Dr M Srinivas, director of AIIMS Delhi, on AI in diagnostics, public healthcare pressures, lifestyle diseases and how AIIMS is a health university hospital. This session was moderated by Ankita Upadhyay, Special Correspondent, The Indian ExpressAnkita Upadhyay: AIIMS sees around 15,000 patients in its OPDs every day, many of whom come from across the country, not just Delhi. Since taking over, how have you balanced healthcare delivery with research and teaching?We are not just a hospital. AIIMS is ideally a health university hospital. The mandate given by Parliament is patient care, teaching, learning and research. We are also adding a fourth pillar — good governance and transparency. Each of these pillars is supporting each other. If we do not do research, who will generate solutions for the country’s needs? India is known for frugal innovation. Technology, treatment protocols, guidelines and evidence-based medicine suited to our conditions must come from here. It’s not going to come from the rest of the world. In fact, it is the other way around. Many of our solutions can serve the Global South. Research also helps us generate evidence and be part of policy and advocacy. We go to NITI Aayog and Health Ministry, share treatment protocols and tell them what research is needed. We look into vaccine trials, nutritional fortification. The iodisation of salt is a result of research from AIIMS.The second component is teaching and learning. Our mandate is to create leaders — teachers, heads of departments, vice-chancellors, policy experts — not only for India but for the world.Ankita Upadhyay: Despite newer AIIMS institutes coming up across the country, why do so many patients still come to AIIMS Delhi?I call AIIMS Delhi the “mother AIIMS”. We are hand-holding the 20-plus AIIMS institutions across the country. We help with design, administration, recruitment, procurement, SOPs and guidelines. What is especially important for us is the work culture — that is something we want to share. We have also created referral protocols so that patients from other AIIMS institutes can come through a green channel for seamless admission and treatment. The referral is two-way: patients can come to us, then they can also go back.Patients still come to AIIMS Delhi because of trust. People believe this is the biggest and best hospital in the country. At times we tell them that our own colleagues and students are leading the institutions elsewhere, and we refer them back.On a unified health record | ‘We are going to have a robust system of not only cyber security hosting and network but also hospital information systems. Once we have that, we will be helping other institutions. We will have a data sharing system’Story continues below this adYou can’t say the other institutions are not doing well. No institution becomes popular from day one. It takes time. What we are building is a pan-AIIMS consortium. Recently, we brought together directors and deans of research across AIIMS and said that if we are doing research for the country, we cannot work in silos. We must work together, share knowledge, teaching practices, administrative experience and take up big research questions jointly.We have software enabling a two-way referral system. The Health Minister launched one such system at AIIMS Delhi and AIIMS Bilaspur. Even without software, doctors call one another and say that I am redirecting the patient. If a patient from a peripheral AIIMS comes to mother AIIMS because of lack of expertise, equipment or a team approach needed for a complicated disease, we are happy to help. Once the critical component of care is completed, the patient can return to the nearest AIIMS for follow-up. AIIMS Director, Dr M Srinivas.Ankita Upadhyay: A lot is happening at AIIMS around AI — from the new Centre of Excellence and collaborations with France to AI-based work in cancer diagnosis and mammography. Many young MBBS students wonder whether AI can replace doctors. What is your view?AI will not replace doctors. It just helps them do more than what they were able to do. In fact, AI is required for institutions like AIIMS because we are dealing with large numbers. When the quantity increases, there is a possibility that quality will suffer. That is where AI comes to the rescue, say in triaging systems.Story continues below this adTake a simple example of chest X-ray reporting. Today we can generate hundreds of reports the same day within a few hours. The report goes to the clinician with a rider that it is AI-generated and must be clinically correlated. If something needs review, it comes back to the radiologist and they fine-tune the diagnosis. Earlier each specialist had to review huge numbers manually. AI reduces that pressure and gives doctors more freedom to do higher-quality work. At the same time, AI also learns because the data is here. We see millions of patients. That means systems trained here will keep improving. AI is definitely a supplement to our services.On introducing a referral system | ‘A referral system would definitely make our job easier. Unscheduled appointments do put pressure on the institution. There is always a mismatch between the load, expectations and availability of beds’Ankita Upadhyay: To what extent is AI being used for cancer diagnosis?In cancer, take mammography. If you want to reach remote places, you will not always have a radiologist available. AI can help make the initial