Digital health is a simple concept wherein the use of technology to help improve individuals' health and wellness is a broad and growing sector. Digital Health can cover everything from wearable gadgets to ingestible sensors, mobile health apps to artificial intelligence, robotic to electronic records.  

Digital health is creating an ecosystem that offers patients with chronic illnesses or those who need monitoring post-hospital discharge; the means to better manage and monitor their condition. Digital health already offers tools for practicing lifestyle medicine; add a few peripherals and medical management improves as well.

Aamod Wagh, Founder and CEO, TigerTech Labs & TigerTech Smart Living, has over 30+ years of global experience in the IT industry. He has been a part of the senior management in global companies and has worked all over the world for the past 2 decades. His experience spans consulting for Fortune 50 companies and developing world-class bleeding-edge IoT products for senior care & dementia care. 

In the recent past, his focus has been on developing targeted products to address the healthcare challenges that directly address the new normal in life post-COVID-19.

TigerTech products are built with a vision to leverage technologies on the cusp of IoT to bring the Future of Smart, Safe and Healthy Living to the Indian masses. One can look forward to a safe, healthy, and secure lifestyle, to innovative products that can actually ‘think’ and at the end of the day ensure that they simplify their lives significantly. 

People have become exasperated due to the healthcare issues being faced

Aamod throws light on the subject, “There are monumental issues with respect to the healthcare industry that the COVID-19 pandemic is specifically bought upon. Examples can be the hospital systems are completely overrun by the pandemic and they are overflowing with patients. There is a huge shortage of qualified staff which further complicates the issue; we also have the physicians and the medical workers who are suffering casualties due to infections. There are thousands of doctors and medical workers who are infected right now and there is also a general fear among the population of what we call HAI i.e. Hospital Acquired Infection due to which there is a direct impact on many things like elective surgeries are being postponed, people are going in for serious issues only. We have doctors and medical workers who are unable to visit patients at home for any kind of emergency care, the reason being the patients are also not very comfortable with that and the medical workers also have the scare of getting infected. There are chronic patients who need long term care at home; they are not getting any assistance right now because of the same issue. There are prenatal-postnatal issues, the expecting mothers who are expected to have their vitals checked on a regular basis; they find it difficult to visit their OBGYN because of the risk of themselves as well as their babies getting infected. India has a large aging population, which is again a serious issue because they are the most affected by the pandemic in terms of the risk of infection. And who is going to care for them, they can’t be expected to go to hospitals, and last but not least the rural population has become exceptionally vulnerable. They are facing a tremendous amount of issues again because of the shortage of doctors as the doctors are all locked into the COVID hospitals and there is literally no medical staff available to provide them with healthcare in the remote villages. These are some of the issues that we have identified specifically because of the pandemic and they have become exasperated because of the issues being faced,” he says.

Need to address these issues ASAP

Aamod suggests that there is an urgent need to address the needs of the people with respect to healthcare,

“It has been witnessed that we have already passed the significant threshold to the number of deaths as well as the number of infections that we currently have. Matters are going to get worse before they get better and everybody knows that. It is critical to try and figure out how we can fix these issues in the short term, medium-term as well as in the long term because issues are fixed and telemedicine and telehealth systems are deployed quickly on a pan India level. The spread of the disease, the fatalities are really going to skyrocket, which is one of the biggest reasons for the need to fix these issues. Furthermore, the healthcare delivery for the rest of the population needs to come on track so that patients who are not affected by COVID and can start receiving attention and care without any risk of infection,” he says.

How does TigerTech propose to address these issues?

Aamod believes that the only viable option that can be seen in terms of continuing to provide world-class healthcare delivery during the pandemic is the adoption of robust and comprehensive telehealth solutions. “Solutions that can use virtual channels not only for communication but also to collect patient data and provide healthcare delivery is literally the only way today that we see to reduce infection for everybody concerned and also to maximize the utilization and productivity of the medical staff. Because again that is the issue with the shortage of staff, it is required to make sure that they are utilized in a much better manner as much as possible,’’ he says.

