Al Hammond

Notes From the Field: I have seen the future of healthcare

India Call CenterEditor’s note: Al Hammond, entrepreneur in residence at Ashoka, will write a series of reports documenting his experiences and the learning involved in started a “base of the pyramid” (BoP) healthcare venture to serve developing countries. This is his first report in the “Notes From the Field” series.

There I was, looking over the shoulder of a woman physician, in a unique 400+ seat medical call center in India, as she dealt with a female patient with abdominal pains. The patient was calling from her home on a mobile, had been initially engaged by a trained lay health worker, and then passed on to the doctor.

As the doctor asked questions–guided by a software tool called a clinical decision support system–and selected the patient’s answers, the questions on the doctor’s computer screen changed. Within a few minutes, the doctor had isolated the problem, decided that she didn’t need to dispatch an ambulance, selected a medicine, and clicked on another tab that sent an e-prescription by text message to the patient’s phone.

The patient can take that message on her mobile to a pharmacy and fill her prescription. The whole process took 3-4 minutes for the patient, and was free (subsidized by the state government). But it also didn’t cost the state much, because it only used a few minutes of the doctor’s time, so that she can deal with more than 100 patients in an 8-hour shift. No clinical office to rent or equip. No patient travel involved. Available when needed, 24-7. And trained lay health workers, paid perhaps a fifth of a doctor’s salary, handle 80% of the calls, so only 20% get passed on to doctors.

Thus, in economic terms, a single doctor is in effect overseeing the treatment of more than 500 patients per day. Of course, not all patients have problems treatable remotely—trauma, cancer, heart attacks and others will be referred to hospitals. But for many primary care problems, this is high quality, and very cost-effective, care.

It gets better. Another example concerns a young mother, calling late in the evening, distraught over her baby’s raging diarrhea. A lay health worker, guided by the smart software and short disease summaries, calmed the mother down and told her what to do. But, she asked, suppose it doesn’t work? All the clinics are closed now, and the hospital is hours away. So the health worker said, Why don’t you call us back every 2 hours—we’ll be here.

Imagine how wonderful that kind of help would be even here in the US. But this service is available exclusively to poor rural families in one state in India, for now. And it works—the call center handles 50,000 calls a day and is expanding to handle 3 times that number.

Truly, I felt I was looking at the future of healthcare. There aren’t enough doctors to provide traditional kinds of medical care in rural areas in virtually all developing countries. And there won’t be enough even in the US as the baby boom starts to age. So a more efficient model, based on de-skilling healthcare and using doctors very efficiently and only when their expert judgment is really needed, is inevitable. Maybe the Obama Administration should go take a look.

As for me, I’m convinced—I and my colleagues who are starting a health-based social enterprise in India are planning to partner with this call center in our pilot effort to transform rural healthcare. More about the struggle to finance that effort, in this market climate, in my next post.