diagnosis, after which confirmation can be done by a specialist. The same applies in tuberculosis screening, where large community-level screening, in the periphery and community settings, can be done using AI-driven tools.We are also looking at how AI can improve lower-end technologies. For instance, AIIMS is going to have India’s first designed MRI in collaboration with MeitY, IIT Bombay. If you have a lower-end MRI machine, AI can enhance diagnostic accuracy of the software. Cheaper equipment can produce standards closer to the best systems. That is where frugal innovation comes in.Story continues below this adMost departments are working on AI projects; many are still in research mode. We are the clinical partners for IISc and IIT Delhi.Ankita Upadhyay: Diseases like tuberculosis and AIDS have dedicated national programmes. Do we need similarly structured programmes for obesity, diabetes, hypertension and preventive health in general?The government is already working on this, addressing non-communicable diseases through the 160-plus Ayushman Arogya Kendras. Screening for oral, breast and cervical cancer is happening. Diabetes and hypertension are also being taken up. So, lifestyle diseases are very much on the agenda.Kaunain Sheriff M: AI in healthcare is being used very loosely as a term, especially in the private sector. Do we need regulation for AI in healthcare like we have in drug regulation?Story continues below this adAIIMS has always taken the lead in regulations, policies and technology assessment. But we are allowing people to do what they want with the intention that they will increase their diagnostic accuracy, treatment protocols and make the patient’s experience safer. If we do a lot of regulation, people will not have the freedom to innovate. Doctors are not handing over final decisions to machines. AI is functioning as a filter, a triage tool, an initial or provisional diagnostic aid.On joining AIIMS | ‘Why do people join AIIMS? It is the ecosystem. You get complex cases, difficult surgeries, challenging patients and you have the pleasure of saying that you are the best in the country and the world’Anonna Dutt: Is AIIMS looking at any incentives to retain its doctors? In recent years several of them have moved to private hospitals.Why do people join AIIMS in the first place? Because of the pleasure of working here. It is the ecosystem. You get complex cases, difficult surgeries, challenging patients and you have the pleasure of saying that you are the best in the country and the world. It is not only money that gives professional fulfilment. There is freedom in the institution to focus on a particular area if one wants.Kaunain Sheriff M: One of the solutions discussed is to have an all-India cadre. The top talent from AIIMS goes out for a few years, trains doctors at local centres, comes back and a legacy is created. Is the government thinking about that?Story continues below this adThat’s a policy question that the government will answer. But it’s happening at a low level, it is happening as a deputation. Second, we are helping institutions, like we went as a team to some of them to start renal transplants and other complex procedures. Also, we have MoUs with other institutions, including the Institute of Medical Sciences, BHU, Varanasi. We are establishing those departments and facilities there. The government has also given an opportunity. We retire at 65. Up to 70, I can be a consultant and a specialist teacher at the new AIIMS. AIIMS Director, Dr M Srinivas.Anonna Dutt: Public hospitals are always overcrowded. What is the solution to that? Previously, there was a discussion on introducing a referral system in Delhi.A referral system would definitely make our job easier. Unscheduled appointments do put pressure on the institution. There is always a mismatch between the load, expectations and availability of beds. Our job is to ensure patient experience, safety and standards. We were the first AIIMS to start NABH (National Accreditation Board for Hospitals & Healthcare Providers) quality accreditation systems.Rinku Ghosh: What has been done on Antimicrobial Resistance (AMR) at AIIMS as antibiotic development takes time? Second, the HPV vaccination drive is on, but what is being done to dispel myths and fears around it?Story continues below this adOn AMR, AIIMS Delhi has taken a leadership role. We are networking with institutions. We are bringing a lot of institutions here, telling them the SOPs, guidelines, what kind of culture sensitivity we undertake, how the department is generating data on antimicrobial requirements, resistance, and sharing it with them. A lot of funding is also coming from the Department of Health Research, Indian Council of Medical Research. We have formed a consortium and data is being shared for policy and advocacy.As for HPV, scientifically we know it is safe and effective. The country is moving in mission mode on this. It is part of immunisation efforts now.Ankita Upadhyay: Out of about 1,306 sanctioned faculty positions at AIIMS, around 446 are currently vacant. What is being done to fill them?We have introduced a recruitment system using blockchain technology and the process is ongoing. Almost two-thirds of the interviews are over, and in the next one or two months, we should be able to finalise results for many of the existing vacancies.Story continues below this adGayathri Mani: The previous Delhi government