The vision of TigerTech is to deliver on all the promises of digital health through a very comprehensive telehealth ecosystem. ‘’We believe that such an ecosystem will help to transition the current healthcare delivery process to the Telehealth platform; also it will ensure that hopefully over time it becomes a standard operating platform for all healthcare delivery regardless of whether it is urban or rural. That’s really what we see happening,’’ Aamod says. He goes on to explain it in detail.

"Let’s look at what a good telehealth system consists of:

-Provide an online collection of patient profile information. 

All the data related to the patient - the symptoms, basic data about the patients, including important aspects like lineage for example did any of the parents have heart disease, are there any pre-existing conditions, frequent health issues all of that data has to be captured online remotely from the patient. 

-It also has to collect the symptoms remotely.

Obviously, because the symptoms come into the picture when the patient is feeling unwell and the way to collect the symptoms for an ordinary patient who is not really used to medical terminologies is to use some kind of artificial intelligence-powered Chatbot that will automatically ask specific questions continuously based on a single parameter provided or single symptom provided by the patients till it finds the right set of answers and then it does what we call a forward triage where it then presents the doctor with a set of options to say that these are the symptoms and these are some of the things that could be wrong with this particular patient. Based on these, the doctor can ask more relevant questions in that space that is the second thing the telehealth system should have. 

-The third is a set of connected devices

Today you know you can ask for symptoms, patient profile information but as a doctor, I need to know what your ECG is saying right now? I need to know what your blood sugar level is right now? what is your spo2 level right now? and there is literally no way of doing that unless the patient has all of these instruments in the house and they do take the measurements and provide that information.

So the best way would be to have a set of devices that connect to the internet. These devices can be sent to the patient’s home. The patient can use these devices to very quickly take their vitals and the data is transported to the cloud and then presented to the physician along with all the patient profile information along with the symptom information so that the doctor is in a much better position to provide a pretty well-informed diagnosis for the patient and then the prescriptions follow. So that is the third part of the artificial intelligence system. 

-The fourth part is the utilization of the multiple virtual channels 

Virtual channels like audio, video, chat, or whatever must be utilized for the doctor and patient to communicate so once the doctor knows what the patient is feeling, what the profile is there has to be some kind of a call between the doctor and the patient to get more information.

-Analytic health insights or analytic engines 

And the last but not the least is the availability of some kind of analytic health insights or analytic engines that can help to analyze the various piece of information that the patient is providing whether it profiles information or the test information coming on a daily basis or all of it together, it should be able to generate some sort of a health index for the patient that tells the patient about how healthy he or she is and this is a great idea for using these kinds of systems even for maintaining daily health or for preventive health. That’s what we see in an ideal system. We really believe that this kind of an ecosystem will allow healthcare providers to provide comprehensive patient care without compromising on the quality of healthcare,” he says.

