E-ICUs

 
Democratising critical Treatment

Presented By:
Team WeRock (IIM Kozhikode)
Komal Kumari, Nancy, Nikita Aggarwal
 Context
India has one of weakest healthcare infrastructure (13 hospital beds/10k population; as against Key Issues
the global median of 29 beds).
 Lack of trained critical care doctors and
Even, if the number of ICU beds grow at ~5% pa, India would have ~120k+ ICU beds in the nurses, especially in Tier 2 & 3 cities and
next 5 years. An e-ICU service provider can be a great help in this regard. even smaller hospitals in metros and Tier 1
cities
Even by taking up 10% of the ICU capacity, it will have 12k+ beds under the management of
the company.
 High risk of infection and lack of protective
A recent report by CDDEP and Princeton University (attached), estimates around ~94k
~95k ICU- gear the healthcare professionals
beds in India (of which ~35k
~36k are public beds).

Problem Overview
In 1000’s Public Private Total
 Trained healthcare workers needed for treating the severe respiratory failure associated with 26 43
Hospitals 69
respiratory problems are limited in India. Even more scarce are ICU specialists or
intensivists Hospital beds
713 1183
1898
 The treatment expertise exists only in a few large centres, predominantly in metro cities
35 59
 At the same time, critically ill patients on ventilators require close monitoring, often 1 nurse for ICU beds 94
1 to 2 patients 18 29
Ventilators 47
 Putting advanced machines such as ventilators in the hands of untrained and inexperienced
personnel can result in higher-than-expected mortality rates Source: report by CDDEP and Princeton University
 Training large numbers of personnel is going to take time and is not a feasible solution in the
short-to-medium term.
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 Problem Statement and Proposed Solution

 Inadequate and inefficient utilisation of ICU infrastructure Effective ICU Management system that
and services enables:
 Inability to deliver quality care
 Integrative tele-ICU System
 Medical errors, inaccurate diagnosisC o - and missed treatment Proposed
 Centralized command centre staffed with
opportunities operative
Solution
(55% - 6 0 % ) 24/7 highly skilled intensivists
 Lack of availability of highly critical care personnel
 Automated early warnings
 Patients are willing to pay for quality care, yet occupancy rates
 Advanced and actionable decision support
and utilization of services is sub-optimal
 Diagnostic assistance
 Inadequate and unstructured expertise (4 0 % - 4supervision.
Private
5 %)

Vision behind the proposed solution Future Alternatives

AI Doctors: AI can help to treat patients by deploying intelligent
Adoption of best practices and highest quality delivery of critical care algorithms which can understand the disease pattern, decode the data
medicine via use of technology. and report the problems to concerned doctors and patients.
Improves outcomes by improving quality of care; Training and skill Biology, Bytes and Bandwidth – The three B’s of healthcare is possibly
development. the future of healthcare. Biology will enable us lower the genetic testing
Improve patient and family satisfaction due to better communication. cost.
Contribute to top line growth of hospitals by providing access to Telemedicine and Tele consulting programmes –Tele medicine and
specialists and increasing resource utilisation. Tele-consulting will be the future of the normal health care system and
can be used for medication post treatment.
Smart Beta
Source: https://knowledge.wharton.upenn.edu/article/technology-changing-health-care-india/, https://readwrite.com/2020/03/23/can-artificial-intelligence-replace-the-role-of-doctors/#:~:text=The%20use%20of%20AI%2Dcontrolled,widely%20used%20in%20US%20hospitals.,
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https://www.nehi.net/writable/publication_files/file/tele_icu_final.pdf, https://www.journals.elsevier.com/resuscitation
 Execution and Implementation Plan
A BRIEF ABOUT TELE-ICUs HOW IT WILL WORK

