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#DigitalHealth at an Inflection point by Mary Meeker, @kpcb reviewed by Manish Sharma @msharmas

Please note the above slides have been extracted from the Mary Meeker, Internet report 2017 purely for the purposes of this article. The statistics mentioned in this Blog have been taken from the Mary Meeker Internet Report 2017, relevant for DigitalHealth. For more details please view the complete report here  

While reviewing the Mary Meeker, Internet Report 2017 I found came across the statement “DigitalHealth at an Inflection point”. So in this article (as also the slide deck above) I have tried to review the Digital Health specific updates and provide a correlation to them by linking it up with the India Internet section that has also been highlighted in the report.

We are seeing a great many startups bringing the healthcare services by deploying Digital platforms, I think it will be an interesting exercise by the incumbents as well as new innovators, to view these two sections of the Mary Meeker report while preparing to expand their digital footprint or while trying to bring in new services to the market. Do we see a new category of Digital Health startups that can leverage the customer segmentation and growth in the customers with access to mobiles and internet penetration.

We start with the India Internet growth story, and proceed to the Digital Health story. 

The India Internet Story

There are some interesting insights related to the India Internet Story. These are:
  1. With 355 MM users, India is second to china in the number of Internet Users. A 40% Y/Y growth and 29% penetration. This presents a large customer base for the Digital Health Startups providing services online
  2. India is number 1 in terms of the number of Android apps downloaded, greater than the US. So an obvious first choice of platform on mobiles
  3. India has been recording a steady growth in the smartphone shipments, at 15% Y/Y
  4. There has been a reduction in the cost of 1GB of data from $3.15/ 1GB to about $2/ 1GB. Including Jio, the cost comes down to $0.33/ 1GB
  5. There has been a push from the Government towards “Digital” services as can be seen from the following initiatives: Jan Dhan, Digital India, Skill India, Startup India. Government’s Policies rolled out with speed and scope
  6. India identity via Aadhar + eKYC, Digital authentication of 1B+ people, 82% of the population have aadhar, has the potential to enable services with speed, scale and scope (e.g., SIM card activation from 1-3 days to 15 minutes)
  7. 46% of Internet users primarily consume local language content. 6 Languages spoken by > 50MM users (excluding english)
  8. Young India: 64 % of the population, 72% of the Internet users less than 35 years of age
  9. 27% increase in the Consumption Class (income levels at which consumers start to have the ability to spend beyond basic necessities). 
  10. India consumption is focused on basics, i.e. 54% of personal consumption expenditure

The India Healthcare Story

  1. India Healthcare has a high and rising out of pocket spend, <20% insurance penetration (a potential area for disruption?)
  2. India Healthcare reimagined: Increasingly accessible via mobile and affordable via online aggregation and price transparency. Savings on Services like Online pharmacy (20-30%), lab tests ordering (40-50%).

The Digital Health at an Inflection Point

There are some interesting insights related to the Digital Health being at an Inflection point. These are:
  1. 100 years ago: human touch; 25 years ago: machine assisted/ analog; Today: technology enabled/ digital
  2. 4 trends highlight the current Digitisation of Healthcare and the Virtuous Cycle of Innovation: Data Inputs, Data Accumulation, Data Insights, Translation. Together these trends are helping measure Outcomes and rapidly iterate to enable compression of Innovation Cycle times.
  3. The earlier analog medical technology is increasingly being replaced with Digital Technology, and is (continuously being) connected
  4. Diagnostics Technology: increase in the number of measured / monitored data attributes
  5. Increasing adoption in the use of wearables, for health and wellness. For health, heart rate and temperature
  6. Leading technology brands are well positioned to participate in the Digital Health wave, with the customers stating in a Rock Health survey they will be most willing to share healthcare data with the likes of Google, Microsoft, Samsung, Apple, Amazon, Facebook and IBM (in that order)
  7. Data Accumulation enabling the proliferation of Digitally native healthcare related datasets
  8. Proliferation of health apps, with a 5% Y/Y growth in the US and 15% Y/Y growth in rest of the world
  9. EHR adoption is leading to a broad and centralised accumulation of data with various types of patient data elements in a native digital dataset , e.g., clinical results, scanned images, vital signs, problems, medications, allergies, etc
  10. In the US there has been an increase in the number of hospitals allowing for the patients digital access to the healthcare information
  11. There has been an increasing digitisation of inputs fueling a 48% Y/Y growth in healthcare data
  12. Data Accumulation: a typical 500-bed hospital generates 50 petabytes of data (1 petabyte = 1 mm gigabytes).
  13. Rise in inputs + increase in digital healthcare data = medical research and knowledge is doubling every 3.5 years
Now that you have these data points available to you, what are the Digital Health business categories can you think of? Digitisation = Democratisation. 

How can we make use of the various natively digital datasets available to deliver better and improved healthcare services to the customers. How can the hospitals adopt Digitisation to improve service delivery. More so what is the shape of a Digitally enabled hospital? Your thoughts? 

Stay tuned to our list of Startup Categories that you can consider for your next startup.


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#DigitalHealth Startup? How to evaluate your #Startup like a VC or Angel by Manish Sharma @msharmas

#Startup, is a favourite word we hear these days from AiM to PM. At times it has connotations of a journey to fulfil, a dream to Startup is to Just go for it, and at times it brings about the memories of your struggles and wins, from that journey. But to startup is to also understand the basics of the entire process of establishing a business and running it.

You can proceed on two paths, just get started and learn by doing or you could get started and follow a process that allows you to ask yourself some questions each step of the way. I worked in a company that had a “Board” room named as Kaizen. I remember spending a great many hours in that room discussing what would be the new path our product would take and also showcasing the future releases of the product to existing and prospective customers. That was a room that also helped the team to see first hand the reactions of these very customers to our solution and not a meeting went by when the team came out of that room thinking what other “WOW” moment we can create for our customers. 

From the Kaizen room, the teams always came out wanting to do better and wanting to be the best. And I feel and see the same enthusiasm from the Digital Health Startups I have been following for quite sometime now. Guess we had built in a continuous feedback loop that allowed us to get updates from our various customers and what they were saying about us and also having the ability to constantly innovate and continuously improve. 

Well I digress, I was here to tell you about how you need to think like a VC or Angel and the reason I mention the story is to state the point, that in the rush and din of starting up, funding, customer acqusitions, round two, series a, b, c… etc, we tend to stop thinking about the basics. The Business Plan Evaluation Aids, that I list in this blog post, will help you define a schedule that will help you continuously improve, track, change and pivot your business plan to meet the needs of the customers you are serving or want to serve. 

And the best part is that the BPEAs are driven by fundamental questions that are generally asked during a due-diligence process of funding, IPO, exits or business evaluations by third party auditors. The BPEAs help you build a “Continuous Feedback Loop” to continuously evaluate yourself with metrics that will help you determine where you are, where you want to go and what you must do to reach your goal. 

Why is there a need for this process, in a startup? Arent’ startups supposed to Hack-It, Jugaad-a-thon it, Frugally Innovate, be Agile? And at the same time we also hear the statement, “9 out of 10 Startups will fail”.  Or of late, have been hearing about stats such as why do most Indian Startups close within 5 years. Lets try to turn that tide and improve the odds. Lets build to last !! (taken from a famous strategy book, i always like referring to and like the title because its not about exits, its about building something tangible and long term. Thats my personal take on starting up)

Lets try, by adding some semblance of method to the Startup madness and agility, by considering the Bell Mason Diagnostic as a Business Plan Evaluation Aid (BPEA) for your startup. The Bell Mason has been used by the Authors of the Model, to evaluate Technology Startups since the late 90’s (and has been used around the world to evaluate about a 2000+ ventures).

I came across an interesting statistic from a study, Venture capitalists reported devoting 8 to 12 minutes on average to evaluate a business plan (Sandberg 1986). Much of the evaluation is purely intuitive, despite the existence of several decision aids, which might be expected to aid both efficiency and consistency in the decision-making process.” 

So if you are able to prepare yourself to provide the VC or Angel with the best information about your startup and a story line that is compelling, you might just get funded. And perhaps that is what differentiates that one startup that makes it?

Another interesting story from the recently concluded Google IO, 2017. I remember one of the top executives from Google making the presentation and talked about how they had been “preparing” for this presentation from a long time. Well its Google, they dont need to do it, they can Just Do It too? Right? 

Same is the case, with Apple, when we have heard, read and seen the great presentations made by Steve Jobs for every single presentation for a new product launch, like the iPhone Launch

Let there be planning and evaluation at each stage of your journey, after all you might either have the time in the Elevator to Pitch or have 8 to 12 minutes, make them count.

The Bell – Mason Diagnostic (BMD) – A Startup Evaluation Model

The Bell – Mason Diagnostic [1] involves answering questions about your Startup. The authors where involved in evaluating Technology Investments. The model can be used by startups to evaluate their current stage, or can be used by corporates, planning on investing in new technologies and ventures (Intraventures).

What is the Bell – Mason Diagnostic Evaluation Model?

The BMD, consists of the following aspects that every venture, startup or intraventure can evaluate themselves on.

1 The Founding Premise

The the BMD Model’s founding premise is

“You dont need to understand the Technology to ask the basic business questions” 

2 The Four Diagnostics

The BMD model is built on the following 4 Diagnostics that each company/ project needs to do, depending on the current Stage of their startup/ venture or intraventure

  1. Space: 12 standard dimensions of any venture
  2. Time: 4 Stages of company development
  3. Quantification: Questions under each dimension to evaluate the company
  4. Visualisation: The graph showing the current status of the company based on the stage of company development

1. Space

There are 12 Standard Dimensions of Analysis of a venture. These highlight the various aspects of a startup. 

The 12 Dimensions of the Bell Mason Diagnostic are: 

12 Dimensions of the Bell – Mason Diagnostic (BMD)

  1. Technology Engineering
  2. Product
  3. Service Delivery/ Manufacturing
  4. Business Plan
  5. Marketing
  6. Sales
  7. CEO
  8. Team
  9. Board of Directors
  10. Cash
  11. Financeable
  12. Control

The twelve dimensions are organized in four groups, each containing three dimensions:

  • ProductTechnology/engineering, manufacturing and product
  • MarketBusiness plan and marketing and sales
  • PeopleCEO, top-level team, and board of directors
  • Finance/ ControlCash, financeability, and operations/control

2. Time: The 4 Stages of Growth
The 4 Stages of Growth for every Startup or Venture or Intraventure according to the Bell Mason Diagnostic are: 

  1. Concept (0 to 12 months) – Discovery
  2. Seed (3 to 12 months) – Definition
  3. Product Development (12 to 48 months) – Development
  4. Market Development (24 to 48 months) – Deployment

There is a more updated definition of the Startup Stages that can be found here >> http://www.bellmasongroup.com/approach/


You can also review the 5D Delivery Process that I have written about here:  http://blog.hcitexpert.com/p/5d-service-delivery-framework.html

3. Quantification:
The quantification process involves asking a series of questions to oneself for your own company or to the startup being evaluated. Each of these questions are based on the 4 Stages, the 12 Dimensions. Each of the questions has a simple rating 1, 2, or 3. Each of these ratings can be attributed with a weighted score to arrive at the efficacy of a company or an idea. This is the way the startups can codify their work using a best practices approach to starting up.