Wearables are great for maintaining health but it is not a medical device

Aamod goes on to explain how wearables like smartwatches, fit-bit are great for maintaining health but they are not medical devices “We are talking about Medical grade or clinical-grade devices. So as a result of the BP is showing 140/110 the doctor is not going to take that as high blood pressure and immediately comes running to your doorstep because so many different parameters are there where the accuracy levels of those wearables are not definitely medical grade. So when I talk about medical devices I am specifically referring to Medical grade devices that have been approved, which have been certified by medical authorities to be able to provide clinical-grade information these are the same devices that the doctors could use in their facilities as well. Basically what we are saying is that if we have a system that has all of these parameter devices, patient platforms, and analytics everything together, the benefits are huge. It will significantly reduce the caseload on hospitals and physicians because now the hospital can actually visit the patient rather than the patient having to visit the hospital it will completely eliminate the infection risk for everybody because there is no contact. It will significantly improve patient convenience because now patients can sit at home and enjoy world-class healthcare delivery. It is significantly again improving doctor’s utilization timing because now doctors don’t have to spend time driving to and fro to a patient’s home. All the time is completely spent in diagnosis which is something they are good at and most importantly it allows high-quality healthcare to be provided to hundreds of rural villages where having an on-site doctor currently is almost close to impossible. So we can have these machines in the health camps in the remote villages where all the patients can be scanned for various kinds of vitals, or blood tests, or heart and lung sounds, or whatever it is. That data can be instantly sent to the doctor and the doctor can conduct a long-distance consultation and everybody can get healthcare as if the doctor was physically there. I think that’s really what is needed. But what we currently have I think is largely the telehealth solutions have focused on video consultations. It is more of a doctor-patient video call, all the questioning is done on the video call and then is an online pharmacy, where the patient agrees to order online the medicines and that is the end of the story. That is really not what telemedicine is supposed to be. It is starting off today like that, but it has a long way to go and I think the kind of systems that we are talking about will help us get there. Also if you look at the current tests if you have an ECG test you have to undergo 12 lids that have to be placed over all your body which requires full contact with a nurse. Now that itself is a huge infection risk, so ideally you should have a contactless device where there is no nurse required to actually administer the test. You should be able to administer the test yourself. Also today you have a device that provides you with information manually which is read on the device and it is typed into some kind of an app and then that app uploads it to the cloud and somebody somewhere reads it. There is a high chance of human error that could happen in that case. Also, we have seen in rural areas where you have hundreds of patients, everybody with 120/80, it is simply not possible because you can actually put false information there without even testing people and there is no way of knowing it,” he says.

RHEMOS making it the new normal for telehealth

Aamod throws light on RHEMOS which stands for Remote Healthcare Monitoring System, 

“What we have done is that we have the RHEMOS telehealth system that we have launched as we are looking at making telehealth the new normal. So in our device or our ecosystem literally there are 4 layers. 

The first layer uses multiple affordable medical-grade devices to collect patient health information and then it transmits the information to the cloud so we currently have three devices plugged into our system. The first device is a single device that captures seven different vitals with medical-grade accuracy. You have ECG, respiratory rate, blood oxygen, blood sugar, BP, heart rate, and body temperature. All of the tests I can do myself with these various sensors that I have simply by touching. And the entire time taken for all of these tests is just three minutes. So a single device if we use it in a hospital, for example, can test 3,000 patients a month or 30,000 patients a year. That is the capacity of this single device. So if you look at urban or rural healthcare, these kinds of numbers are significant. The other set of devices we have are largely focusing on blood tests like we can do hemoglobin testing, HBA1C, complete lipid profile, everything can be done using your smartphone. All these devices talk to your smartphone and capture the entire information and transmit it to the cloud,” he says.

Tackling issues faced by the Healthcare industry 

“We also have the digital stethoscope which can listen to the sounds of your heart and lungs very easily, again you would have the patient and doctor sitting in different locations but the doctor can easily listen to the sounds remotely. So the idea is that these devices are FDA certified etc. But they provide hardcore medical information which can be depended upon by the doctors as they sit remotely and they can depend on the varsity of the information also these devices are designed for self-administration of the test, there is no nurse or medical assistant who can get the test done. There is no contact between the patient and anybody else, so the infection risk is down to zero. And because they do not need medical staff it significantly reduces the staff cost that they are a reasonably large part of any healthcare. It is an important aspect that we need to look at from the financial aspect and if you look at the rural care space, rather than talk to nurses to go down to a village, you can have an Asha worker in a village who can be easily trained to use these devices and hold health camps, that is the beauty of these whole concepts to spread healthcare delivery across the country. These are the primary building blocks that you need and we already have them in place,” says Aamod.