 Tele-ICU enables intensivists/super-specialists from across the country to

connect to beds across remote locations where there are no trained critical - Device data integration using
Video monitoring,
care professionals. computer vision: bedside
image capture, real
 With a tele-ICU system, it is possible for 1 intensivist to cater to 5x more time image analytics monitors, infusion pumps,
patients (60-80 sick patients as opposed to the usual ratio of 1:15, where an ventilators
intensivist is seeing a patient at bedside). 2
 Tele-ICU also enables efficient utilisation of ventilators in Tier 2/3 cities.
Through tele-ICUs, specialists in the command centres can pre-emptively 1 3
determine which patients cannot be managed using only nasal oxygen under - Patient data repository (EMR):
pressure and would require ventilators, thereby ensuring appropriate triaging labs, radiology, demographics
of patients for a limited number of ventilators. data, patient history, bedside
documentation
 Additionally, the monitoring technology reduces exposure to medical staff by
reducing touchpoints with patients around tracking vitals, in-turn reducing the OUR USP: HIGH QUALITY CLINICAL CARE
risk of infection and PPE requirement.
1 Clinical Decision Support 2
OUTCOMES (coming from technology or upskilled
personnel or from both)
• Improved patient safety
• Decrease in length of stay and cost EXPERT PHYSICIAN
3 EFFECTIVE
• Significant decrease in patient mortality and morbidity
COORDINATION INPUT
• Reduced complications
(Between bedside and command (coming from technology or
• Enhanced medication safety upskilled personnel or from both)
centre: video conferencing, voice, text)
Smart Beta
Source: https://knowledge.wharton.upenn.edu/article/technology-changing-health-care-india/, https://readwrite.com/2020/03/23/can-artificial-intelligence-replace-the-role-of-doctors/#:~:text=The%20use%20of%20AI%2Dcontrolled,widely%20used%20in%20US%20hospitals.,
Stock Valuation Competition https://www.journals.elsevier.com/resuscitation
https://www.nehi.net/writable/publication_files/file/tele_icu_final.pdf,

 Ward
 Emergency
 Outpatient
Daily Rounds
This cycle will be repeated
till the patient get
discharged from the hospital
Monitoring 24/7
Early warning systems will be
stimulated and proactive decisions
will be taken on demand.
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Workflow Chart
New Patient Admission
It can happen through two way
visual/audio interface. At this
stage, data transfer and visual
assessment takes place.
Review Admission
COMMAND Specialists or intensivists will
execute medical review at the
command center.
CENTER
WORKFLO
W Instructions and
Recommendations
Recommendation plan by the
cloud-physician will get conveyed
through e-record at the hospital.
Best Practices
Periodic reviews of best practices
and standard quality are
 Key Metrics & Financials
METRICS TO MEASURE SUCCESS ESTIMATED COST

Metric Description Operational Expense  Amt

# of hospitals
E-physicians service charge/month (3 Full time
# of ICU + HDU beds covered E- physicians, 6 Nurses) 9,00,000
# patients Total number of ICU patients admitted and treated.
One-time expenses  
Training fees (50 bedside staffs) 70,000
# patient bed days Total number of days that patients were in the ICU.
Capex for remote monitoring at the bedside  
# of interventions Number of interventions that project will be a part of Cameras, printer, scanner, webcam, microphone,
in the treatment plan of the patient that were instituted speaker and networking infrastructure 4,50,000
remotely from our command centre over and above
those normally carried out at the bedside. Estimated project cost 14,20,000

Length of stay (LOS) This number tracks the number of days a patient was KEY RISKS
admitted an in ICU. A drop in the LOS with the
constant severity of illness signifies an improvement in
quality of care.  Operational expenditure heavy pricing: wasted expenditure if
the occupancy rate is low
Severity score (APACHE) APACHE score, an indicator of the severity of illness in  Doesn’t scale easily: Services model, expect a single player to
patients admitted to the ICU. scale to a few thousand ICU beds at best (patients handled on a
Mortality Rate (MR) Observed number of deaths in a unit. monthly basis would be 2.5-5X the number of beds they
cover)

Smart Beta
Source: https://knowledge.wharton.upenn.edu/article/technology-changing-health-care-india/, https://readwrite.com/2020/03/23/can-artificial-intelligence-replace-the-role-of-doctors/#:~:text=The%20use%20of%20AI%2Dcontrolled,widely%20used%20in%20US%20hospitals.,
Stock Valuation Competition https://www.journals.elsevier.com/resuscitation
https://www.nehi.net/writable/publication_files/file/tele_icu_final.pdf,
Thank You!