4. Visualisation:
Once the Founding Team has answered and presented their idea within the purview of these stages and dimensions, the results are plotted onto the radar chart. 

Each of the sections of the radar chart, corresponds to a dimension of the BMD and depending upon the outcome of the questions under each of the dimensions, helps the person evaluating the proposal to identify the steps ahead.

So how does the Bell – Mason Diagnostic Evaluation Model, work?

Identify the Stage of your startup: Based on the Stage your startup is at, The Bell Mason Diagnostic presents the various dimensions that you need to focus on. 

These dimensions are relevant for that stage of your company (venture or intraventure). Each of these dimensions comes with a series of questions that need to be reviewed and answered by the startup team (project, venture, intraventure). The focus areas for each startup stage are defined by the following radar chart.

[2]: Source: How Bell Mason Diagnostic measures the companies – https://www.finsia.com/docs/default-source/jassa-new/jassa-1996/warning-bells-or-sound-of-success-.pdf?sfvrsn=2

You can event do a quick run through each of the dimensions relevant for the current state of your startup and rate each of the dimensions with a score of 1 to 5. That will help you identify if you are able to move your startup from one stage to the next. It also helps the startup to evaluate what are the tasks they need to perform to move from one stage to the next.

For instance, at the concept stage the BMD shows that the Startup needs to evaluate the following dimensions: technology, business plan, CEO, cash and financeability. [2]

Another important aspect of the Bell Mason Diagnostic, is to help the startup identify the equity they can give out at that stage of the startup. Using this method the founders can understand the finance they would need, the type of finance they can go for and the amount of equity they should be able to give away at each of the stages 

How to, Build to Last

As startups we need to beat the odds i shared earlier, 9 out of 10 startups fail? Why startup if you accept the fact that you are going to be keeping the batting average at the above number. The average is not acceptable as a rapidly evolving startup nation. 

We need to focus on how we can build organisations that are Built to Last and while we can still remain agile in our delivery process, but at each stage of your startup, we need to evaluate the current state by answering these in-depth questions which can pile up quite fast and under the radar. 

The BMD helps the startups run an iterative and a continuously improving and evolving analysis of their company that in turn generates a list of activities, to-do lists, product backlogs, etc that will help the company to move to the next stage of their startup journey.

While I am not proposing that you keep doing the same thing again and again, you can surely use the BMD to also identify if you need to pivot, exit, re-strategize and work at other aspects of your business plan to improve what you are building/ developing.

There are many other models of Startup (or venture, intraventure) Evaluation. In this blog post I have tried to present the Bell Mason Diagnostic to help you get started on a task of evaluating the current state of your startup. Be it due-diligence, or preparing for presentation to new board members or members of the executive team, use this model to help you identify the next steps to be taken. 

Just remember building a product requires getting your fundamentals right, the BMD framework can help you do that.

While you are working on evaluating your startup using the Bell-Mason Diagnostic (BMD), you might also consider reviewing the following Business Plan Evaluation Aids (BPEAs). “A BPEA is a highly specialised subset of human decision aids used for the specific purpose of screening entrepreneurial business plans. Any decision aid is used to provide assistance and structure to improve the accuracy and consistency of human judgment.” [6]

1) the FVRI System (Fiet, Gupta, et al. [2003]) and 
2) the New Venture Template (Mitchell [1995])
3) The Venture Opportunity Screening Guide (Timmons [1994])
4) ProGrid Venture (Bowman [1997])

I have put together an excel sheet that will help you arrive at the “Go – No-Go” for each of the Startup Stages. Let me know and I can share the same with you. Drop me an email at manish.sharma [at] hcitexpert [dot] com. In the followup Blogs I will present some of the other BPEA tools listed above and share the various categories of healthcare startups.

If you are a Digital Health Startup, I would like to hear and share your story, what is the solution you are developing, more importantly why?

Here is an interesting write up by Shailesh Gogate (@sgogate), on 5 lessons learned while assisting Healthcare #startups 

Source: http://www.bellmasongroup.com/approach/

Here is an Update, got an interesting update from Mr. Raj Grover, shared by him on the Fundraising for Indian Startups on what aspects should be covered in a startup pitch 

[5]: The Bell Mason Diagnostic: http://www.bellmasongroup.com/approach/
[6]: Assessing the Efficacy and Standardization Potential of Five Competing Venture Capital Investment Evaluation Approaches  http://www.kevinhindle.com/publications/C16.2005%20JPE%20Efficacy%20of%20five%20approaches.pdf
[7]: An exhaustive list of 200+ Incubators in India: https://inc42.com/startup-101/startup-incubators-in-india/?utm_source=facebook&utm_medium=social&utm_campaign=authors


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What is #BlockChain? Implications for Healthcare by @msharmas

In my previous article I discussed about the benefits and barriers to the use of an Integrated Health Information Platform. In healthcare the need for presenting the Information to the Right Person at the Right Time has been proven to improve outcomes in patient treatment.

Will HIE 2.0 benefit from the use of Blockchain in presenting the information to the Right Person at the Right Time? 

What is Blockchain?
Various definitions of Blockchain have been put across based on the context of the use. Some of these definitions are: 

A digital ledger in which transactions made in bitcoin or another cryptocurrency are recorded chronologically and publicly.

“The blockchain is an incorruptible digital ledger of economic transactions that can be programmed to record not just financial transactions but virtually everything of value.” Don & Alex Tapscott, authors Blockchain Revolution (2016)

The Blockchain is a decentralized ledger of all transactions across a peer-to-peer network. Using this technology, participants can confirm transactions without the need for a central certifying authority. Potential applications include, fund transfers, settling trades, voting etc.

Blockchain is a distributed system for recording and storing transaction records. More specifically, blockchain is a shared, immutable record of peer-to-peer transactions built from linked transaction blocks and stored in a digital ledger. [1]

A Blockchain is a data structure that can be timed-stamped and signed using a private key to prevent tampering. There are generally three types of Blockchain: public, private and consortium. [6] 

How is Blockchain different?

Traditional databases are proprietary to the entity that maintains them and owns them. And the information stored within these databases are accessed only by providing access via an application or shared by the entity in some form of a distributed architecture. 

On the other hand, “blockchain is enabling a database to be directly shared across boundaries of trust, without requiring a central administrator. This is possible because blockchain transactions contain their own proof of validity and their own proof of authorization, instead of requiring some centralized application logic to enforce those constraints. Transactions can therefore be verified and processed independently by multiple “nodes”, with the blockchain acting as a consensus mechanism to ensure those nodes stay in sync.” [2]

A quite often stated example for explaining Blockchain is the Google Doc example. Earlier, collaborating on a document involved a serial approach to making changes to a document. Only once the author has completed the document, can it be forwarded to the next person to edit and provide feedback. 

But consider the Google Doc (or any of the other collaboration tools), once you have created a google doc, you can start creating the document and also share the same document with other collaborators who can also make changes to the document at the same time allowing for reconciliation of changes to be incorporated within the document to finalise it. The author takes the comments from the collaborators and generates the finalised document.  

Blockchain: How it Works?

A transaction is requested. The transaction is broadcasted to the peer-to-peer network consisting of computer nodes. The network validates the transaction and the initiating entity’s status using relevant algorithms.  The transaction record is then considered to be verified.

On verification, the transaction record is added with other transactions to create a new block of data for the decentralized ledger of all transactions across a peer-to-peer network.

The new Block is added to the existing ledger of all transactions, i.e., the Blockchain. The transaction is now complete. 

Types of Blockchains

Permissionless or Unpermissioned Blockchain allows anyone to join the network and participate in the block verification. For instance, a permissionless blockchain example is the Bitcoin.

Permissioned Blockchains restricts the nodes in the network who can contribute to the consensus of the system. Only permissioned nodes have the rights to validate the block transactions.

For instance, most enterprise Blockchains are permissioned blockchain and allow for privacy, scalability and fine-grained access control. [5]

There are more types of Blockchains.
Interoperability in Healthcare

The context of discussing Blockchains in healthcare is Interoperability. There are various use cases that come to mind, when we talk about interoperability in Healthcare. (most are N:N interactions) 

  1. HIMS to Lab Equipment
  2. HIMS to PACS
  3. HIMS to HIMS
  4. HIMS to Apps
  5. HIMS to Portals (Patient, Physician, etc)
  6. Portal to Portal
  7. Stakeholders to HIE
  8. Hospitals to Insurance

You can consider the number of stakeholders in the Interoperability ecosystem and continue to add them to the above list of use cases. And that allows one to understand the current fragmented nature of the Patient’s Healthcare Information. 

Each of the above stakeholders, generate the patient care record and have the need at one time or another to share this information with others in the ecosystem. We have already seen the benefits and barriers to information exchange. 

For the purpose of this blog, lets consider the Healthcare Information exchange use case. HIEs’ share the patient information in a network that is accessed by participating entities. The Patient information available on the HIE can be accessed as and when required by the patients’ treating doctor. 

The availability of a patient information, at the right place and at the right time was (one of) the intended purpose of a Health Information Exchange. HIE frameworks relied on a centralised or federated or hybrid architectures [3] to make the information available to the participants in the exchange. The exchange is maintained by an entity.

In the nationwide Interoperability roadmap defined by the ONC (US) [1]. They define the critical policy and technical components required as  

  1. Ubiquitous, secure network infrastructure
  2. Verifiable identity and authentication of all participants
  3. Consistent representation of authorization to access electronic health information, and several other requirements

Additionally, the ONC challenge stated Potential uses to include:[6]

  1. Digitally sign information
  2. Computable enforcement of policies and contracts (smart contracts)
  3. Management of Internet of Things (IoT) devices
  4. Distributed encrypted storage
  5. Distributed trust

In India, an  Integrated Health Information Platform (IHIP) is being setup by the Ministry of Health and Family Welfare (MoHFW). The primary objective of IHIP is to enable the creation of standards compliant Electronic Health Records (EHRs) of the citizens on a pan-India basis along with the integration and interoperability of the EHRs through a comprehensive Health Information Exchange (HIE) as part of this centralized accessible platform. 