Addition of more devices

Aamod briefly explains that there would be more additions to the group of devices already available, “We have these 3 devices already in place and we are looking at adding more devices on the list such as FHR, MHR, UCM which is the fetal heart rate, maternal heart rate and uterine contraction monitor which is going to be significantly important in the rural space as there are a lot of fatalities that happen in the rural areas for no rhyme or reason and the only thing they need is high-quality healthcare and with these kinds of devices we will be able to provide all these kind of devices in the rural areas without having specific doctors present there. So I think that is going to be an important aspect there. So like I said, that is the first layer, the second layer in the ecosystem is our cloud platform. The first job of the cloud platform is to collect the registered information, their profile info, and also the test data, all the information related to the patient is going into that, collect the systems through an AI chatbot and it will conduct a forward triage and all this will be sent to the doctor and it calls for the doctor to go ahead and treat the patient. The 3rd layer is the live communication layer where you will have a video or audio call with the patient on the bandwidth available. Which allows you to have questions and answers and then allows you to come to a diagnosis and provide the prescriptions and while the doctor is providing the diagnosis or prescriptions, all the data about the patient is being displayed in front of the doctor and patient for any kind of reference,” he says.

“The last layer is the analytics layer, now there is a significant amount of information for each patient already collected, so analytics engine takes all those information, analysis it and generates insights for the patient which is like a wellness index which tells the patient how healthy they are on a scale of 1-100 so a number to 80 – 100 means that you are reasonably healthy, a number between 60 – 80 mean you are healthy but there is something wrong and you need to see a doctor, 40-60 means that you definitely need to be in a hospital and below 40 means you need to be in an ICU. So this is a very simple methodology as a patient cannot read an ECG, they do not understand the difference between systolic and diastolic pressure but they understand a number and if you tell them that this number needs to be above 8- then they know exactly what that means and it becomes easy for them to keep a track of their health. Also from a doctors perspective, if I am looking after a ward of 200 patients, there is no need for me to look at charts for each patient to figure out who needs emergency care, I can just look at a monitor somewhere which is showing the health index what each patient have out there, so the minute the index falls below 80 it will start flashing in red which will tell the nurses or caregivers that these are the patients who need emergency care. So that is something again which is built-in, so in conclusion, I believe we will be the first telehealth solution to provide a complete and comprehensive solution of devices, cloud-based platform, forward triage, and healthcare analytics all on a single platform. I think that is really what we are coming from,” says Aamod.

Our devices can seamlessly connect to other platforms

Aamod explains that the devices developed by them can be connected to any platform for seamless usage. “Obviously the question will be asked about connectivity to other platforms like a lot of hospitals already have invested in building their platforms so yes, of course, we can directly connect seamlessly to any platform that the hospitals want and we are looking at how we can assist of leverage these kinds of systems to assist the patients in need, we are also looking at using this from a long term perspective more than a healthcare wellness basis and to detect and provide interventions before the illness occurs not after. So that is our focus,” he says.

Personalized healthcare is our focus

Aamod throws light on their focus on personalized healthcare, “From a midterm to long term basis, what we are missing today is the concept of personalized healthcare when you have so much of detailed information at the patient level, it will be that much simpler to be able to provide healthcare that is tailored very uniquely to an individual to enable prevention, quicker intervention, quicker diagnosis, and better treatment so that the outcomes are far better than what you see,” he says.

Telehealth use accelerated due to pandemic

Aamod throws light on the matter that due to the pandemic, there has been a significant increase in the use of telehealth worldwide and not only in India, “Healthcare delivery to be delivered while reducing the spread of the virus to mass populations and to medical staff is of importance. In terms of numbers in India, between March and May, we have seen more than 5 crores telecommunications in India on various platforms which is a huge increase. And we are seeing people embrace this as the new normal and they are being forced into a situation where they have no option but to embrace it but once they start using it, they are founded to be as good and convenient as what they were earlier experiencing with the doctor visits. Also, the hospitals are leveraging more telemedicine to provide pre-op and post-op care. For example, if I got discharged post-heart surgery, I would still need to be kept under observation, for 2 months and that is done by having a  nurse visit homes 2 -  3 times a week to record the vitals, today, it is impossible to do that, so hospitals now are using these kinds of devices and using the systems to patients home where the patient can self administer the test and the hospital can see how well the patient is doing, to make sure there is no emergency care required or re-admission required and the recovery is going on smoothly. So those are some of the examples, diagnostic labs are also using these devices, they do a lot of COVID tests and whenever a patient tests positive, they provide a COVID isolation package where they look after the patient for 15 days while the patient is quarantining at home,” he says.

