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How this startup is using pen and paper to transform India’s healthcare industry

Doxper, a healthtech startup, is helping doctors to digitise their case sheets using digital pen and encoded papers.

, ET Online|
Last Updated: Feb 19, 2020, 05.17 PM IST
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The company has been on a consistent path to scale up. From their first customer in January 2016, they have since signed up with 2000 clinics and 40 hospitals.
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India’s efforts to digitise health records face a fundamental problem. A skewed doctor to patient ratio means healthcare practitioners get only a few minutes with the sick. In these few minutes, it is unreasonable to expect the doctor to do both – consult and digitise medical observations and recommendations.

Working on his research in the domain of precision medicine and oncology informatics, Randeep Singh saw that doctors struggled with gadgets for data entry and recording of healthcare data. Further digging into the facts made him understand the inherent gap prevalent in this sector. An idea took shape and Doxper was founded with an aim to up the ante in data storing for hospitals and healthcare professionals.

“We could have, for once, undertaken the painful exercise of digitising these paper files, but one centre or a few hospitals wouldn’t have sufficed. For what we envisioned to achieve, it needed more than that, it needed a paradigm shift,” recalls Singh, who doubles up as Co-Founder and Chief Scientific Officer of the company he set up in 2015.

He was joined by Shailesh Prithani who had worked with an oilfield services company, Schlumberger, for 10 years and Pawan Jain who had been a programmer for the most part. While Singh and Jain knew each from their time together in IIT Bombay, Prithani got introduced to them via a common network and decided to hop onto the bandwagon as well. “We decided to step into this industry and do something that the doctors had been longing for. We brought zero behaviour change approach to ease the doctors’ daily clinical practice and eventually succeeded in 2016 January when we signed up our first paying customer. Since then it’s been a journey,” reminisces Singh.

Pen and paper code
So how exactly does Doxper claim to make the lives of doctors simpler? Powered by cloud computing, machine learning and AI, the company essentially positions itself as a digital pen and encoded paper-based clinical documentation system. Pens and paper in a hospital are replaced with Doxper pens and encoded papers. All that the doctors and medicare professionals need to do is to write using the Doxper pen on the encoded papers. “We wanted to innovate an altogether new data input modality for healthcare. After all, digitisation forms the backbone for efficient, fast and sustained growth in any industry,” he says.

What’s more, the widely common issue of doctors’ illegible handwriting is also taken into account with modules that can pick up accuracy between 80-90%. “Their handwriting may not be very clear, but it is consistent. Over a period of time, the doctors’ medical vocabulary is captured as per the patterns that have existed,” he highlights.

The product is customisable and can come in handy for individual clinics, small and large hospitals and even in public health. The Doxper workflow, which is presently patent pending, uses proprietary handwriting recognition and clinical Natural Language Processing (NLP) algorithms at the backend.

For healthcare organisations, it helps in higher compliance via record keeping, driving higher patient engagement, offering continuity of care in cases where patients lose or forget their case files as well as helping patients comply with their treatment plans through automated reminders. Moreover, Doxper claims, the data can also help in improving operational efficiencies resulting in higher RoI in terms of monetary value.

Doxper pen with docking station

India at the heart of it
The founders are of the firm belief that the scope for such a product in India is immense. The India Brand Equity Foundation pegs the healthcare market in India to reach $372 billion by 2022 on the back of rising incomes, more conscientiousness towards health and better access to insurance.

And herein lies the volume of opportunity. Singh reasons that while healthcare services being delivered in India are highly comparable to the top countries across the globe and are achieved at a fraction of the cost vis-a-vis the west, yet western counterparts are able to present more papers, journals and findings versus an Indian cardiologist. “We can become the epicentre of big breakthroughs in healthcare because of the kind of high-quality data that India can generate. This can easily be done through the help of our quality doctors, researchers and data scientists. It has to start with better documentation and digitisation,” Singh asserts.

The reasons for the gap in this space are glaring enough. Despite the presence of many Electronic Medical Records (EMR) and Hospital Information System (HIS) companies in India for over two decades, any meaningful data or digitisation pertaining to the sector stands inadequate. “The major reason for this is that they were all missing one very important aspect - they are altering the doctor’s behaviour. If we look at India on the whole, the average consultation time is just a few minutes and the doctor can’t be expected to do both: consult patients and document the consultation. We knew that we had to change things at this basic level if India had to be on the global healthcare research map,” adds Singh.

And then there are other dynamics that play up. Building trust forms an essential component that makes all the difference in the healthcare sector.

Besides this, Singh says, there is no incentive for digitisation in healthcare. “The healthcare infrastructure in the country is stretched anyway; both in terms of capacity and the price point it is delivered at. To add to it, government policies are either unclear, conflicting or are not implemented well. The USA spent $40 billion over 10 years incentivising doctors to digitise their practice. How many countries can afford that kind of money?” rationalises Singh.

Forging a path ahead
The company has been on a consistent path to scale up. From their first customer in January 2016, they have since signed up with 2000 clinics and 40 hospitals. Doxper charges for the digitisation solution, with customers choosing from the basket of services basis their specific requirement and cost. “We have started adding more analytical tools and services that customers can opt for as well. The growth has been upward at nearly 3X YoY. We are processing close to 6 lakh prescriptions and case sheets each month,” reveals Singh.

But such acceptance has been preceded by clouds of apprehension looming in the past. Most investors believed that pen and paper would vanish in five years and be replaced by computers, tablets or voice-based EMR/HIS systems.

“It has been 4 to 5 years hence and the needle hasn’t moved a bit. Not that it never will, but whenever that happens, we will be ready for it,” says Singh, the confident streak evidently coming through.

Incidentally, many had also nudged them to use a computer instead, but the founders stayed true to their belief of how the ‘pen and paper’ system worked infinitely better due to the lack of infrastructural challenges that could play up in the former.

Other challenges exist today too, primarily from an operations perspective around managing fast growth and executing projects in a better manner. But Singh brushes it all aside in a good humoured way. “These are good problems to have. If you have to make any idea scalable, there are many challenges that will come in the way,” he quips.

Last year, the startup raised $4 million in a series A round led by healthcare-focused fund Alkemi Venture Partners. Going forward, the company plans to go international and has Middle East, Africa and South East Asia as the initial global markets that it wants to tap. “We have kept steep targets and we are on track to achieving those step by step. More products are in the pipeline. We want to be present wherever pen touches paper,” Singh concludes on an assertive note.

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