IHIP is envisaged to enable
  1. Better continuity of care, 
  2. secure and confidential health data/records management, 
  3. better diagnosis of diseases, 
  4. reduction in patient re-visits and even prevention of medical errors, 
  5. optimal information exchange to support better health outcomes

With the understanding of What is Blockchain, What is Interoperability in Healthcare and What are the use cases for Interoperability in healthcare, do you think Blockchain Technology can be used in Healthcare? Do share your thoughts and use cases.

And while you share your usecases, do read up on the very interesting two part series from Dr. Senthil N, on the  Unintended Consequences of new Technologies in Healthcare, Thoughts on Blockchain 

In the next part of the blog, I will explore some of these use cases in healthcare and for the purpose of defining how Blockchain can help interoperability of Patient Transactions across healthcare facilities.


3. Health Information Exchange – Architecture Types https://corepointhealth.com/health-information-exchange-architecture-types

4. Bitcoin is the Sewer Rat of Currencies, interview of Andreas Antonopoulos by Mark Frauenfelder http://ow.ly/XDMe30bumBy

5. Blockchain – What is Permissioned vs Permissionless? by Deva Annamalai on Core Dump https://bornonjuly4.me/2017/01/10/blockchain-what-is-permissioned-vs-permissionless/

6. ONC Blockchain Challenge: https://www.healthit.gov/newsroom/blockchain-challenge

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Benefits of an Integrated Health Information Platform #IHIP by @msharmas

We have seen the benefits of Aadhar and how a public data repository can be used for public good. Population Health based clinical data repositories too can play a similar pivotal role in providing potentially great benefits

The use of Healthcare IT in the Indian context is picking up with most of the corporate hospitals going for the #EHRs and HIMS solutions. And these are present mostly in the Tier I cities and urban areas. There is a move now to get these solutions to the Tier 2 and Tier 3 centers as well. I would be looking to review reports that highlight percentage of IT enablement in Healthcare facilities, as part of follow up articles to this one.

The Center for Healthcare Informatics has rolled out an RFI detailing the requirements of an Integrated Healthcare Information Platform (IHIP). You can also visit the dedicated website to review the details of the IHIP RFI:
In this article I would like to highlight the benefits that will accrue from implementing such a solution in India. With no historic data of past implementations of such a system in India, I have reviewed the information available in journals and public domain regarding similar implementations across the world and what are the benefits and barriers in implementing an Healthcare Information Highway of patient healthcare data.

Benefits of Implementing an HIE

  1. Benefits of Implementing HIEs:
HIEs that have been implemented in the US have conclusively shown emergency departments gaining efficiency in patient visits with the use of HIE based solutions.
HIEs have shown to reduce the length of patient stay, readmission risk, and number of doctors involved in patient visits [1].
HLNY ER Dept Infographic_HIEGains.png
  1. Discharge Planning
One of the examples of benefits of an HIE, is the ability to generate alerts 24-hour to 48-hour prior to the patient’s’ discharge to Transportation services, Pharmacies at the patient’s location and alerts to help patient identify long term care and home care facilities. [2]
  1. Transfer of Radiology Images:
Currently the process of exchanging patient radiology images either does not exist or at best is time consuming with problems faced by the patients and providers treating the patients.
The ability to access and view radiology images is important for an accurate and timely patient diagnosis and treatment. Historically, the process of image exchange has happened via CDs with an understanding the receiving and reviewing physician will have the ability to view the PACS images leading to high costs and long time to diagnosis.
Enabling a Transfer to PACS capability helped in cutting these lacunae in the image sharing workflow, enabling providers to quickly share images with each other. [3]
  1. Vaccination and Immunisation details:
HIEs are now moving towards incorporating the exchange of patient immunisation details. Thereby enabling patient centered technology implementations.
  1. Disease Surveillance and Immunisation Records
IHIP will provide increased view of disease outbreaks and allow the governments at the state and national levels to deploy resources effectively and efficiently. IHIP based identification and surveillance of disasters and outbreaks is a big benefit of implementing a platform such as IHIP. And additional areas that provide a fillip to the IHIP-initiative needs to be identified and those aspects of the IHIP needs to be implemented in the initial stages.
  1. Medication Information Sharing via HIEs:
The ability for the patient to build and maintain an electronic Drug Profile is important for the continued care for the patient. Presence of a Comprehensive Patient Drug profile has direct correlation to improved patient safety. Improved medication information processing has a direct correlation to the benefits of an HIE like the IHIP since it will be able to provide a more complete clinical picture of the patient. [4]
  1. Telemedicine service enabled by HIEs:
Telemonitors will be able to provide patients a way to measure and record their vital signs daily from home using a touchscreen tablet/ mobile/ PC. The information will be then wirelessly transmitted to nurses monitoring the information for changes, giving patients with, complex disease states such as heart and respiratory conditions, a sense of empowerment around their health. Telehealth has far reaching benefits for specialists providing their services to patients in the rural, underserved and non-tier I cities. With the presence of digital payment gateways and transactions, Telemedicine is fast becoming a viable business model for certain types of visits(e.g., follow-ups, referrals). [5]
  1. New Use Cases for an HIE:
When HIEs have been implemented, new use cases can emerge that extend the usefulness of HIEs. For example, HIEs have been able to send hospitals alerts and reminders when patient transitions occur, device to device data transport, sending and receiving of claims attachments, and exchanges of documents for referrals [6]
  1. Security of Patient Information (PHI):
The greatest benefit of an IHIP-like solution is the Implementations of Security protocols for transport and transfer of patient information between healthcare facilities and between patients and hospitals. This ensures creation of “Trust” centers of patient data.
  1. Improves the Trust in sources of information
One of the reasons a physician would order for a repeat test for a patient in case of a referral, would be “Trust” on the presence of a similar/ same test result available for the patient in an earlier visit. Enabling information sharing via IHIP in a standardised and secure format will enable “Trust” between healthcare facilities as trusted sources of information. [7]
  1. Strategies to avoid Information Blocking:
Information Blocking has been known to be a major cause of hindrance to the benefits brought out by an HIE. Information Blocking is healthcare facilities not sharing patient healthcare record information causing holes in the episodes of care of a patient’s longitudinal record. To avoid this from happening, “Increasing transparency of EHR vendor business practices and product performance, stronger financial incentives for providers to share information, and making information blocking illegal were perceived as the most effective policy remedies,” wrote researchers. [8]
  1. Paradigm Shift in HIE from 1.0 to 2.0:
HIE 1.0 was characterized by a focus on “the noun,” that is trying to address perceived market failures by solving a wide variety of rich use cases through comprehensive interoperability.
By contrast, HIE 2.0 focuses on the verb that is trying to meet market needs most pressing to participating providers; HIE 2.0 has fewer legal challenges because it is trying to tackle less complex use cases and in many instances has the ability to marshal financial, technical and organizational resources. Tripathi also pointed out that HIE 2.0 comes in many shapes and sizes including point-to-patient; point-to-point; vendor-specific; transaction-specific national level; enterprise-level HIE organizations; State-level and regional collaborative HIE organizations and National level collaborative HIE organizations.
Three areas identified to spur innovation and move towards HIE2.0 were: Lab data transmission, Lightweight directed query of patient information, eCPOE and measures.

Problems Implementing HIE: A review of Global HIE Experiences

  1. Unspecified Interoperability Standards:
Barriers to HIE relate to incomplete and unspecific interoperability standards and the cost of interfacing the EHR with the HIE.  The lack of mature, agreed standards around interfaces, patient consent and patient identification are significant barriers to success.
  1. Accurate patient identification is not only a data management and data quality issue, it’s also a patient safety issue
  2. Clinical Information Generator and Vendor relations
In the India context, healthcare facilities like hospitals, laboratories, pharmacies deploy systems that are proprietary in nature and not necessarily standards based. In the event of strained relations between healthcare facilities and respective vendors, there is a need to consider addressing the need to have the patient related information to be relayed to the patient in a HIE readeable format. This information can then be uploaded by the patient thereby ensuring the continuity of care records are maintained in the IHIP, specific to the patient.
In this scenario, there could be a loss of updates to the public health based registries and the hospital based registries and it should be incumbant on the hospital to ensure the data is transmitted before the changeover of systems happens.
  1. Identifying ROI for various Stakeholders
A study needs to be enabled by the government at the national and state levels that will study the benefits of implementing interfaces that will share information between the Healthcare facilities and the IHIP. Potential savings can be quantified based on cost and projected savings in improved efficiencies enabled by the implementation IHIP towards patient safety and care coordination for the stakeholders.
Additionally, its important to quantify the cost of implementing HIE-based interfaces by the various healthcare entities (like Hospitals, Laboratories, Diagnostic centers, pharmacies, etc). It will be important to identify the Revenue Streams to sustain IHIP data sharing, and how can it be sustained by the stakeholders.
  1. Breach of Security of Data contained in IHIP or connected interfaces
We have seen various types of hacks that have breached the security of patient records stored in hospital systems. Enabling security at various levels needs to be ensured before any of the Stakeholders connect with the IHIP. Security guidelines will have to be defined and adhered to and reported on a regular basis as a regulatory requirement.
Security is also necessary at the IHIP level which has been defined as a main requirement for developing the IHIP infrastructure.
In the US Architecturally, RHIOs employ either the CHMIS approach of a centralized database, the CHIN model of federated independent databases, or some combination of the two, hybrid model.
  1. Usability & Access to Information Ok, so the data about a patient has been stored in the Data Repository for all to access and review at the time of emergencies, for enabling a continuity of care record for the patient and for generating population health management analysis. But, what if the data is not easily accessible, the functionality to access the care information of the patient, requires multiple access requests and clicks and permissions. What if, the data has now been stored in the public data repository, who can access it? Who can view it? Can there be an unauthorised data access by persons not connected to the health care of the patient? [25]
  2. Information Blocking:
For-profit EHR vendors have a natural vested interest in increasing revenue by limiting the flow of data.
“The specific forms of and perceived motivations for information blocking were harder to predict a priori,” Adler-Milstein & Pfeifer explain. “What we found in relation to specific forms is that EHR vendors appear to most often engage in information-blocking behaviors that directly maximize short-term revenue. Our respondents reported that EHR vendors deploy products with limited interoperability and charge providers high fees unrelated to the actual cost to deliver those capabilities or refuse to support information exchange with specific EHRs and HIEs.”
Hospitals and health systems likewise utilize information blocking as a means to prevent clients from seeking services elsewhere to keep from losing out to the competition.
“In our results, the most commonly reported forms of information blocking among hospitals and health systems point to their interest in strengthening their competitive position in the market by controlling patient flow, which has been reported in other studies,” they wrote.

