“India will become a global leader in digitally-driven healthcare”

Fitterfly is a health-tech startup working in the field of Digital Health and Digital Therapeutics. The company is on a mission to help millions prevent, reverse, and manage chronic health conditions like diabetes, obesity, heart disease through clinically proven 360-degree care programs.

In an exclusive interaction, Dr Arbinder Singal, Co-Founder and CEO, Fitterfly and Shailesh Gupta, Co-Founder and COO share their views on the digital healthcare scenario in India and how their company using digital technologies for healthcare delivery.

How do you define digital healthcare? What are the current trends in this space?

Dr Arbinder Singal: Digital healthcare is the umbrella term for all healthcare services that are delivered online through devices such as smartphones, tablets, and desktop computers. In the wake of the pandemic, there has been a rapid rise in the demand for digital healthcare services such as doctor consultations, healthcare information, delivery of pharmaceuticals, and doorstep delivery of diagnostic tests etc. This first phase of digital health lasted from 1990 to 2015. With changes in perception and rising demand for preventive care, Digital Therapeutics (DTx) has emerged as an advanced technology-driven therapeutic approach aimed at prevention and treatment of chronic ailments such as diabetes, obesity, PCOS, and heart disease.

People are becoming increasingly receptive to this new form of digital healthcare wherein interventions are based on clinical evidence related to individual patients. For the purpose of diabetes management, cutting-edge software programmes are used to monitor patients and analyse the data related to their glucose levels, and body’s response to different food items.

Who are the stakeholders of digital healthcare and how broad is its scope? 

Dr Arbinder Singal: The first stakeholders in the digital healthcare system would be the patients themselves; second is the technology platform providers including companies such as Fitterfly, which build these platforms, or those like 1MG, Practo, delivering digital health. The third set of stakeholders would be the providers of actual healthcare like doctors, labs, diagnostics, hospitals, and various other companies.

The DTx approach enables monitoring and modification of lifestyle habits related to food, nutrition, exercise and sleep etc. The discipline and ease of adherence brought about by DTx players like Fitterfly is empowering people to take control of their healthcare decisions through transparency, continuous monitoring and superior outcomes. With the rising prevalence of diabetes and heart ailments, digital healthcare has incredible scope and the market will keep growing steadily in the foreseeable future. The DTx market is expected to cross the $22,601 million mark by 2031 at a CAGR of 19.4%, and we expect the actual numbers to be even higher than these projections.

What are the lessons from COVID-19 and how has the pandemic accelerated digital adoption?

Shailesh Gupta: In the initial days of the pandemic, people felt stuck at homes as transportation services were shut, business activities were suspended, and regular healthcare was also halted. Suddenly, tech-driven food delivery, online groceries and other such services took over. Even in healthcare, there was an opportunity to leverage digital technologies such as video communication for consultations and access to care. This brought about a shift in the mindset of the public. Second, as a doctor and founder of a healthcare platform, the change that I noticed was that prior to the pandemic, not even 10% of people were interested in paying for online consultations. However, the compulsion of the pandemic and the effective outcomes have led to a scenario where everyone is ready to pay for online services. The change was huge for doctors as well since they were initially not providing digital services but explored the online option later – and it has now become a mainstream channel. Last but not the least, the fact that we had UPI and people could seamlessly and easily pay through apps like BHIM UPI, PhonePe or PayTM etc., made the transformation easier and more conducive.

It is widely understood that preventive health management through digital therapeutics is not only safer and convenient, but also more effective and affordable compared to conventional hospital-based care. In fact, more than half of the patients with problems like diabetes now prefer digitally driven healthcare support.

Has the policy and regulatory framework in India evolved enough to fast-tracking the adoption of digital healthcare? What is the current status and way forward?

Dr Arbinder Singal: Despite being late on the digital revolution, India has rapidly scaled its capabilities and diversity of digital services including healthcare. At the outset of the pandemic, the government took the key decision of declaring telemedicine as an essential service, and put its weight behind digital diagnostics, online delivery of healthcare consultations, and point-of-care delivery. These decisions proved to be force-multipliers and doctors managed to save a large number of lives through a diversity of digital services including remote monitoring of COVID-19 patients, and doorstep delivery of diabetic screening services.

As we now aim to mainstream digital therapeutics, there are concerns related to data security and privacy, but the government has shown great intent by introducing draft legislations aimed at addressing these concerns. The need of the hour is for stakeholders including the authorities and the healthcare sector to come together and ensure a robust cybersecurity, AI-powered monitoring of digital assets and data security framework. There has been a lot of development on this front and AI-powered smart cybersecurity solutions are now being offered to healthcare providers. We are also witnessing a rise in domestic development of software and hardware solutions that are secure by design. With India’s incredible IT talent and a young workforce that is more receptive to digital interventions than most other countries, we are set to witness mass adoption of DTx services in the years ahead.

A lot of concerns have been raised about patient data privacy and protection. How are the private players in this space ensuring there is no misuse?

