Apollo Hospitals: Personalizing healthcare with technology

Apollo Hospitals: Personalizing healthcare with technology

Apollo is one of India`s largest healthcare providers and is acclaimed for pioneering the private healthcare revolution in the country.

Renowned cardiologist Dr Prathap C. Reddy was working in the US for over a decade when he decided to return to India and create a world class hospital. He realised that while there were several accomplished Indian doctors around the world, a lack of quality facilities prevented them from returning and working in their native country. Subsequently Dr Reddy established Apollo Hospitals in 1983.

Since Apollo`s inception, it has transformed India`s healthcare sector. Beginning with its flagship site in Chennai, which to this day remains one of the country's top hospitals, it now has 70 hospitals and a robust presence across the healthcare ecosystem, including hospitals, pharmacies, and primary care and diagnostic clinics. The group also has telemedicine units across 10 countries, health insurance services, global projects consultancy, medical colleges, medvarsity for e-learning, colleges of nursing and hospital management and a research foundation. Further initiatives such as 'ASK Apollo', an online consultation portal, and enterprises such as Apollo Home Health, seek to enable consistently extend the continuum of care.

Innovations in healthcare

Apollo Research and Innovations (ARI), a division of Apollo Hospitals Enterprise Ltd., spearheads research and innovations, enabling the introduction of cutting edge technologies, therapies and other innovations in its ecosystem. ARI is a dedicated organisation responsible for scouting, evaluating and deploying innovations in the hospital ecosystem. Ms Shobana Kamineni, Executive Vice Chairperson of Apollo Hospitals, explains this emphasis laid by Apollo towards technology and innovation: “Apollo is the first healthcare organisation to realise that it couldn't standardise multiple hospitals and patient services without the use of new technology. Hence embedding technology innovation and bench to bedside research into Apollo’s ecosystem is of paramount importance to us. These are cornerstones of a consistently evolving patient centric healthcare system”.

Apollo has introduced many cutting-edge initiatives - assessment of one`s genetic predisposition is one such step to personalising healthcare for an individual. Apollo has introduced a genetic predisposition test as part of its personalised health checks (PHC) - a single test to analyse and assess unique DNA makeup of the patient to find out what conditions they are more prone to. Genetic predisposition DNA tests can be carried out for over 60 conditions including cardiovascular, diabetes, and cancer. By monitoring a patient’s pre-disposition and combining it with his current clinical assessment, physicians can personalise advice given to a patient in terms of their diet, exercise, general lifestyle, the frequency of specific tests and doctor consultations so as to stay healthy. "For example, if someone is highly predisposed to cardiovascular disease and their clinical assessment is on the borderline, the physician can proactively monitor a patient`s lipid profile," says Mr Seemant Jauhari, CEO of Apollo Research & Innovations (ARI), who explains that "it's about staying more aware about one`s health and staying healthy". Currently, Apollo undertakes almost 200,000 PHC tests annually.

Another revolutionary initiative was the introduction of liquid biopsy, rated as one of the top 10 groundbreaking technologies in the world by MIT Technology Review in 2015. “These technologies make it possible to detect cancer cells and their associated components earlier than current methods,” Jauhari says. “Our clinicians and scientists at the research foundation undertook research on liquid biopsies for non-invasive diagnosis of brain tumours.”

Thereafter Apollo, in collaboration with its partners, introduced liquid biopsies as part of its precision oncology program, a treatment designed specifically for diagnosis of different types of cancer. This has paved the way towards the development of more exosome based diagnostics by providing clinicians non-invasive tools for prognosis, diagnosis, cancer recurrence, and therapy personalisation.

One of the other key areas of innovation Apollo is pursuing is in the area of cervical cancer. India has one of the highest incidence rates in the world. Apollo is engaged with companies from Israel and US which offer technologies that include a urine-based DNA test, optical signature- based probe and an Electrical Impedance Spectroscopy (EIS) based medical device that differentiates between cancerous and pre-cancerous cells.

Further, four years ago, Apollo embarked on a mission to establish a bio-repository backed by clinical information - as such this information baseline can be leveraged to spawn research and offer personalised healthcare in the future.

Apollo thus incubated its Biobank in 2013. This self-sustainable bio-bank leverages on bio-samples from Apollo’s nationwide network of hospitals and has emerged as the country’s single largest biobank. It is a catalogued library that systematically archives ethically consented and anonymised patient samples with associated clinical data. The samples are utilised to develop novel diagnostics tests and therapeutics. Jauhari mentions that such repository enables researchers to develop biomarkers and pharmacogenetic tests. A genetic test to prescribe an effective blood thinner and a breast cancer recurrence monitoring diagnostic were two products which were rolled out by the bio-bank.