Interoperability in Healthcare: Some thoughts to share

Having followed the implementations in India for sometime now, I always wonder why interoperability is not a top priority or not implemented in most systems. They are HL7 compliant, but are they really interoperable? And I dont mean the part from HIMS to Lab or Rad equipment, that part is fairly well defined and documented. 

– But from the Patient to Hospital to Patient
– Patient to Insurance to Patient
– Patient to app to hospital to Patient

Take for instance most systems are able to share the discharge summaries as emails to patients, and a print out, even today. But on discharge can the patient “share” her discharge summary from an app or application to another practitioner who takes care of the patient rehab? Are for instance, the systems involved in the above use case, interoperable? 

Another point, how many Healthcare Apps (the production versions) have any data sharing via standards? They can however email PDFs of the recorded data. So what can be done to enable out-of-the-box interoperability in the Healthcare Apps? With the growing number of mHealth Apps, we will soon find ourselves in another new set of “Data-Silos” being created on a daily basis.

Recently we moved from Cash to Cashless to Less Cash scenarios … so is it right to say, in healthcare context, we are working from a Paper to Paperless to Less Paper scenario in Healthcare before going totally paperless? 

And if so: 

1. What will be the business case for interoperability and for sharing the discharge summary/ medications in a format that is easily exchangeable?

2. Can a Healthcare IT think tank, work on defining the standards of “workflow” of the data being generated in healthcare today? Starting from the Patient through the healthcare ecosystem and back to the Patient?

3. Can the Healthcare IT vendors form a group of HIMS, LIMS, Pharma Apps, HomeCare solutions that enable a “Patient Data Workflow” exchange group (a mini-IHIP) that actually enables the “Interoperability” of patient data as a great showcase. It could perhaps be tied to the IHIP effort or NDHA. It adds onto the work that is being planned in the Phase 1 of the IHIP project, by being able to provide feedback on issues, solutions, recommendations, pain points etc.

Its important to note, that a system like IHIP has a potential to solve the accessibility of patient care problem in India. My view is that there is a need to see interoperability from a Patient’s point of view rather than from the point of view of “Systems”. There is a need to map the flow of data from the Patient and back to the Patient, and this can help in enabling a radically different approach to interoperability in Indian Healthcare.

With Aadhar based solutions allowing for the consumer information to be securely transmitted and verified, it only behoves well if we were to adopt an “HIE of Patient” approach to IHIP wherein the Information is exchanged between various stakeholders in the Patient’s Care Continuum and that information finally rests with the Patient’s Electronic Health Record (PEHR). With the EHR standards mandating the Healthcare Information belongs to the patient, it will be extending that mandate to IHIP.

And here is a review by Mr. Rajendra Pratap Gupta, Policy Maker, Researcher, Author, TED Speaker, Economic & Political Strategies, Innovation, Healthcare) on how “India aims to be a Global Leader in Digital Health,



  1. Cancer Care set for Digital Leap with the National Cancer Grid in India: http://health.economictimes.indiatimes.com/news/health-it/cancer-care-set-for-digital-leap/58758858
  2. NY Health Information Exchange Improves ED Quality, Efficiency
  1. HIE Partnership to improve Health Data Exchange of Imaging
  1. Health information exchange and patient safety
  1. Vermont HIE adds telehealth component
  1. DirectTrust HIE growth shows priority of Interoperability
  1. Health information exchange: persistent challenges and new strategies
  1. Health Information Exchanges report Information Blocking
  1. Maine Rural Veterans Health Access HIT Strategies
  1. The Value Of Health Care Information Exchange And Interoperability (a must read paper on how the costing for HIEs can be done)
  1. Health information exchange: persistent challenges and new strategies
  1. Information Blocking: Is It Occurring and What Policy Strategies Can Address It?:
  1. What is HIE?:
  1. Health Information Exchange?:
  1. HIE Benefits?:
  1. Guide to Evaluating Health Information Exchange Projects
  1. HIMSS Library for Information on HIEs
  1. Health Information Exchange – Overview
  1. 10 things to know about health information exchanges
  1. Selecting & Using a Health Information Exchange | AMA
  1. The Sequoia Project eHealth Exchange
  1. What is Health Information Exchange? | HIMSS
  1. IHIP, India
  1. Are Data repositories set to become data dumps? https://www.digitalhealth.net/2017/04/another-view-neil-paul-21/
  2. Powering the Patient Relationship with Blockchains: https://www.healthit.gov/sites/default/files/7-29-poweringthephysician-patientrelationshipwithblockchainhealthit.pdf
  3. Lessons from the UK | Healthcare IT News


Manish Sharma

Founder HCITExpert.com, Digital Health Entrepreneur

Connect with me via any of my Social Media Channels

#PhilipsChat on #IoT in Healthcare with @prsdsrnvs and @drvikram

87% of healthcare organizations will have adopted Internet of Things technology

Internet of Things (IoT) in Healthcare, or Internet of Medical Things (IoMT) are seeing an increasing adoption rate in Healthcare Organisations. In a recent study the following statistics were part of the report: [1]

1. 60% of healthcare organizations have already introduced IoT into their infrastructure 

2. In just two years, 87% of healthcare organizations will have adopted Internet of Things technology.

3. The most common area where IoT is being utilized is for patient monitoring and maintenance. 73% of surveyed healthcare executives said they used IoT in this area, while 42% said this was the main use for IoT

4. 64% of respondents said they use IoT for patient monitors, 56% use IoT for energy meters, and 33% use IoT for imaging devices.

5. 80% of healthcare executives said IoT has improved innovation

6. 76% said visibility across their organization has improved, while 73% said they have enjoyed cost savings following the introduction of IoT.

7. 57% of respondents believe workflow productivity will improve as a result of the adoption of IoT, resulting in considerable cost savings

8. 36% believe IoT will create new business models, while 27% said the use of IoT technology would improve collaboration with colleagues and patients.

And here is an #Infographic: IoT in Healthcare: Types of Opportunities, I think it will be apt to share the same with you at this time to review the market opportunity. 

The study however also highlighted the disadvantages to introducing IoT. Such as security risks, with healthcare organisations facing many cases of breaches in the past year. 

The report pointed out, 89% of healthcare organizations that have adopted IoT said they have suffered a security breach as a result, while 49% said malware was an issue.

Coming to the Tweetchat!! I am honored to be considered for hosting the tweetchat with Mr. Srinivas Prasad, CEO, Philips Innovation Campus, in India and Dr. Vikram, Founder and Editor of Healthcare India.

Mr. Srinivas Prasad (@prsdsrnvs), has over 3 decades of experience with various Technology companies. Prior to his current assignment, Prasad was Vice President-IT at FMR India, a leading US Multinational in Bangalore. He has also established and served as General Manager for the Software Architecture Division of Sony in India.

Earlier in his career Prasad worked for Alcatel Business Systems in France and Indian Telephone Industries in various capacities, leading teams in developing telecom products for the Indian and Global markets. Before his current role as CEO-PIC, he headed the Healthcare division at PIC as Sr. Director.

Prasad has an outstanding academic record and holds a Bachelor of Engineering degree in Electronics and Communication and a Masters in Business Administration.

Having a unique distinction of being a Hindu Hitachi Scholar, he has published papers at the Telecom IEEE conferences. Prasad has worked in Japan and France earlier in his career. He has been part of several national committees in India including the CII taskforce to drive Broadband adoption in India.

An ardent cricket enthusiast he has played for Karnataka state, South Zone and represented the Country earlier in his career. Read more about Prasad and his achievements at http://en.wikipedia.org/wiki/M._R._Srinivasaprasad.

Dr. Vikram Venkateswaran
Dr. Vikram Venkateswaran is a healthcare management thinker, speaker and author. He is also the founding editor of Healthcare India. He started his career as a dental surgeon running a chain of dental clinics in New Delhi. He has an MBA from IMT Ghaziabad and has worked with healthcare systems in India, US and Europe.

On April 10th, 2017 between 3 – 4pm IST, I would like to welcome all experts to share their thoughts and insights with Mr. Srinivas Prasad and Dr. Vikram  on how to leverage IoT in Healthcare.

Agenda for #PhilipsChat : #IoT for Healthcare

Q1: In the near term (1-3 years), What are the top 3 innovations in IoT that can benefit healthcare?

Q2: Is an IoT based system going to be a utility or a service?

Q3. Do you see any device, connected via any protocol and with any cloud as the future, if yes how will that be achieved? Standards?

Q4: In India, what are the Digital Infrastructure requirements for enabling IoT based Innovations in Healthcare? 

Q5. How can hospitals leverage IoT based solutions for service delivery and patient care? 

Q6: What are the aspects of Connected Care for the Patient Care Continuum (tell us about one solution each that can benefit consumers)

> Healthy Living
> Prevention
> Diagnosis
> Treatment
> Homecare

Q7: What are the Healthcare based Smart City components? How can Local, State and Indian Government’s make IoT solutions in healthcare economically viable?

Q8: How can private hospitals justify the RoI’s of Smart Hospital Components? 

Q9: Give us a Buzzword we are going to be hearing regarding IoT based innovations in Healthcare.

CT: (Closing Thoughts) Tell us a 5 Year view of IoT in Healthcare and what would a Patient Experience in a Smart Hospital?

Signoff: And everyone’s favourite question of the Tweetchat, What areas of IoT based innovations are you looking to partner with Startups for? Can you give us two areas?

To participate, just log onto your twitter account on mobile, web or tablet on 10th April Between 3-4pm, as mentioned earlier and tweet with the hashtag: #PhilipsChat 

Transcript of the #PhilipsChat


  1. 87pc Healthcare Organisations to Adopt Internet of Things Technology by 2019
  1. #Infographic: IoT in Healthcare, Types of Opportunities http://blog.hcitexpert.com/2016/05/infographic-iot-in-healthcare-opportunities.html
  2. The Current Status of 8 Future Technologies on Healthcare by @msharmas http://blog.hcitexpert.com/2016/09/the-current-status-of-8-future-technologies.html


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Founder HCITExpert.com, Digital Health Entrepreneur

Connect with me via any of my Social Media Channels

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Understanding the Medical Diagnosis processes, to build an AI based solution by @msharmas

Human Intelligence

is The ability to adapt one’s behavior to fit new circumstances.