Shailesh Gupta: Healthcare is a mass service sector, and the large operators have been using legacy on-premises technologies to maintain patient data and hospital records. When the pandemic compelled everyone to quickly pivot to online service delivery, a rapid deployment of third-party tools and services became necessary. Functionality of a tool prevailed in considerations over the potential security hazards. Incidents such as the AIIMS cyberattack and many other instances which may or may not have been reported, are an outcome of such security vulnerabilities. The nature of data ranges from sensitive patient medical records to their credit card numbers, insurance data, personal information etc., and all these can be misused or sold by hackers on the dark web.

There is a lot of awareness on the subject, and today companies like Fitterfly which are investor backed, are paying great attention to building security of cyber assets, and taking the necessary steps to ensure that there is no inadvertent loss of data or breach by hackers. Employees are trained on cybersecurity practices, and advanced cloud-based AI cybersecurity solutions are now being increasingly deployed. We also invested in getting ISO 27001 certified for data security protocols. Leading healthcare providers are taking steps such as authentication of users who are granted access to their network. Role-based authorization to limit access only to the data pertinent to a user is ensured. Further, there is a growing demand for two-step verification processes and integration of Secure Sockets Layer (SSL), etc. Data encryption is another major step taken by most players. The encryption algorithms are being deployed in a way that there is a lower number of keys held by authorised users or service providers and lowering the likelihood of a breach.

In case the breach happens, what could be the possible remedies?

Shailesh Gupta: In the worst-case scenario where a breach takes place even after these measures, a clearly structured, quick, and consistent response framework is necessary. Healthcare providers are focusing on establishing redundancy through backups, and processes that can proactively isolate the affected systems, and switch operations to the backup servers after isolation of the affected devices. All these measures prove useful in containing the breach and quickly resuming operations that get affected by cyberattacks.

Last, but not the least, there are strong legal and procedural remedies available for the customers. For instance, the patients can file a complaint or a lawsuit about the misuse of data. These lawsuits and complaints are dealt with utmost seriousness by courts as well as the medical bodies in India, and action can be taken against the providers if there is misuse or unauthorized sharing of individual data.

In which ways is your company contributing towards the use of digital technologies for healthcare delivery?

Dr Arbinder Singal: Our aim is to use the advancements in software and hardware to create an integrated digital therapeutics platform that can address the root causes of the problems. The approach we are taking is based on using data analytics to enable early-identification of diseases as well as crafting personalized care services that deliver consistent positive outcomes. Fitterfly started by building a highly advanced digital therapeutics platform for tracking nutrition, blood sugar responses to various foods (personalised glycemic response engine- Fitterfly IP), stress assessments, sleep quality management, fitness assessment and exercise plans. Considering the need for mass usage, we built it as a cloud-powered platform that could be scaled extensively both on android and iOS platforms.

Apart from building a tech stack that helps in managing diabetes, obesity, and heart problems which serve as the bedrock for various health complications, we have also focused on going beyond prescriptions and helping our patients achieve behavioural change, habit building through integration of expert supervision, and empathetic guidance. We work with a diversity of experts such as doctors, psychologists, nutritionists, and physiotherapists to achieve positive outcomes in over 95% of cases. Fitterfly’s research and effectiveness of services have received extensive attention and we have presented papers at global events such as the American Diabetes Association 2022 (5 papers), International Diabetes Federation 2021 (4 papers), US Endo 2021 (2 papers), European Conference on Endocrinology 2021 (2 papers), RSSDI India 2021 (4 papers), ESICON India 2021 (4 papers) and American Association of Clinical Endocrinologists 2021 (2 papers). We aim to spread awareness and bring together multiple stakeholders such as the central and state governments, insurance companies and IRDAI and employers to create an ecosystem.

At Fitterfly, we are also driving awareness about the adverse effects of chronic diseases like diabetes on the economic outcomes for the affected persons and their employers alike. The objective is to now ensure DTx coverage for health conditions such as diabetes, PCOS, obesity and heart diseases, and contribute to reducing India’s disease burden through scalable deployment of technologies. We have achieved great outcomes through the technology with over 95% of the people witnessing 20% to 30% drop in their glucose levels within three months. This data has been published in various platforms such as the European Conference on Endocrinology and Advanced Treatments and Technologies in Diabetes. People have also achieved weight loss ranging from 5 kg to 10 kg in three months and their fat percentage came down by 60%. Their quality of life and fitness have also shown improvements of over 50% to 70% after regular usage of the Fitterfly technology.

What is your outlook for the digital healthcare industry in India?

Dr Arbinder Singal: India is placed at a very bright spot from a demographic perspective. The country not only has the world’s largest youth population, but also a massive workforce of talented individuals who are tech savvy and well poised to take the country forward in a digital world. When it comes to early adoption of innovative technologies, Indians again rank among the best performers in the world.

To ensure that this massive demographic dividend is encashed, and India is propelled towards continuous economic growth, DTx platforms will play a key role. Companies like Fitterfly will continue to devise solutions that reduce absenteeism, costs of healthcare and loss of productivity for the businesses. Users of digital healthcare platforms like Fitterfly continue to enjoy superior life quality and productivity. Thus, the outlook is extremely good, and we believe India will soon rise to become a global leader in the digitally-driven healthcare sector.