Will technology solve the shortage of ICU specialists? Malayalee doctor introduces alternative possibilities
Dileep Raman, a young doctor who went on to study in the United States after completing his MBBS with a gold medal from Thrissur Medical College, was seen with suspicion when he heard that he was going to retire and start a startup there. Those who even wondered if this doctor was crazy! There was a strong conviction behind that ‘crazy’ decision to come back to India and build your own venture despite having the opportunity to practice at some of the world’s most famous hospitals. Dr. Dileep Raman wanted the knowledge gained to be used not only for a few patients in a hospital but also to bring as many people back to life as possible. He used technology for that! Friends Dr. Dhruv Joshi and Engineer Dhruv Sood joined hands to give life to the startup 'Cloud Physician'.
Simply put, 'Cloud Physician' is turning hospital intensive care units into 'smart ICUs'. The 'Cloud Physician' virtually provides 24x7 services to doctors and nurses who specialize in the field of intensive care in hospitals within this network. It is a system that accurately monitors the movement of the patient's eyeball while in the ICU and helps to give immediate instructions in a timely manner. In India, where there is a dearth of skilled health professionals, 'Cloud Physician' is pioneering revolutionary changes in the healthcare sector. Based in Bengaluru, Dr. Dileep Raman's startup specializes in intensive care units in various hospitals from Ladakh to Kerala. Introducing Cloud Physician who combines medicine and technology. Dileep Raman Manorama Online.
- The 'bulb' burned in the United States
After completing my MBBS at Thrissur Medical College, I went to the US for higher studies. She specializes in Internal Medicine, Pulmonary and Critical Care. He was there for seven years from 2008 to 2015.
I used to work at the Cleveland Clinic. It is a large hospital network. They have hospitals in many places. There are ICUs everywhere. But there was a shortage of specialist doctors in those ICUs. They have overcome this limitation through the tele-ICU system, which appoints key doctors to a central unit and directs them to other ICUs.
Needless to say, there is a shortage of ICU specialists in the United States itself and the situation in India is even worse! In all, there are about 4,000 ICU specialists in India. It takes 10–12 years to train an ICU doctor. It will take at least 25 years to train the required ICU specialists in our country. He decided to return to India after thinking about what could be done to address this shortfall. Dhruv Joshi, my colleague at the Cleveland Clinic, also joined me.
- Startup
In 2015, we returned to India. I traveled all over India for two years and learned things. Technology in the United States cannot be applied here as well. Huge sums will have to be spent. Technology is needed to suit the Indian context. We had in mind a system that could connect even remote villages. For this, he traveled from Ladakh to Kanyakumari and studied the situation. Then in 2017 he did a pilot project in Mysore. The project in Mysore was a success. So in 2017, Dr. Dhruv Joshi and I started 'Cloud Physician' with our engineering friend Dhruv Sood.
- Indian technology
Dhruv Sood was the one who supported us in technology. He was also a man who had been in the United States for nine years. Dhruv Sood is an expert in healthcare technology. Software adapted to the Indian context was developed under the leadership of Dhruv. If Western technology is used, 50 ICU beds will cost around `5 crore. In our technology we do not have to spend even a tenth of this amount. We have 15 ICU Specialists and 35 ICU Nurses at our Main Command Center in Bangalore. We currently serve 450 ICU beds. We are active in 32 hospitals in 13 states. Many of these are government hospitals. Our service is also available at the hospital in Leh-Ladakh. Specialists are never going to reach such remote villages in India. Tele-ICU is very helpful for hospitals in those areas.
- The work of the cloud physician
A hospital needs good internet access and electricity to access the services of a cloud physician. A team of ours will visit the hospital and assess the situation and needs there. Our software will then be installed on their ICU devices. No need to buy new equipment for this. ICUs in some hospitals sometimes do not have adequate equipment. Only then will you be asked to buy it. A high definition camera will be placed in the ICU. With this high quality camera, even the movement of the pupil of the patient can be accurately monitored.
Button and switch of the ventilator The cameras are placed in such a way that the monitors in the ICU can see all this accurately. These scenes can be seen live at the Command Center in Bangalore. This is how specialist doctors examine patients in the ICU and give expert advice. Complete information of patients is collected with their consent. The patient's every minute information is accurately recorded with the help of software. If the patient's condition worsens the moment the duty nurse or doctor is not around, the Command Center in Bangalore will immediately send this message to those on duty. This will make it possible to get immediate medical attention even a little too soon. This is made possible by a 24 x7 live teleconferencing system.
- Service during the covid period
When an ICU specialist works in a hospital, he can see a maximum of 8–12 patients a day. Through our technology, an ICU specialist can examine 60–80 patients. The health workers there will do what needs to be done for the patient in the ICU. We will give the required 'input' for that. We started before covid. But with the arrival of covid, things changed again. The number of ICs also increased. The number of ICU specialists has not increased accordingly. During this covid period we were able to provide specialist care to about four thousand covid patients in the ICU.
- Decisions worth living
Cloud Physician services are available at Manjeri Medical College and Kozhikode Beach Hospital in Kerala. The project is being implemented in partnership with Maitra Hospital. This will enable junior doctors and nurses to help. For example, the patient's condition in the ICU is deteriorating. The hospital has no specialists. Every moment is precious. The decision can be made immediately in consultation with the doctor at the Command Center through the teleconferencing system in the ICU for expert service. When Kovid arrived, ventilators were newly installed in many hospitals. But health workers may not even know how to operate it. Even such training can be provided through a teleconferencing system.
- Stress can be reduced
ICU doctors are always busy. They can't work 24 hours a day. They will discuss the patient’s current condition with our specialists after rounds. It will decide how to treat it. This system is very effective in taking a second opinion and dispelling doubts. It also helps to reduce the pressure on the shoulders of ICU doctors. They are the ones who have to pay a huge price for every moment of delay. The technology is being used to reach out to more trained doctors.
- The future is in technology
Former health minister Shailaja Teacher has also said that the future lies in technology. The Cloud Physician System at Kozhikode Beach Hospital was inaugurated by the teacher. Successfully still working there. Our medical professionals must be trained to adapt to new technologies. This is because our human resources and skills are limited. We do not have health workers in proportion to the population. That’s where we need to partner with technology. There is no fully trained ICU specialist in the Kerala Government Service. Therefore, such systems should be implemented in hospitals with public-private partnership. It should coordinate as many specialists as possible and reach as many people as possible with the help of technology. That way we can save a lot of lives.