In Psychology, human intelligence is not regarded as a single ability or cognitive process but rather as an “array” of separate components. Research in building AI systems has focused on the following components of intelligence: [1]

  • learning,
  • reasoning,
  • problem-solving,
  • perception, and
  • Language-understanding

These components of human intelligence are also utilized during diagnosing a patient and defining the treatment plan and protocol for the patient.

The process of Medical Diagnosis

The process of how a Doctor goes about her diagnoses of a patient, is the ability of a Doctor to adapt to varying presenting illnesses of her patients.

  • Identify the Chief complaint of a patient
  • Gather information about the history of present illness
  • List the possible diagnosis & record the differential diagnosis for a patient
  • And then perform relevant diagnostic tests to determine the most likely causes for the presenting complaints

The Doctor initiates the process of identifying the most likely cause of the patient’s presenting illness and then based on the results of the diagnostic tests, proceeds to confirm a diagnosis and then proceed towards defining a treatment plan for enabling the patient to recover from the disease.

In the above simple process defined for a medical diagnosis, the Doctor (based on her training) makes use of all the “components of intelligence” to arrive at the most likely treatment plan for a patient. The process obviously gets more involved and complex depending on the type and nature of diagnosis.

Medical Diagnosis or Medical Algorithms?

From the above “very simple example” it’s clear that the doctor uses her learning and reasoning to proceed towards the best possible treatment pathway for the patient. And this can be treated as a series of Questions that help the doctor arrive at the “confirmed diagnosis” for the patient.

The process of Medical Diagnosis can then be treated as an Algorithm that helps the doctor arrive at a conclusion based on the presented facts.

Dictionary defines an “Algorithm” as, a process or set of rules to be followed in calculations or other problem-solving operations

The doctor in the above scenario has being processing via a set of rules and calculations and problem-solving operations to arrive at the confirmed diagnosis.

The doctor goes through a perception analysis to determine what specifically is presented based on the patient’s illness and then determines based on, not only the diagnostic test results, but also based on other parameters of a patient’s active and confirmed diagnosis.

Medical Diagnosis work in clinical practice generally has four models: [4]

  • Pattern Recognition, wherein the doctor recognizes the current patient’s problem based on her past experiences with other patients, e.g., Down’s syndrome.
  • Hypothetico-deductive, wherein the doctor performs a certain battery of tests to test a hypothesis, a tentative diagnosis
  • the Algorithm Strategy: the algorithm strategy has been used in Healthcare and has been represented using Medical Logic Modules [5], Arden Syntax for Medical Logic Systems [6] and Clinical Pathways [7] and finally the
  • Complete History Strategy has been defined to be the identification of Diagnosis by possibility. Evidence based medicine is then used to come to a conclusion of the final diagnosis. [8]

The training process to arrive at a Medical Diagnosis has been used in the past to the development of expert systems or Clinical Decision Support Systems (CDSS). Early medical AI systems have tried to replicate the clinical training of a doctor into meaningful implementations of AI in healthcare.

Usecase for Artificial Intelligence in Healthcare

Understanding the process and workflow in healthcare is going to be important in implementing solutions that are “aware” and intelligent. And the systems that need to be developed for Healthcare need to be able to assist the clinicians with systems that are more close to the clinicians natural daily workflow.

Consider the current scenario of a physician meeting with a patient in a clinic setting, with the current systems in place the “Patient Visit” workflow generally involves the doctor having to divide her time between talking to the patient, examining the patient and recording the findings on an EHR (electronic health records) system. Most such visits can last from 5 minutes to an hour depending on the specialty (for instance, general medicine to mental health). Additional complexity is added to the workflow based on the patient diagnosis.

There have been many studies that have recorded the doctor’s reasons for resistance to enter the visit data into a system [9]. A time and motion study of a patient – doctor interaction can be revealing in an EHR vs a non-EHR setting. While EHRs have shown their ability to reduce potential errors (as has been well documented in the report, to err is human) the additional steps of transcribing the visit data into an EHR is generally seen by the doctors as being a disruption in their natural visit or encounter workflow.

On the other hand, take into consideration a study of the workflow of a pathology department such as biochemistry or hematology, where the technology implementation is relatively easily accomplished. The pathology departments main “Entity”(from a systems perspective) to be processed is the patient sample and the level of automation required to process the various tests that need to be performed on the sample is quite well defined by its degrees of freedom, the test ordered by the doctor. Similarly the entity in a radiology department is the image that is the outcome of a radiology exam.

In radiology department for instance, an AI-based solution can enable operations at scale for enabling reading of radiology images from rural areas, where in the images get uploaded by the medical assistant or radiographer at the remote location. The AI systems now have the ability to read and report the images with increasing accuracy, but we still have some way to go before we achieve a greater deal of accuracy.

On the other hand, the “Entity” in a patient doctor interaction in a visit, the patient, has many more touch points within the patient care continuum and the level of complexity of this interaction needs to be dealt with in a completely different approach. While the processing in a pathology or radiology department is based on the sample or an exam, which is a snapshot at particular point in time, the treatment of a patient constantly needs to be monitored and presents more data points on an ongoing basis.

An AI-based solution to help a physician therefore needs to be applying for instance, the four models of medical diagnosis to a patient visit before we can call a patient visit as an intelligent or aware encounter.

If a doctor divides her time between listening to the patient regarding her present illness, and simultaneously recording the information on a computer system, there has been a disruption in the doctor’s natural workflow of focusing on the patient, of listening to her present illness, asking questions about onset, etc. and reviewing the results of the investigations and radiology reports. The doctor is trained to handle all these data points and process the information from the perspective of the four aspects of the medical diagnosis training of the physicians.

Here is an interesting story you would like to review showcasing a doctors 35-hr shift in Delhi, India. By the way the story lends itself to creating some really interesting “Intelligent Digital Assistants” for the doctors.   It also presents to experts developing AI based solutions for Healthcare, a fantastic time and motion study of a Doctors’ shift and the touch points to where the technology can be integrated into the Doctors “workflow”
Current systems do not allow that, they tend to focus on implementing a strategy of recording by exception, by recording only the exceptions and all the other aspects being marked as normal, for instance. While such aspects have been proposed and devised by working with the physicians, still they are workarounds to do what the technology of today allows or allowed in the past. 

These are re-creations of paper based systems that have been translated to an electronic health recording system.

The Patient – Physician interaction needs to be revamped, in the current information technology systems by enabling the various components of human intelligence we have highlighted earlier:

  • learning,
  • reasoning,
  • problem-solving,
  • perception, and
  • Language-understanding

Ideal scenario for a Patient – Physician interaction would be the implementation of a solution that “records” all of the conversation during a visit and automatically creates the Visit note, by understanding the Chief complaint, presenting illness, history of the patient, procedures ordered, medications prescribed, follow-ups or referrals ordered, et al. Purely based on the conversations between the doctor and the patient.

Such a scenario requires the implementation and collaboration between various components of the Artificial Intelligent ecosystem. And that will be the true and useful implementation of AI for the Patient and Physician interaction, enabled by Artificial General Intelligence capabilities.

The change needs to be implemented by not only incorporating the changes to the core algorithms, but it also involves incorporating changes to the UI and UX design changes. AI based solutions will force a change in the way current systems have been designed.

Its important to explain the way the physician thinks while interacting with the patient. 

It’s been of late seen technology solutions to be hindering the doctor patient visit process. And hence it my endeavor to try to present the case that AI while hyped to be replacing doctors, is not yet ready for the prime time. There are areas of immense potential, radiology image processing for instance but then that’s from a process improvement perspective. And not doctor patient interaction perspective. 

For years now, technology in healthcare has been trying to take the paperless approach and has tried to “replace” paper while forgetting that there is a more important component of enabling workflow in the Patient Care Continuum. 

And it’s because of this reason, I argue that whilst it’s great for the technology hype cycle to see AI as the deliverer, we need to remind ourselves once again, that it’s not about going paperless, but ensuring the 15 min that a patient gets of the doctor’s time, are well spent with the conversation being patient focused and the technology receding to the background and generating the relevant care records.

In other areas of healthcare too it is about process improvement.

And add to that the fact that in most implementations in healthcare, clinical documentation is either cumbersome or non existent, the hype cycle of AI needs to consider these issues. From my understanding since the underlying data is fragmented, not standardized and not interoperable in majority of the instances; I took a shorter term view of the AI implementation in the systems in this article.

Current Status of Artificial Intelligence in Healthcare

There has been data explosion in Healthcare not only from the perspective of the patient care continuum, but also from the point of view of the resource management and scheduling, inventory and purchase management, insurance, financial management, etc.

While most of the current focus has been on building AI-based solutions that are in the patient care continuum, there are definitely many more areas within a healthcare organization that will benefit from the implementation of intelligent systems.

Just the other day, I attended a conference around AI and the panelists were mentioning the following uses of AI

  • ecommerce recommendations
  • learning for students based on concepts in school
  • autonomous cars
  • AI based treatments plans for cancer patients
  • intelligent assistants, chatbots
  • Teaching computers to see; etc.

And while they all highlighted areas of advancement in AI tech, they are yet to reach the ability to currently create a system that converts a doctor patient conversation to actionable events that can spawn workflows that needs to be instantiated based on the ever changing patient condition.

In the near-term, I see there will be specialized implementations of AI that will enable the brute power of technology to present the best case scenario for a particular patient condition, but an AI Physician is still a work in progress. This has been shown to be a success with the advent of cancer care solutions using IBM Watson. 

The AI systems are being implemented in various scenarios in healthcare and you could consider them to being “trained” and being presented with a great amount of data and studies. As more data is presented to these AI systems, their level of accuracy will only improve and provide benefits in-terms of scale and reach thereby reducing the time to diagnosis and time to treatment for patients having affordability and accessibility issues in healthcare.

Artificial Intelligence has already started making its way into healthcare, with 90+ AI startups getting funding to deliver solutions like;
  • helping the oncologist define the best treatment plan specific to each patient
  • a virtual nursing assistants, to follow-up with patients post discharge
  • drug discovery platforms, for new therapies
  • Medical Imaging and diagnostics
  • The use of AI in diagnosing diseases, patient education and reducing hospital costs
  • You can also find a great discussion on machine learning, wherein how machine learning could replace/ augment doctors via the health standards podcast with Fred Trotter.

