It could be said there’s really no wealth but health itself, but in rural India, some 840 million people are challenged by obtaining the healthcare they need. For the average citizen, just getting to a medical appointment might require a day-long journey. Inadequate infrastructure and a lack of specialists and oversight challenge community resilience outside India’s urban areas.

With the aggressive Covid-19 pandemic, India has had to consider how telemedicine can support healthcare systems in resource-poor regions with facilitated teleconsultations led by community healthcare workers.

When the pandemic hit, iKure’s Sujay Santra was well-positioned to address continuity of care for rural patients with a telemedicine platform that facilitates critical contact between rural patients and specialists.

But it goes beyond just setting up a video consultation and writing a prescription.

In this discussion, Sujay Santra, Founder and CEO, iKure, and Julie Lockner, Executive Director, IBM Data and AI Offering Management detail efforts to identify high-risk cardiac patients in India by combining wearable data and historic patient data.

Thanks to a 2019 project with IBM, iKure now has an AI platform based on pre-built models available through IBM Cloud Pak for Data to analyze patient data captured from devices, hospital visits and home-based interactions with community health care workers. This is one strategy iKure employs to help specialists better manage care for patients – especially those who remain under shelter in place orders today.

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Santra launched iKure in 2010 after his father, who lived in a small town in West Bengal, was diagnosed with heart disease and taken to a local doctor. When his condition didn’t improve, a visit to the cardiology clinic in Bangalore revealed the local doctor had prescribed his father the wrong medicine.

Santra felt technology could help prevent such calamities – and began to envision an organization that could provide the best medical healthcare to people living in rural India. The idea: take healthcare beyond health facilities and hospitals to the doorstep, both providing last mile healthcare and eventually driving critical changes in public healthcare.

Today, iKure is a leading for-profit, primary health care provider providing affordable and accessible healthcare delivery to the most remote parts of India, covering close to nine million across seven Indian states, plus Africa, Malaysia and Vietnam.

Ensuring last mile healthcare through a hub and spoke model 

The organization employs community health workers – mostly women – from the villages, who are provided smart phones loaded with the iKure application and medic bags that have various essential point-of-care devices to measure blood pressure, EKG and hemoglobin levels, enabling them to capture patients’ vitals at home.

When this data is entered into the iKure application, the system signals whether the patient is within normal range. On other days these patients can visit clinics, or the “spokes” which operate twice a week, where they can access doctor consultations, vision-testing machines, medicine and other essential tests. If they need access to other pathology tests or specialist consultations, they can reach those services at a “hub” only 12 miles away.

“Through a combination of a layered approach right from the hub to the spoke to the last mile of community health workers, we can provide a comprehensive sustainable primary healthcare to the remotest parts of India,” notes Santra.

With the pressing demand to find ways to meet the needs of the beneficiaries without risk of Covid-19 exposure, iKure can take advantage of a Wireless Health Incident Monitoring System (WHIMS) to screen and monitor patients at their doorsteps, as well as for those visiting iKure’s hub clinics. This technology allows healthcare workers to facilitate the interactions between patients and doctors – and in turn, helps doctors manage patients’ health profiles, diagnoses, and prescriptions, through treatment plans created over multiple sessions.

The key to patient monitoring is iKure’s wearable Braveheart patch, which captures several points of data such as EKG, body movement, skin reactions and others – data transmitted into routers. Once iKure captures these parameters, a cardiologist can detect symptoms of a heart condition.

Managing the case load: Building a decision support system for cardiologists 

Even with these accomplishments, Santra still faced a giant hurdle: capturing and sharing patient data would be only one part of the solution.

With 1000 patients generating a large amount of data from every interaction, iKure embarked on a pilot with IBM to demonstrate how AI could help cardiac specialists better manage patient care by ranking more severe cardiac cases first. (The data iKure captures per patient is extensive, amounting to 152 parameters, each given a score based on severity. From there iKure presents doctors with the top 10 patients who need care immediately).

“The IBM team from US, Singapore and India were working as one team with iKure to make the lives of our doctors and our teams easier in terms of how we can prioritize the patients based on the of severity based on their other conditions – so we could identify the patients early on, in terms of cardiac management as well as prevent heart attacks and saving many, many more lives.”

iKure’s solution has helped bring trust and confidence to stakeholders and health officials alike — and allowing the organization to expand its platform outside India, including setting up an additional 200 hubs in the next four years. According to a Forrester report, trust is critical to successfully scale AI. Those organizations that do overcome this hurdle are likely to be the fastest-growing businesses in their industry.

Cloud Pak For Data’s flexibility means iKure can apply AI capabilities to such a wide variety of data that streams through various devices, platforms and integrations and that has been integral to iKure’s success and health of its patients. As Santra describes, with a better data repository they may be able to predict unknowns and prepare for other unprecedented events – including any future health crises.

“With platforms like the one we have worked on with IBM we would never been able to treat patients beyond a basic level,” Santra said.

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