MD - Portea Medical, who spoke at the panel discussion on “Are we fit for the world of new consumers?”, highlighted the importance of collaborating with entrepreneurs to fill the gaps in the patient experience eco system. As Dr Trehan says, “As healthcare service providers we are too steeped in our own work. So even though we may realize there are gaps in customer experience delivery, we don’t want to get distracted from our core job, which is healthcare delivery. We would rather leave the job of filling those gaps to an outsider who can do it well.”

Meena Ganesh shares a similar view when she says that entrepreneurs offer an outsider’s fresh perspective on the existing gaps in healthcare. They are therefore better equipped to offer disruptive technology solutions that put the customer right at the center. Her own venture, Portea Medical, was born out of a need in the hitherto unaddressed area of patient experience – quality home care.

There are enough examples of hospitals that have gained significantly by partnering with or investing in such ventures. For example, the Children’s Medical Centre in Dallas actively invests in tech startups to offer better care to its patients. One such startup produces sensors smaller than a grain of sand, that can be embedded in pills to alert caregivers if a medication has been taken or not. Another app delivers care givers at customers’ door step for check-ups. Providence St Joseph’s Health, that has medical centres across the U.S., has invested in a range of startups that address different patient needs – from patient feedback and wearable monitoring devices to remote video interpretation and surgical blood loss monitoring. UNC Hospital in North Carolina uses a change management platform developed by a startup in order to improve patient experience at its Emergency and Dermatology departments. The platform essentially comes with a friendly and non-intrusive way to gather patient feedback.

When intrapreneurship can lead to patient centric innovation

Hospitals can also encourage a culture of intrapreneurship within the organization. According to Meena Ganesh, this would mean building a ‘listening organization’ because as she says, listening and being open to new ideas leads to innovation. Santosh Desai, MD& CEO - Future Brands Ltd, who was also part of the panel discussion, feels that most innovations are a result of looking at “large cultural shifts, outside the frame of narrow business”. So hospitals will need to encourage enterprising professionals in the organization to observe behavior trends as part of the ideation process. Also, as Dr Ram Narain, Executive Director, Kokilaben Dhirubhai Ambani Hospital, points out, they will need to tell the employees who have the potential to drive innovative initiatives, “Do not fail, but if you fail, we still back you.” Innovative companies such as Google actively follow this practice, allowing employees to pick projects they are passionate about and work on them to deliver fresh solutions.

Realizing the need to encourage new ideas among employees to enhance patient experience, many healthcare enterprises are instituting innovative strategies. Henry Ford System, for example, began a system of rewarding great employee ideas. One internal contest was around clinical applications for wearable technology. The incentive was particularly attractive – a cash prize of $ 10,000 to the winners. Not surprisingly, the employees came up with some very innovative ideas that included: a system to record mobility of acute care patients through wearable trackers, health reminder system for elderly patients and mobile game interface with activity trackers to encourage children towards exercising. The employees admitted later that the exercise was so interesting that they would have participated in it even without a cash prize incentive.

Another example is Penn Medicine in Philadelphia which launched an ‘innovation tournament’ across the organization as part of its efforts to improve patient care. Participants worked with professors from Wharton Business School to prepare for the ideas challenge. More than 1,750 ideas were submitted by 1,400 participants, out of which 10 were selected. The focus was on getting ideas around the front end and some of the submitted ideas included:

  • Check-out management: Exclusive waiting rooms with TV, Internet and other facilities for patients waiting to be discharged so as to reduce space congestion and make their waiting time more comfortable.
  • Space for emotional privacy: An exclusive and friendly space for individuals and families to mourn the loss of dear ones in private.
  • Online patient organizer: A web based app that helps first time patients prepare better for their appointment by providing check lists for documents, medicines, etc to be carried and giving information regarding the hospital navigation, the consulting doctor etc.
  • Help for non-English speakers: Iconography cards to help non-English speaking patients express themselves and seek help in case of emergencies or other situations.

As Arlen Meyers, MD, President and CEO of the Society of Physician Entrepreneurs, says in a report, although many good ideas come from the front line, physicians must also be encouraged to think innovatively about patient experience. An academic study also builds a strong case to encourage intrapreneurship among nurses. Given they comprise a large part of the front-line staff for healthcare delivery, nurses should also be given the freedom to create and design innovative systems for improving patient experience.

According to a Harvard Business Review article quoted in a university study, employees who have the potential to be intrapreneurs, show some marked characteristics. These include a sense of ownership, perseverance, emotional intelligence and the ability to look at the big picture along with the desire, and ideas, to improve it. But trust and support of the management is essential to bringing out and taking the ideas forward.

Creating an environment conducive to innovation is the first step to bringing about innovation-driven outcomes. These were just some of the insights on healthcare management gleaned from the Hospital Leadership Summit hosted by Abbott. In over 150 countries, Abbott, which is among the top 100 global innovator companies, is working with hospitals and healthcare professionals to improve the quality of health services.

To read more content on best practices for hospital leaders, visit Abbott’s Bringing Health to Life portal here.

This article was produced on behalf of Abbott by the Scroll.in marketing team and not by the Scroll.in editorial staff.