Some of the other areas where AI is being implemented in Healthcare. Microsoft, Apple, IBM and other major players are all looking to AI help in curing people. And they are forming a group that creates the standard of ethics for the development of AI.

AI in healthcare also has a potential to be leveraged to be implemented in the following aspects of Healthcare Industry: 

  • Billing and Insurance Workflow, Insurance reconciliations and provider workflows can be enhanced by enabling total automation of the processes by enabling handling of the insurance claims by AI based Insurance agents. The exceptions and outliers can be escalated for manual interventions and closures.
  • Improving customer experience in healthcare by providing a 360 degree engagement, the SMAC based solutions will use the power of integrating the data streams from multiple sources to help deliver a better service to the patients.
  • Inventory and Supply chain processes can benefit from AI driven optimization by incorporating e-commerce driven innovations that allow for a democratization of product to vendor mix by searching and delivering the best cost options to the procurement department. Thereby bringing the costs down. Logistics improvements delivered in other industries need to come to healthcare to allow for the reduction in the cost of procurement of drugs, devices and durables. AI will help organizations in identifying variable costs and help them understand how to handle scenarios that will present themselves in an ongoing basis.
  • AI enabled resource management and scheduling will allow for identifying areas that need to be staffed with more resources and when additional resources need to be hired to meet with the increasing demands or provide elastic resource management based on ever changing operational demands. Booking appointments with doctors, will become a job taken up by Bots or AI assistants, enabling the nursing and administrative staff to focus more on delivering care and enhanced service experience for the patients.
  • AI-based people management systems will help hospitals in recruitment, retention and performance management of their employees. By presenting an analytics driven approach to people management, systems will be able to help employees to be trained to take up newer roles and responsibilities.

So by when will AI really take over Doctors?
It’s clear from the image above, that estimates of how much processing power is needed to emulate a human brain at various levels (from Ray Kurzweil, and Anders Sandberg and Nick Bostrom), “along with the fastest supercomputer from TOP500 mapped by year. Note the logarithmic scale and exponential trendline, which assumes the computational capacity doubles every 1.1 years” [10]. Kurzweil believes that mind uploading will be possible at neural simulation, while the Sandberg, Bostrom report is less certain about where consciousness arises

Based on the above point of view, an interesting question to ask today:
If a Doctor goes through 7+ years of training to become a specialist, how many days will it take for an AI based Physician?

The answer perhaps lies in the following statements

Chief scientist and AI guru Andrew Ng of Chinese search giant Baidu Inc. once put it, “worrying about takeover by some kind of intelligent, autonomous, evil AI is about as rational as worrying about overpopulation on Mars.” [11], [12].


What is it that makes us human? It’s not something that you can program. You can’t put it into a chip. It’s’ the strength of the human heart. The difference between us and machines.
– Terminator Salvation, 2009

[1]: AlanTuring.net What is AI?
[3]: Improving Diagnosis in Health Care | The National Academies Press https://www.nap.edu/catalog/21794/improving-diagnosis-in-health-care
[4]: The diagnostic process in general practice: has it a two-phase structure? http://fampra.oxfordjournals.org/content/18/3/243.full
[5]: Managing Medical Logic Modules.
[6]: HL7 Standards Product Brief – Arden Syntax v2.9 (Health Level Seven Arden Syntax for Medical Logic Systems, Version 2.9) http://www.hl7.org/implement/standards/product_brief.cfm?product_id=290
[7]: Clinical Pathways via Open Clinical, knowledge management for medical care http://www.openclinical.org/clinicalpathways.html
[8]: Sackett DL, Haynes RB, Guyatt GH, Tugwell P. Clinical Epidemiology. Boston: Little, Brown and Co., 1991; 3–18.
[9]: Barriers for Adopting Electronic Health Records (EHRs) by Physicians https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3766548/
[10]: Artificial General Intelligence,
[11]: AI guru Ng: Fearing a rise of killer robots is like worrying about overpopulation on Mars
[12]: The Artificially Intelligent Doctor Will Hear You Now
[13]: Why we are still light years away from full artificial intelligence | https://techcrunch.com/2016/12/14/why-we-are-still-light-years-away-from-full-artificial-intelligence/
[14]: AI In Healthcare Heatmap: From Diagnostics To Drug Discovery Startups, The Category Heats Up

[15]: Doctor’s 35-hr shift on 8 bananas, a toilet in nearby cafe
[16]: Gigerenzer’s simple rules by NS Ramnath on Founding Fuel 
[17]: A.I. VERSUS M.D: What happens when diagnosis is automated? By Siddhartha Mukherjee


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The Current Status of 8 Future Technologies on Healthcare by @msharmas

It’s mid-2016, and here is a look at the current status of 8 Future Technologies that might be having a significant impact on Healthcare

Most if not all these technologies will make an impact on Healthcare, and hence it is important to understand the various scenarios and the stories detailing how the experts from across the world are incorporating these technologies in healthcare

1 Internet of Things

By 2020, there are expected to be 50B IoT devices with a total economic impact of $3.9Trillion – $11.0Trillion across all the industries, out of which $1.6 trillion impact in the “Human” segment.

Experts have identified the various areas in Healthcare, where IoT-based solutions can be implemented in healthcare. 

  • IoT refers to any physical object embedded with technology capable of exchanging data and is pegged to create a more efficient healthcare system in terms of time, energy and cost.
  • Dr. Vikram in his article on how IoT can transform healthcare opined the benefits of remote patient monitoring in emergency cases
  • Dr. Pankaj Gupta, noted in his article for IoT-based solutions to be aggregators of healthcare data from primary, secondary and supporting care market will begin to be aggregated. It will be in the interest of Insurance, Pharma and Govt to support IoT driven Healthcare Market Aggregation
Digital Health startups are working on the following categories as showcased in The Map of Healthcare IoT

  • Clinical efficiency, 
  • clinical grade biometric sensors/ wearables, 
  • consumer home monitoring, 
  • brain sensors/ neurotechnology, 
  • fitness wearables, 
  • sleep monitoring and infant monitoring

IoT platforms need to be created to ensure the utilization of data being generated by the IoT devices deployed in healthcare. Absence of platforms to aggregate IoT device data will result in loss of meaningful and contextual insights being drawn for the patients’ conditions.
Here is an Infographic, by Team HCITExperts, IoT in Healthcare, Types of Opportunities

2 Augmented Reality

Pokemon Go happened and augmented reality has triggered the imaginations of the innovators to work on bringing the technology to Healthcare

By 2020, an IDC report states AR – VR revenue will hit $162Billion by offering major applications for healthcare and product design.

In a recently concluded Intel developer conference, Microsoft’s Windows chief Terry Myerson announced a partnership with the chip maker that will make all future Windows 10 PCs able to support mixed reality applications.

For instance, Live 3D imaging is one of the hottest topics in optics today, transforming medical imaging capabilities and delivering the immersive experience behind augmented and virtual reality.  

Tim Cook in a recent interview indicated Augmented Reality to be a bigger market than virtual reality.

3 Virtual Reality

With VR technology projections reaching $3.8Billion by 2020, there will be an increase in the use of VR technologies in Healthcare

Virtual reality has an increasing number of implementation opportunities in Healthcare for education, training and patient treatment.

While the cost of using VR in healthcare is still something that needs to be dealt with, partnerships like the one with Intel and Microsoft only bodes well for bringing the technology mainstream and be cost effective.

VR tech is currently being used to 

  • virtually zoom around the patient’s brain to pinpoint an aneurism before the operation. 
  • 3D virtual renderings of the patient’s anatomy lets physicians get a very real experience before operating on the patient
  • the Virtual Reality is being used to present the patient a virtual human agent that replicates a Doctor & Patient communication, where patients can get their questions answered in an environment free from judgement
  • train surgeons how to use new or unfamiliar devices
  • presenting medical images such CT-Scans and MRIs as 3D renderings for improved accuracy of diagnosis 
  • and as an alternative treatment for seniors

4 Blockchain 
Interoperability in Healthcare is a big topic for debate and a sore unsolved puzzle. With the US HHS and ONC seeking research on Blockchain for Healthcare, there seems to be growing interest in the technology. 

For instance, “By combining the blockchain with the peer-to-peer business model, this creates the potential for a near-autonomous self-regulated insurance business model for managing policy and claims. No single entity would control the network. Policyholders could “equally” control the network on a pro-rata basis” 
– Cyrus Maaghul in Why out of hospital Blockchains matter

Blockchain technology is being researched to be the super secure healthcare data aggregator of EHR data and IoT devices data

Blockchain technology is supposed to benefit healthcare 

  • in population health and clinical studies, 
  • interoperability, 
  • patient centricity, 
  • security,
  • supply chain management 
  • Merck has already announced its exploring the use of Blockchain technology for clinical trials. For instance, if a patient is enrolled for multiple clinical trials, a single blood test common to all the clinical trials needs to be done only once and can be shared across the clinical trial studies the patient has enrolled for.
  • In a recently concluded challenge, ONC in the US announced 15 winners for the use of Blockchain in Healthcare

5 Artificial Intelligence
Artificial Intelligence has been a topic of research all these years, but with the advent of the Data Age, Artificial Intelligence is fast moving mainstream and presents a viable business opportunity. 

“By 2025, AI systems could be involved in everything from population health management, to digital avatars capable of answering specific patient queries.” — Harpreet Singh Buttar, analyst at Frost & Sullivan.

In a recently published report, AI adoption by enterprises is imminent. 38% of respondents are already using AI, another 28% will adopt it by 2018. 

The AI ecosystem is projected to be worth $5.5Billion by 2020

Artificial Intelligence ecosystem consists of:

  • Deep Learning
  • Evidence Based
  • Machine Learning Systems
  • Prescriptive Analytics
  • Natural Language Generation
  • NLP/ Text Mining
  • Predictive Analytics
  • Recommendation Engines

Artificial Intelligence has already started making its way into healthcare, with 90+ AI startups getting funding to deliver solutions like; 

  • helping the oncologist define the best treatment plan specific to each patient
  • a virtual nursing assistants, to follow-up with patients post discharge
  • drug discovery platforms, for new therapies
  • Medical Imaging and diagnostics 
  • The use of AI in diagnosing diseases, patient education and reducing hospital costs
  • You can also find a great discussion on machine learning, wherein how machine learning could replace/ augment doctors via the health standards podcast with Fred Trotter.