“But today what is happening is that today a patient has to buy a thermometer, oximeter and take their own readings and enter in the diagnostic lab’s app and the doctor will check and accordingly treat that so that is the process. What is happening there, a lot of patients who might be having their blood oxygen level falling less than 90 which is not a good sign, those patients are largely scared of entering the correct data, if they enter the rating as 87, chances are that somebody will come and take them to the hospital which they do not want so they might enter 92 – 93 just to not go to the hospital which is not good for them but that is the human emotion which takes over so a lot of these labs are looking at leveraging these devices to the patients for 15 days, the device will automatically take all the vitals transport the data straight to the diagnostic lab system so there is no false manual data that is provided. Then rural healthcare initiatives are picking this up more not only for this pandemic but they look at this as a way forward and ensuring a good amount of healthcare can reach the proper audience as fast as possible. So that is where we really are I would say. Again, last but not the least, promoting telehealth platforms is literally the only way to provide multidisciplinary collaborations between physicians, specialists, and patients which earlier was not possible. Since they all are on the same platform now and they can see the patients' earlier records and converse with them easily without exchanging 20,000 emails between each other so that really is what we are doing to address this issue,” says Aamod.

TigerTech strives for a safe, healthy, and secure lifestyle to simplify lives 

Aamod throws light on, “Couple of things here. Over the last 2 – 3 yrs, we have seen an increased awareness amongst the population with respect to general health, general fitness. The numbers of gyms that are coming up are huge. People who have adopted wearable devices to track their steps, BP, calories again have skyrocketed in the past 1.5 – 2 years.  What we see is the beginning of a lovely trend towards health. People want to keep themselves fit and they are willing to do whatever it takes to make sure they do not fall sick which is literally the first step towards preventive healthcare. So these wearable devices provide very indicative numbers for few health measures and they do not provide them with medical-grade accuracy and they are also not directly connected to the doctors so that the doctors can immediately review the results in case of any alarming situation. What we believe is that we should be able to leverage technology to provide every average Indian family with portable affordable medical devices in their homes that can ensure that the entire family stays healthy by testing themselves regularly so that is the first step. As I said, these devices can do 7 tests the heart and lung sound, blood pressure but in addition to that what we are looking for is how these devices can work without any hospital visits and make sure that your data is always stored on the cloud so as a user of these devices I can see how well you are doing for the past 6 months,” he says.

Telemedicine - The New Normal

COVID has been a real curse for the world but for the telemedicine group that has been trying to promote the concept, it has accelerated the adoption in a significant manner. “The hurdles that were seen before for telemedicine with doctors and patients have fallen by the wayside. Because the doctors also used to feel that till I can meet my patient, touch, and diagnose, I am not comfortable using machines. Even the patients were of the same thinking that I want to see my doctor, once I see my doctor I feel good. Those kinds of psychological barriers that were there have fallen by and now they are forced to use this and obviously the convenience of finding the doctor at the comfort of their homes unlike before wherein they had to drive through traffic, find a parking and then meet the doctor. So they find this better.  But now that more and more people are adopting this process we can see and enjoy the convenience so this will be the new normal not only till the COVID pandemic but also post that as well like work from the home concept which started with the pandemic situation but now people are finding it that it works so a lot of people are going to stop spending on renting properties or offices as there is no point in doing that. This particular technology will ease the pressures of the healthcare systems as we see it. As more and more patients leverage it for basic healthcare, while hospitals can start focusing on more serious cases that need attention. The generic illnesses like cough and cold can be taken care of through this platform. That is how it is really going to begin and grow,” he says.

(Edited by Rabia Mistry Mulla)