One of the many stories 37-year-old doctors Dhruv Joshi and Dileep Raman like to recount is how their ‘smart ICU’ technology picked up early signs of oxygen levels plummeting in the ICU of a district hospital in Karnataka.
Cloudphysician, the start-up firm founded by the two doctors in 2017, uses IT to relay visuals and data from the ICU to a manned command centre, where intensivists and other specialists make swift decisions on treatment protocol.
Talking of the oxygen crisis in the hospital ICU in April, during the second wave of Covid-19, Joshi says, “Oxygen pressure at the ICU had fallen to a critical level, which our command centre team picked up by monitoring the ventilators. The oxygen being delivered to the patient was much below the level that had been set.” The sounding of an early alarm by Cloudphysician “averted a possible mass fatality event”.
The technology makes up for a critical vacuum in the country’s healthcare system — the paucity of trained ICU specialists such as intensivists, pulmonologists and anesthetists — a lacuna the two doctors identified five years ago when they left for the US to do their specialisations after graduating from medical schools in Bengaluru and Thrissur.
“While we were at Cleveland Clinic (Ohio), we were solving many of the problems associated with the shortage of specialist doctors. We were using technology to solve these problems. While doing so, we realised that this problem is much bigger in India,” says Joshi.
While the first wave of Covid-19 highlighted the lack of ICU ventilator facilities in the country, the second wave showed that the scaling-up of infrastructure alone — without equipping ICUs with trained doctors and staff to handle the equipment — can be an exercise in futility.
There have been reports of how hundreds of ICU ventilators provided to hospitals through the PM Cares scheme were not being utilised due to the lack of trained intensivists and ICU experts to handle the equipment.
“The fact is, we are very short of doctors, especially specialist doctors for ICU patients. There are only around 350 intensivists in the country for three lakh ICU beds. More than 95% of ICUs do not have access to specialists. With the onset of Covid, there has obviously been a surge in the number of ICU patients and the problem has exacerbated significantly,” says Joshi, adding that while the response to the crisis has been to build ICU infrastructure, the lack of treatment expertise has not received much attention.
“You must remember that the ventilator is a complicated machine. Once you get one, you need somebody to use it appropriately,” he says.
This is where Joshi and Raman’s Cloudphysician stepped in. The Karnataka government turned to the duo to get ICUs running in as many as five government hospitals.
Last year, Cloudphysician received funding from ACT Grants, a non-profit created by the startup ecosystem in India, to deploy its technology-based ICU expertise in government hospitals.
Between April and June, when the second surge peaked, 10 hospitals — both in the government and private sector — turned to Cloudphysician to support their ICUs, Joshi says, adding that their smart ICU technology has so far serviced over 3,500 Covid patients in Karnataka.
The start-up is also using its technology in government hospital ICUs in Maharashtra and Kerala.
While the Government of Karnataka used its own tele-ICU facility through the first and second waves of the Covid-19 crisis — where top critical care experts in Bengaluru carry out tele-rounds of hospitals twice a day — what sets apart the solution offered by Cloudphysician is that it is present in the ICU 24/7.
Cloudphysician has now been roped in to run a 24-bed ICU facility at the 150-year-old government Epidemic Diseases Hospital, which is equipped with 24 PM Cares ventilators but does not have trained staff to operate the equipment 24/7.
The 24-bed ICU was supposed to be in place in 2020, but the lack of staff meant it could take off only in June this year.
Cloudphysician is now a 100-employee company, with 60 of the staff clinicians — doctors, nurses, specialist doctors, intensivists, pharmacologists and dieticians — and 30 of them part of the engineering team that works on machine learning, AI, and web and mobile development. The firm has a proprietary software called Radar which it uses in ICUs.
The deployment of Cloudphysician’s ICU systems in government hospitals has been backed by Karnataka Deputy Chief Minister Dr C N Ashwathnarayan, a qualified doctor.
“The technology enables hospitals to have their beds and patient data remotely monitored through CCTV and inter-connected sensors while giving hospitals access to highly qualified intensivists and nurses,” Dr Ashwathnarayan said.