Some of the other areas where AI is being implemented in Healthcare. Microsoft, Apple, IBM and other major players are all looking to AI help in curing people. And they are forming a group that creates the standard of ethics for the development of AI.

Finally have a look at the AI in healthcare: Category Heatmap


6 3D Printing 
3D Printing in Healthcare is making fast inroads in many disruptive ways. The projected market size for 3D Printing in Healthcare as suggested in the IDC report:

“Global revenues for the 3D printing market are expected to reach $US35.4 Billion by 2020, more than double the %US15.9 Billion in revenues forecast for 2016.

This represents a compound annual growth rate (CAGR) of 24.1 percent over the 2015-2020 forecast period, IDC research reports that while 3D printers and materials will represent nearly half the total worldwide revenues throughout the forecast, software and related services will also experience significant growth”

Gartner expanded the number of profiles from 16 in 2014, to 37 technology and service profiles in their latest Hype Cycle for 3D Printing 

3D Printing in Healthcare is being used in the following ways: 

  • 3D Printing and Surgery. All surgical and interventional procedures with complex pathology, extensive resection and/or extensive reconstructions could benefit from this technology: Orthopedics, Cardiovascular, Otorhinolaryngology, Abdominal, Oncology and Neurosurgery.
  • A bespoke 3D Printed model of the patient’s forearm changed the standard course of a 4 hour surgery to a 30 min less evasive soft tissue procedure
  • Affordable prosthetics
  • the FDA has touted the use of 3D Printing in personalised medicine, ans has already cleared 85 medical devices and one prescription drug manufactured by 3D Printing.

Researchers are also exploring the use of 3D Printing which could come mainstream in the future such as Printing prescription drugs at home, Synthetic skin, 3D Printing and replacing body parts.

7 Drones

Last year in a conference a researcher proposed the use of Drones for delivering healthcare in much the same way Katniss receives medicine in the Hunger Games movie or for that matter in the movie Bourne Legacy, UAVs are shown to retrieve the blood samples of Jeremy Renner.

The worldwide market for drones is $6.8 billion anticipated to reach $36.9 billion by 2022

Similarly, there is an active interest in the use of drones to be monitoring traffic, to delivering pizza and products ordered online. 

In context of Healthcare, UAVs are being field tested for transporting samples and blood supplies, medical drone manufacturer Vayu is using UAVs to deliver cutting edge medical technology in Madagascar. In Rwanda, estimated 325 pregnant women per 100,000 die each year, often from postpartum hemorrhage. Many of these deaths are preventable if they receive transfusion via drone delivery in a timely manner. 

In India, Fortis hospital plans on using drones during Heart Transplants, to cut the travel time and save lives. An estimated 500, 000 are in need for organ transplants in a year in India.

Drones & UAVs are also being tested for delivering emergency medical supplies during accidents and natural disasters.

8 Robotics

Robotics in healthcare has been used for sometime now, for instance the Da Vinci surgery system is being used for a myriad of surgeries. 

Just the other day i came across an article on robots being used for some of the tasks at the reception of the hospital.

“Cloud robotics can be viewed as a convergence of information, learned processes, and intelligent motion or activities with the help of the cloud,” the report explains. “It allows to move the locus of ‘intelligence’ from onboard to a remote service.”Frost and Sullivan report on Cloud Robotics.

The overall world market for robotics in healthcare will reach $3,058m in 2015, and expand further to 2025.

The global robotics industry will expand from $34.1 billion in 2016 to $226.2 billion by 2021, representing a compound annual growth rate (CAGR) of 46%.

I was reviewing the articles on Robotics in Healthcare and came across this very comprehensive article Robots/ Robotics in Healthcare by Dr. Bernadette Keefe, MD which provides a comprehensive look at the current and future trends.

Other areas robots are being used in healthcare in addition to the above scenarios are: 

Forrester’s Top Emerging Technologies To Watch: 2017-2021 http://bit.ly/2dmVRkZ  via @GilPress

And there you go, we look forward to you sharing your experiences and thoughts regarding these Future Technologies and share them with our community of readers. 

We appreciate you considering sharing your knowledge via The HCITExpert Blog

Suggested Reading

  1. The Future of Healthcare Is Arriving—8 Exciting Areas to Watch | Daniel Kraft, MD | Pulse | LinkedIn http://ow.ly/KrGS304kGjs
  2. Why the A.I. euphoria is doomed to fail | VentureBeat | Bots | by Evgeny Chereshnev, Kaspersky Lab http://ow.ly/CMKu304kGyU
  3. Looking Back At Today’s Healthcare In 2050The Medical Futurist http://ow.ly/4Dl6304kVZZ
  4. Incisionless robotic surgery offers cancer patients better chances of survival: StudyTech2 http://ow.ly/gpMS304l3wq 
  5. Robots/Robotics in Healthcare | Bernadette Keefe MD http://ow.ly/wRbb304lz44
  6. By 2020, 43% of IT budgets will be spent on #IoT: Jim Morrish, Machina ResearchThe Economic Times http://ow.ly/VKuT304lFi9  
  7. Forrester’s Top Emerging Technologies To Watch: 2017-2021 http://bit.ly/2dmVRkZ  via @GilPress
  8. Are killer bots about to do away with smartphone apps? – http://www.bbc.com/news/technology-37154519 
  9. Where machines could replace humans–and where they can’t (yet) | McKinsey & Company http://ow.ly/v9BY100dNn6 
  10. 2016’s hottest emerging technologies | World Economic Forum http://ow.ly/Jq2R100m4AS 
  11. The Top 10 Emerging Technologies 2016list, compiled by the Forum and published in collaboration with Scientific Americanhttp://www3.weforum.org/docs/GAC16_Top10_Emerging_Technologies_2016_report.pdf 
  12. Rwanda’s hospitals will use drones to deliver medical supplies http://money.cnn.com/2016/10/13/technology/rwanda-drone-hospital/index.html?iid=hp-toplead-intl 
  13. 4 Trends Shaping The Future Of Medical Events https://t.co/rUUUJ7oqkK #digitalhealth #hcsm https://t.co/KuPgGW4k9Z 
  14. Post-PC Tech Rules at Intel Developer Forum 2016 https://lnkd.in/fKux3Ek 
  15. House MD vs Doctor #AI- Who will turn out to be the better by @RoshiniBR http://ow.ly/elXy304mYpv


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    @IFTTT you could in Healthcare by @msharmas

    Was reading this article published in a leading newspaper sometime back,

    Naturally, I tried thinking of usecases to apply the technology in a Healthcare setting. 

    About IFTTT
    IFTTT works with a series of simple recipes using channels.  

    IFTTT stands for IF this then that

    Channels are “connected” apps, like Gmail, Google Calendar, Google Contacts, Twitter and many others supported by IFTTT. You can download IFTTT for android or iOS and start connecting channels to your account.  

    IFTTT allows you cook up your own recipes. Recipes are composed of this and that. Once you have connected the apps to your IFTTT account, you can start creating recipes. 

    “this” in the recipe stands for a Trigger Condition or criteria, much like the IF condition you would create in an excel sheet, or in code.
    “that” is the action that would be performed when the Trigger condition is met. Based on this condition being TRUE, IFTTT will execute that Trigger Action.
    Lets take an example now, assume you are attending a conference and you would like to keep a list of tweets that you liked, and you want to retweet these out later or incorporate these in a blog. Given this scenario, you could do the following steps in IFTTT

    1. Download the App on your phone and create an account
    2. In the IFTTT app enable the Twitter & Google Drive “channels” by connecting to your Twitter and Google Drive credentials
    3. Once you have connected the channels, lets head over to Create a recipe
    4. Click Create recipe and it will ask you for a Trigger Channel, select Twitter
    5. Next, select the Trigger Conditions from the list of possible options provided by IFTTT based on the channel selected
    6. For our usecase we will select “New Liked Tweet by you” as the Trigger Condition
    7. Next we want IFTTT to save the “Liked” tweet in an excel file, for that we will select the trigger Action channel as Google Drive
    8. And we will select the Trigger Action as “Add row to spreadsheet”
    9. IFTTT will keep adding all the tweets you liked to the spreadsheet that you have selected

    IFTTT you consider Healthcare Use cases 
    OK, so we now have some understanding and agreement in terms how we are able to very simply, and with no coding, able to create a logic statement and get some work done. In fact you have just “Integrated” two apps and got them to “interoperate”

    Lets now assume, IFTTT you could use in Healthcare use cases, What would you do?

    What IFTTT offers is a set of features that allows for the end-user to create some of the rules based on their day-to-day circumstances. Lets say a nurse wanted the EHR system to Alert a doctor based on a certain specific parameter, but incorporating that logic would require a “code-change” to be done by the EHR vendor. The process is long-drawn to bring in such changes. 

    Instead IFTTT the EHR system can incorporate the ability for the nurse to create her own recipe by providing Channels corresponding to various modules in the EHR system, and also provide the end users Trigger Actions  and Trigger Conditions (pre-defined by the EHR vendor).

    Lets consider some of the usecases that can be enabled for an IFTTT type functionality in Healthcare

    • appointment reminders for doctors based on urgency of care
    • reminders to the nurse to change patient medication dosage based on doctors suggestion of lab results
    • pharmacy requisitions based on quantity on hand value defined
    • checking and validating medical actions for medical errors
    • patient discharge process alerts to all departments

    IFTTT app allows for the end user to create her own “recipes” and “share” these within the community. And considering every patient’s treatment circumstances are different, clinical teams can setup trigger and action criteria that are active for a particular patient and can be continuously changed based on patient condition. Additionally, it also provides the end-user the ability to make enhancements to the system’s in-built logic by enabling customisation at the user end and instantaneously.

    Once the patient gets discharged the clinical staff can have the ability to save all the tasks related to similar disease “patients like” scenario, to be templated for future

    IFTTT you could Connect Healthcare Devices
    Thinking a bit ahead to the future, one could control certain medical devices based on trigger based activities. So imagine, the nurse comes along with the doctor for the ward rounds and she is able to adjust the IV flow based on a doctor’s recommendations

    IFTTT patients’ could

    Patients too can be allowed to use IFTTT-like functionality by allowing them to create a folder in her google drive that contains all her electronic records emailed to her or her doctor

    Patients can also setup reminders for their appointments since their hospital app enables the IFTTT-like functionality.
    Patients can be sent alert notifications on their wearables or phones, about daily Medication reminders using IoT-based devices that dispense their medications

    The power of IFTTT is in the simplicity and custom trigger and action criteria it provides it’s users

    While writing the above article I recalled the time I was working in a Healthcare IT Product development company in Bangalore and we were looking to incorporate an Alerts & rules engine into our HIMS product. While defining the requirements for the solution, we had discussions with our end users in terms of how they would like the notifications from the system to be delivered. They all reported “Alert Fatigue” to be a factor in terms of how they went about using the system. They wanted to be able to control what alerts they saw and how they would like to view these alerts. 

