After the global community was impacted by the severe pandemic the importance of healthcare and the healthcare IT sector have felt like never before. There have been many healthcare startups who have come across and are doing quite well. In recent years we have seen healthcare becoming an integral part of the Indian business ecosystem. There are successful entrepreneurs who are adding valuable contributions to different economies around the world. We at Medicircle, a healthcare media company, are interviewing Healthcare Leaders to know more about their contribution and journey. We aim to inspire the younger generation with recent facts and observations of the healthcare industry.    

Surjeet Thakur is the co-founder and CEO of TrioTree Technologies. TrioTree is a HIS company, which has so many clients from India and around the globe. Surjeet specialises in a lot of domains like healthcare IT, healthcare consulting, hospital Information Systems, project management and implementation. He has vast experience, as he has been mentoring his team for a long time and has produced exceptional and successful results.

How do you deal with lapses of standardisation in healthcare?

Speaking on the challenge of non-standardisation, he says, "I have been in healthcare for almost 22 years. I've seen Healthcare IT grow. I joined Healthcare IT at a time when people used to wonder what an info computer in a doctor's chamber was. We were trying to build a solution. When we started off this, our focus was more on EHR and EMR. Because HIS is one thing that is actually bread and butter. So operations registration billing and that sort of thing, which is expected that the solution will do. Instead, we focused from the angle that the clinicians or any care provider be able to use the system. They are the source a patient ultimately goes to.”

Adding to it, “If you look at how healthcare has evolved, it has evolved from patient care to quality of care and now the focus has moved to patient experience. And now efforts are made to improve the quality of care. But that is particularly challenged by the lack of reliable data on quality. And of course by the technical difficulty measuring the quality. As the saying goes that if you can't measure it, you can't manage it. There's an ongoing effort in the public and as well as private to actually improve the quality of data capture, develop better measures and to understand the quality of care and develop innovative solutions for long-standing challenges. When there is no standardisation every hospital thinks that the processes they tried to adopt are the best. This occurs as there is no fixed measure. These standards of JCI standards of NAPH, fortunately, or unfortunately should standardise not the processes, but the data capture. For example, when we talk about initial assessment, whether it's nursing or clinical, there is absolutely no standardisation on this type of data set. Though the government of India has come up with guidelines for metadata standards, MDDS standards and EHR standards, it's still to be adopted."

Furthermore, “This non-standardisation actually creates a bottleneck in creating a solution which is sort of uniform and you don't know how you are doing as compared to others, because again, there is no standardisation. The Government has bought the licence of SNOMED for all healthcare providers and all hospitals, clinics actually can subscribe to that and use it. Unfortunately, it has not received acceptance of that usage, but things are changing. I mean Covid taught us that you have to go for those standards.” 

Acceptance of healthcare IT pre and post COVID

He tells, "Covid has been an unprecedented global crisis for all the health systems. This includes hospitals, clinics, individual practitioners and labs. During Covid, diagnostic centres were unable to give simple RT PCR reports, at times the tat was more than 72 hours. So, it has put tremendous pressure on the entire healthcare system. What we have learned from it is that we need to improve resilience. We have to improve accessibility, affectability and of course, sustainability. So, the challenge is to enhance the health care system capacity. Challenges of oxygen not being there, beds being unavailable can only be tackled by increasing the infrastructure.”

Adding on, “Second is access to health care by the people. We as a country need to provide access to remote healthcare. This is the reason why one saw telemedicine flourishing during the Covid times. Telemedicine was there for the last 25-30 years, but it, unfortunately, needed a global crisis, a pandemic like COVID to come as a saviour. Now, we have seen doctors, who were slightly reluctant to use the system, use it. And it has also to do with the behaviour of the patient too. There was certain resistance in the clinical fraternity to use the system because they thought that maybe if once I start using the system, I might not be able to give the same sort of attention to my patients and my consultation time would increase but that sort of thinking has changed. I mean, now we had the same doctors who would want to use a telemedicine platform to actually deliver care. So yes, there has been a paradigm shift pre and post COVID. Now, the challenge is to look at whether there is a sustenance in that zeal by the clinical fraternity to use the system or not.”

Narrating, "From experience, I can say that the newer generation of doctors wants to use a system now. And the third changemaker is the patient. The patient expects that I have to physically meet the doctor because till the time he doesn't actually touch my palm, I don't get a feeling that I'm being cared for. That patient behaviour has now changed. So yes, there has been a paradigm shift but only time will tell whether it's actually a spur or there will be sustenance."

The expansion plan of TrioTree Technologies

Explaining their spread, he says, “We have got clients all across India, including our North, South, East and West. Plus we have got clients in Malaysia, Singapore, in the Middle East as well as in Oman. We have a lot of acquaintances in the UK. Now we want to expand in other geographies like the African market, Indonesia, and Singapore. Currently, everyone faces the challenge of travel. So we are approaching it as a partnership approach. Where we are having local partners there with whom we are coordinating, we're doing remote training for them”. 

Competition between funded and non-funded startups

He narrates, “Our company was bootstrapped, though we took some funding from friends and families. This was a very conscious decision that we made. So there are two ways of actually acquiring a customer: either the customer pays for it. So the more clients that you have, you will have word of mouth and you will get more clients. The other way is with an investment that will actually give you that thing that you can acquire customers with, the money part. Both have some pros and cons, everything comes with its advantages and disadvantages. So if I say let's look at this from a short term and long term perspective. From a short term perspective, of course, investment actually helps you with a jumpstart. But ultimately, what happens is all about acquiring customers. And if you have an idea, if you have a product that actually solves the problem and not an imaginary problem, you grow. So to answer your question, yes, the investment has few benefits in the short term, but long term, what actually matters is whether your product fits into the market or not.”

The secret behind TrioTrees Success

Explaining he says, “This field is highly localised and unorganised. So, there will be a small company in a small town which will cater to all hospitals in two or three towns around and it will not have any expansion plan. That's a harsh reality that you have to compete with them also. And when your costs are low you can offer any price. But now I think that primary health care facilities have become more mature. They have understood the difference between cost and value. So now the focus has moved from cost to value. Because we came from the other side of the hospital, we understood the pain slightly better than our contemporaries. So as a part of our induction, we make everyone undergo five days of mandatory healthcare training, not the product training or, or the development training. Because if you are in this industry, you need to first understand what the real challenges are and what we operate.”

He narrates, “A support guy might receive a call at six o'clock saying that my discharge paper is not getting printed and we solve this for me. The hospital expects our support guys to understand the intricacies and the challenges in that. Because of this care, the majority of our client acquisition actually happens through word of mouth. So I think the focus is not only about selling a product, it's about selling a solution.”

Words for future entrepreneurs 

He advises, “If you want to enter healthcare then you should be here for the next five to 10 years. This industry is only going to grow into leaps and bounds. What I'd say is to start a business and wait for any successful fruition. Let's understand success is always relative. It's not about how much revenue, it's not about how good the product is, or how many clients it reaches across geographies. But it takes a sound mix of confidence, risk tolerance, self-discipline, determination and competitiveness. If you have an idea, you have the talent for doing it then you should also have the professionalism to do it. But to build a worthwhile business, what one requires is dedication, ethics, and single-mindedness. Most importantly you need to be madly in love with your own idea. If you can't believe in your idea, how do you expect others to join you? So go for it. There's no wrong or right answer. That's the best part of being an entrepreneur. And success will be yours, too.”

(Edited by Priyal Shah)