Indian Healthcare’s Digital Wonder

How an Indian healthcare company digitised five million health records in four years.

There's a new king in the Indian digital healthcare sector, Doxper, the digital pen, created by Shailesh Prithani, Pawan Jain and Randeep Singh.

Doxper has already taken hold in nearly 1600 independent clinics and 20 of the country's top corporate hospitals, including three chains. The company is processing close to 500K case sheets every month and has so far, through its platform, digitized case sheets of over 3.25 million unique patients, with a total of nearly 5 million records.

It is a fantastic feat for a startup launched just 4 years ago.

Doxper is a digital pen and encoded paper-based clinical documentation system powered by cloud computing, machine learning and AI. Doxper provides seamless clinical documentation with no behaviour change and no more burnout.

Spreading its Wings

"Quality of healthcare services delivered in India today is extremely high and is comparable to the top countries globally. A senior cardiologist in India would have done at least ten times more interventions in his career than his peer in West that too, with record-setting success percentage. The doctor in West would present ten times more papers, journals, findings at conferences than our cardiologist here if at all anything meaningful research he can do. The amount of high-quality data that India can generate every day is insane, and if done properly, we could become the epicentre of big breakthroughs in healthcare with help from our qualified doctors, researchers and data scientists. But we are way far behind in this journey. It has to start somewhere, and it starts with better documentation and digitization," explains Prithani.

Doxper is fully customizable and delivers in any care setting - individual clinics, small and large hospitals and even in Public Health. The Doxper workflow is patent pending with proprietary handwriting recognition and clinical NLP algorithms at the backend.

How is Doxper different from Others?

Existing solutions involve typing, tapping or speaking (voice recognition). As this requires unfamiliar multi-tasking and increases consult times, very few doctors in India and other emerging markets are using any form of technology to capture data. In the West, typing leads to physician burnout as it is often done outside of office hours.

There are several EMR/HIS companies in India. Some of them have been around for at least a couple of decades. But meaningful digitization and data capture at scale has been abysmal. Hence, there was something which they all were not doing right - they were all altering doctor's behaviour in a care setting which is extremely stretched and where the priorities are not aligned. Average consultation times in India is barely a few minutes. A doctor can either treat the patient or document the consultation in the computer, but not both. Priority is to treat the patient anyhow, and that is expected out of our doctors.

"We knew that we have to change things at this basic level if we need to put India on global healthcare research map," adds Prithani.

Sound Strategies

But defining a problem statement and solving it are two different things. Ideas are available, but the execution is the key. Building Doxper needed the right team, keen focus, high-quality tech, a lot of perseverance and the right amount of luck. "The team managed to get all these together somehow. Crossing 500 doctors and acquiring, and successfully implementing their first hospital customer were notable milestones for the company. By then we knew that we had a product that solves a huge pain point and customers are willing to pay for," he adds.

Numbers tell only Half the Story

It is one thing to have a vision and another thing to scale. How did Doxper manage that? According to the CEO, the startup had ample reason to grow up, and it did face challenges. From, overlapping and poorly enforced Government policies to the inability of customers to pay adequately for services in India, the startup faced many hurdles. Lack of mindset towards digitization and slow pace of decision making add to the woes."First doctor, first 50, first 100 - we celebrated well. We improvised at each step and built what our customers wanted. We spent a lot of time with our customers understanding their needs in-depth. Honestly, signing our first 500 doctors was a back-breaking exercise for us. We were selling a concept which is always harder to sell. Our first hospital took over a year to sign from the date of first engagement. It takes time," he recalls.

Balancing Quality with Innovation

In healthcare, many companies have an assembly model line thinking, where they consider healthcare as an opportunity and problem. Looking at how can you reduce cost, become more efficient, because clearly, you are trying to provide it to a vast sector, hospitals/doctors in India. So how did Doxper handle economy of scale?

"The economy of scale plays out in every sector - it's simple math anyway. Demonstrating quality and constantly innovating, working closely with our customers gives us credibility and allows us to scale. We are also a cloud-based solution, which was not the norm in healthcare information systems even a few years ago. Even the Epics and Cerners of this world are transitioning to the cloud, to allow their customers to benefit from low costs without compromising on consistent quality and innovation updates. A cloud-based infrastructure also allows for interoperability which the US is struggling with because they started with legacy, silo-based solutions - and the incentives to digitize is, a fairly recent phenomenon with the Affordable Care Act of 2008. India, in any case, has to leapfrog legacy, silo-based solutions and can't afford billions of dollars from the government as a top-down incentive," he notes.

But what is the technology that shapes Doxper?

"All the successful companies start with problem first and find only the most relevant tech, and not even tech in a few cases, to solve that problem. We do the same. Our thesis is to solve a problem, small or big, in the best possible way that can be done using the most relevant tech or non-tech measures as may be required. And, if it's tech, we either will have the capabilities in house, else we will outsource or partner or acquire," says Prithani.

The Old Guard Vs New Guard

The startup couldn't exist without clashes and criticism with the old guards of the industry. The team take all feedback very seriously and fix whatever they believe should and can be fixed about the product or business.

Doxper now faces even higher expectations of growth. "The company plans to use the funds to double down on its growth in India, expanding geographically across the country. Further investments in technology and R&D are planned to improve the accuracy of the ML/AI powered handwriting recognition engine and to develop products in business and clinical analytics," he concludes.