While increasing strata of people living in towns and cities have access to annual health checks, rural India continues to lack basic healthcare facilities. Apollo is trying to bridge this gap in healthcare, arising from variance in availability and access to healthcare, by introducing India’s first integrated rural healthcare delivery network - The Total Health Foundation Programme. As part of the program, Apollo has adopted a village named Aragonda in the state of Andhra Pradesh. This project is driven by the sheer vision of Dr Reddy which proposes to track an individual from "womb to tomb". Under the program, Apollo is tracking several clinical parameters - such as the patient’s health, sanitation, diet and overall wellness - from the day he or she is born till the day he or she breathes last. Today, over 60,000 people are part of the total health programme. This project aims to identify risk factors for the cohort, facilitate primary and tertiary healthcare and provide relevant interventions to keep the cohort healthy. If successful the programme envisages a replication across villages across India.

In line with rapidly changing healthcare scenarios, Apollo is seeking to leverage digital health as a critical success factor for healthcare delivery. Ask Apollo is Apollo`s endeavour to enable virtual consults and remote delivery of healthcare. It enables patient`s to consult virtually with 1,000+ doctors across 52 specialties through video, call or email. It is an integrated and advanced online healthcare platform that offers a suite of services such as appointment booking, online consultation, health checks, online health records and homecare services.

Jauhari says this was a pioneering effort: "The doctor appears on your phone screen and based on an appointment schedule one can have a virtual consultation sitting in the comfort of one`s home. The doctor writes the diagnosis and the prescription is mailed across." Not only does it mean people don't need to step foot inside a hospital, it also makes sense given that India has around 350 million Smartphone users who could use such a remote healthcare platform.

India`s top private hospitals today face an acute shortage of critical care doctors, and in such circumstances, Apollo has undertaken expanding of remote management of intensive care units. Apollo runs electronic intensive care units (e-ICU) that enable top intensive care specialists to monitor ICU patients, help and guide doctors at smaller hospitals to treat a critical patient even if they are located in another city. Clinical staff monitors patients remotely using cameras, video, and microphones. Apollo monitors 200 patients in six states from its e-ICU facility in Hyderabad and plans to open three new centres to track 1,000 more patients.

Yet, as a public listed company, Apollo's focus is still on the health of the patients. "Any research we undertake has to be translated from an idea to a clinical application in the end," Jauhari says.

End-to-end healthcare

Apollo Hospitals is focused towards providing quality healthcare to every individual and empowering them in their healthcare journey. This journey of becoming an umbrella for all healthcare needs is fulfilled by having Pharmacies, health insurance services, medical colleges, colleges of nursing and hospital management.

Apollo Pharmacies has grown from being based within the hospitals to a chain of over 2,400 outlets across the country. Today Apollo pharmacy is Asia`s largest network of pharmacies. "We're one of the few retail clinics in India that are profitable," says Ms Kamineni. “We haven't given a wrong prescription in over 20 years. Our supply chain is so effective; we interact with almost 100 million people a year.”

Only 20% of India's population is covered by health insurance. To address this, Apollo partnered with Munich Re Group (the European Union`s largest re-insurance company) a global leader in health insurance, to form Apollo Munich Insurance. Apollo Munich brings together a deep understanding of emerging healthcare needs, and sophisticated technical and underwriting prowess, to ‘uncomplicate’ health insurance. It has over 80 branches throughout the country, making healthcare more accessible to the vast swathes of the population who couldn't access it previously.

Apollo Hospitals is committed to the maintenance of excellence in education. The belief that clinical services supported by medical education and research is relevant to the need of the country, and therefore should be an integral part of Apollo Hospitals, led to the introduction of various programs for medical education and hospital management. Apollo’s educational program began due to a shortage of clinical staff. “We couldn't get enough nurses to run our hospitals, and that's why we started nursing colleges. Then we went into education, training and post-graduate training,” says Ms Kamineni.

Referring to this all-encompassing network, Ms Kamineni says: "We realised we couldn't grow hospitals in India without building the surrounding infrastructure. We're probably the only organisation in the world that has an end-to-end healthcare presence.”

Creating solutions

"It's ironic,” Jauhari says, "where you really need access and affordability you need technological presence, tolerance, and paying capacity, which are hard to find in rural India. That's really the challenge; there is a gap between the segments of the population where new technologies and innovation don’t have widespread adoption." He cites that whilst cutting edge innovation only begun being adopted in urban areas, it shall take longer for changes like this to be deployed in rural India.

“If we're able to come up with innovations that disrupt existing healthcare models then we'd be able to make things more affordable. I hope remote healthcare can bridge that gap because there's a huge shortage of good doctors, and 80 to 90% of them reside in urban, not rural India. Technology is the only way we'll be able to bridge this.”

Ms Kamineni explains that the next wave in healthcare technology will be delivered through start-ups like these. "Innovation in biotech, biomarkers, devices, IoT platforms and ecommerce are likely to change the landscape. Apollo is rapidly establishing a platform where clinicians are able to find solutions to real problems. This would create a hugely powerful ecosystem which could address real challenges around accessibility, affordability, and personalised healthcare."