planned to construct around 15 hospitals in Delhi but they could not be completed due to cost escalation. The current government is now planning to complete these hospitals through PPP (Public-Private Partnership) mode. Is it a good idea to privatise government hospitals?I can’t answer on policy matters. If the Delhi High Court or the Delhi government asks us to handle something like this, we can definitely do a training and teaching programme. In fact, when the former L-G asked us to lend a helping hand, we did a gap analysis for all Delhi hospitals. Some of the recruitment has happened because of our push. What we did, intelligently, is to ask the doctors and nurses getting inducted into the system to get that experience of AIIMS. Connecting doctors is the most important thing.We are also looking at how we can have a two-way referral system. The secondary hospitals in Delhi are not fully occupied and there is a huge load on tertiary care and quaternary care. We have to see if the patient who is stable in a tertiary hospital can be referred back to the secondary hospital. So, we will make optimal utilisation of resources. There is going to be a lot of hand-holding, inter-two-way referral between the hospitals.Deepto Banerjee: Every year there is some concern around NEET-PG. This year, there were minus 40 cutoffs. Do you think this could lead to talent dilution 10-15 years from now?We have almost one lakh-plus MBBS doctors coming out. And we hardly have up to 80,000 PG seats. Clinical seats are definitely less. Just MBBS is as good as not having anything. One needs to have post-graduation and the seats are limited. Then look at the other side. Hospitals are there but they are not being run 24×7 because there is a lack of doctors and only resident doctors can be working in the middle of the night. That means for the hospitals to have patient care, you also need resident doctors. So, there is a need for post-graduate seats on one side and patient care on the other. If we match them together, there is definitely nothing wrong in pushing more people into post-graduate courses.Uma Vishnu: Should there be a NEET exam at all? Should the entry barrier be lowered?These are all policy decisions. The National Medical Commission (NMC) will decide at an appropriate time whether to do it or not. If it is to be done and we come into the picture for how to do it, then definitely we will help. AIIMS will take the leadership role and then we will conduct the examination. If the government or NMC asks us to give modules for competency or give AI-driven teaching learning processes, we are there. If they ask us to create an infrastructure or ecosystem or material for teaching and learning for undergraduates or postgraduates, we are there. We are enablers, we are supporting the government.Devansh Mittal: What role do you see for the Ministry of Ayush, given the proliferation of untested drugs and treatments in the country?Many of our departments are doing work on yoga, meditation and are supplementing and complementing therapies with holistic therapies. But evidence is important. If research happens in AIIMS and if it is tested, validated, stamped and published from the institution, the trust of the people will increase. Of course, Ayush also has its own research institutions. We are trying to break silos. There has been an MoU between AIIMS and the All India Institute of Ayurveda. Then we are also working on research at the molecular level.Anuradha Mascarenhas: Data exists in silos across private hospitals, diagnostic labs and government portals, making it difficult to create a unified health record. Any observation on this?This is being addressed. If you look into the National Health Authority today with PMJAY (Pradhan Mantri Jana Arogya Yojana) and other things, there is a good amount of data with them. We are going to have a robust system of not only cyber security hosting and network but also hospital information systems. Once we have that, we will be helping other institutions. We will have a data sharing system. The DPDP (Digital Personal Data Protection Act, 2023) Act gives provisions for that. If we have structured data, we will be in a position to analyse that and help the nation make not only protocols, but also look into the demography and anthropometric measures.Kaunain Sheriff M: Will AIIMS recruit engineers and data scientists in-house, the way Mayo Clinic has worked with DeepMind and in-house data scientists?That work has already begun. Some of our doctors are doing PhDs in AI at IITs. We are also recruiting data scientists and have MoUs with IIT Delhi, IISc Bengaluru and other technology partners. Collaboration is the best way. What prevents progress is silos. If doctors, scientists and technologists sit together, understand national needs and develop solutions jointly, that is the best model. For some areas like rare genetic disorders, molecular biology and bioinformatics, we will also build more in-house support.Sohini Ghosh: What is being done to ensure better supply of medicines for patients of rare diseases?Rare disease may be rare as a disease per se but when you look into our 1.4 billion population, numbers are so big, it doesn’t appear to be rare. Our job is to ensure early diagnosis. Our job is to create the right ecosystem for teaching, learning, research and training doctors on the kind of regimen, protocol, drugs and guidelines to follow. We are doing that.