    An IFTTT-esque functionality incorporated within EHR systems will go long way in helping the end-users “customise” the solution based on their current requirements. They would be able to create focussed alerts based on their daily work. 

    Afterall, the workflows in the hospital undergo a constant change and an EHR should be able to allow the end-users to incorporate customised workflow and rules


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    Social Media Technographics – A way to engage your audience by @msharmas

    “Taken together, the Social Technographic groups make up the ecosystem that forms the groundswell. By examing how they are represented in any subgroup, strategists can determine which sorts of strategies make sense to reach their customers.” – Forrester

    As part of a successful social media campaign, its important to know the audience with whom we are sharing the content and creating the content for. 

    I came across this insightful categorization from Forrester, that provides a categorisation of your Social Media users, using the Social Technographics ladder on the basis of their level of activity on your Social Media Channels

    To enable an engaging social media strategy, it will be important to guide your followers across the various steps in the ladders, leading them from being Inactives to being Creators of thought leadership content.

    By examining each sub-group, social media strategists can determine which sorts of strategies make sense to reach their target customers. Companies that can understand the typography of their end customers can therefore better target their audience with topics and articles of relevance.

    Based on the Forrester Social Technographic ladder of engagement, the people participating and engaging with your content has been categorized by Forrester with the percentage for each type of person.

    Suggested Reading

    1. Forrester: Consumer Technographics https://www.forrester.com/data/consumer/dashboards
    2. Forrester: Consumer Technographics https://www.forrester.com/data/consumer/reports 
    3. How To Create A Social Media Marketing Plan In 6 Steps http://ow.ly/USsyb 
    4. The Data Digest: Twitter And Social Technographics by Reineke Reitsma | Forrester Blogs http://blogs.forrester.com/market_research/2010/01/the-data-digest-twitter-and-social-technographics.html
    5. The Data Digest: Introducing Forrester’s Empowered Customer Segmentation http://blogs.forrester.com/anjali_lai/16-07-12-the_data_digest_introducing_forresters_empowered_customer_segmentation 
    6. The Social Marketing Playbook For 2016 https://www.forrester.com/The+Social+Marketing+Playbook+For+2016/-/E-PLA124 

    How do you plan on using this categorization for your Social Media Strategy for your own brand? I look forward to hearing back from you with your thoughts and insights.

    We are using the following interactive Word Cloud to understand the conversations our readers are having around Digital Health topics


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    #Interoperability the Missing Link for #DigitalHealth Apps by @msharmas

    In India we have 204.1 million smartphone users in 2016 [ http://www.statista.com/statistics/467163/forecast-of-smartphone-users-in-india/ ], it’s only natural to find startups using the mobile as the way to acquire customers by providing mobile Health based products and services.

    While it is a great way to provide accessibility and affordability of healthcare services via mobile health solutions, it is also important to understand the need to ensure interoperability of the healthcare data being captured in these apps.

    Today we have apps for Diabetes Management, Appointments Scheduling, Continuous Monitoring, Remote monitoring, Activity monitoring linked with wearables, women and child health, cardiology, telemedicine, secure messaging apps, etc. The list in the past couple of years has really grown exponentially. And that is great, since the mobile phone has become the centerpiece device for most people.

    One aspect seems to be missing in the Go-to-Market rush,

    It reminds me of the scenario in healthcare regarding medical devices, which traditionally were never developed for the purpose of sharing data with other systems or outside the location they were placed. It just sufficed that they were connected to the patients and displayed the readings the doctor viewed during her rounds.

    And I find the same happening with the DigitalHealth Apps.

    I have been following some of the DigitalHealth Startups that have developed apps that cater to one specialty or another, and I have come across most of these mHealth apps to be trying to build in the feature-set, i.e., to be a patient’s one stop shop for healthcare related data. In doing this they are duplicating the patient health record and there is a speciality-specific personal health record in each mHealth App (just like the medical device).

    Since, each of the mHealth apps’ provides a feature for the patient to upload and store their records, soon we will have more “silos of information” than ever before. Multiply that with the number of apps a single user might have on her phone for capturing one or the other healthcare related parameter, the problem compounds.

    The problem of solving the interoperability of patient information will continue to be an area of concern.

    Its therefore very important for the startups developing mHealth apps, to start the app development process by incorporating the Interoperability Standards in healthcare. I think this should be the first step in the app development process and in fact patients and the healthcare VCs, investors should demand the app to have the ability to generate interoperable medical records out-of-the-box. The question that one should ask before downloading and using an app should be, “Will I be able to share my medical data between apps, in a Standard and interoperable form?”

    Quality & Interoperability

    Just as there is no compromise on quality, there should be no compromise on interoperability

    Take for instance the medical devices, no one insisted on interoperability, or the cost of enabling interoperability was perhaps higher than the cost of the machine, that no one went for it. It was perhaps thought, its OK, anyways the doctor goes on her rounds she will see the information

    Similarly, today if we take a ‘share-it via app way’ out to interoperability, we will not have demanded for the “right way” of doing things, we would simply have been taking the same approach as before.

    Interoperability should be a plug’n’play option and not a separate service that the vendor chooses to provide, if paid for. It should not be a “Optional”, or paid add-on.

    Last i checked there were 100,000+ “medical apps” on the various app stores. How many of these are interoperable? If earlier we had to contend with medical devices that were not plug’n’play interoperable, today we have siloed data being created by mHealth apps.

    Solutions to the Problem

    The EHRs should have the ability to “add” apps data to the patient EHR allowing for incorporating the mHealth App Data into the patient’s longitudinal record.

    The app developers should consult doctors and capture “contextual” healthcare data of the patient. The app should have the ability to share this data via the HL7 certified, interoperable document.

    Additionally, when a mobile user deletes a mHealth app from her device, any data stored for the patient should automatically be sent to the patient’s registered email as a HL7 enabled document. Providing a summary and detailed medical record information of the patient. These should be downloadable into any EHR or another app. 

    And there you go, its fairly simple and we look forward to you sharing your experiences with our community of readers. We appreciate you considering sharing your knowledge via The HCITExpert Blog
    Team @HCITExperts [Updated: 29th May 2016]

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    Benefits of an AI-Based Patient Appointments service for Hospitals by @msharmas

    One of the areas where AI can be implemented in the Hospital with high volume of transactions, is the Appointments Scheduling of Patients. On any given day, there are a finite number of slots available for a doctor, e.g. 10 min or 30 min slots, depending on whether its a first visit or a follow up visit. In most hospitals, Routine patients are scheduled in advance and some patients are scheduled based on an urgency, to the physician schedule.  [Denton et al – 8]
    A typical workflow for booking an appointment can go like this:

    1. Patient calls (or visits) the hospital, and speaks to the person at the reception, at a specific department
    2. The person looks up the available time slots, that a doctor is free and available in the clinic
    3. Consults with the Patient on the best time possible for her appointment and then schedules the appointment

    Now this three step process can either happen on a call, at the hospital reception or via a website provided by the hospital. But in real life, the appointment booking process for a patient might not be so straight forward. Here are some of the different scenarios that might occur:

    1. Doctor is not available, asks her medical assistant to cancel all her appointments. Existing appointments need to be shifted to other doctors or rescheduled based on patient priority.
    2. Patient calls at the last moment and asks for her appointments to be re-scheduled or cancelled
    3. Patient does not show up for the appointment, and asks for a new appointment
    4. During a clinic day, multiple new and urgent cases need to be seen by the physician, which delay the subsequent appointments
    5. Scheduling of renal therapy patients or cancer therapy patients also needs supervised scheduling that is closely related to the patients’ care protocols and care plans
    6. Scheduling based on urgency and emergency situations also changes the “scheduled” visits of a doctor 
    Considering these challenges in the daily working environment of a hospital, an AI-based scheduling solution can help the hospitals in providing an optimal use of resources. For instance a research from Indiana University [4] found using Artificial Intelligence in patient care can be cost effective and improve patient outcomes.

    Consider for instance the following statistics of a Government Hospital in Rajasthan, India [6]:

    • Nearly 1.27 crore patients were registered at OPD in medical centres affiliated to medical colleges and
    • 9.27 crore in state medical institutions in the year 2014-2015
    • in the year 2015 around 35,000 patients per day were registered at the OPD at medical college-affiliated centres

    The High number of patients (the 35,000 per day patients registered at the OPD at medical college-affiliated centres) and the resource scheduling scenarios, presents an apt usecase to implement an AI based Appointment Scheduling system.

    While it not only present a challenge to manage the care of all the visiting patients, it also allows for the administration to ask; How many doctors, nurses and medical assistants should be scheduled to manage the care planning & scheduling requirements of each of these patients, visiting one or many departments of the hospital.

    In addition to Patient Scheduling, AI based algorithms can be deployed in such settings [2] to help the hospital administration in optimising the time of their most important resources: Physicians, nurses and medical assistants.

    Handbook of Healthcare System Scheduling – Reference [7]

    Additional Scenarios where the AI based resource scheduling systems in Healthcare [7] can be deployed are:

    • Operating Theatre + Operating Team Scheduling
    • Renal Dialysis Centers
    • Radiology Diagnostic Facilities
    • Medication Reminders Apps
    • Acuity-based nurse assignment and patient scheduling in oncology clinics
    • Care Plans based activity & event scheduling
    • Procedure Scheduling
    • Health Checkups Packages

    Once an AI based solution has been implemented, the scheduling, rescheduling, planning, allocating and many other scenarios are handled by an AI based Scheduling Agent allowing for hospital administrators and physician scheduling managers to focus on treating the patients. 

    And Scheduling a patient appointment becomes an autonomous process:

    A. Jane emails Dr. John to schedule an appointment for a followup visit. Jane receives a confirmation email regarding the appointment with Dr. John from his assistant Amy. A reminder is set in her calendar.

    B. Jane, on the day of the appointment is unable to make it to the hospital and sends an email requesting for rescheduling her appointment to the next wednesday. Amy reviews, Dr. Johns schedule and responds to Jane with a confirmation of her re-scheduled appointment.

    In the above example Amy is an AI assistant to the Physician, nurse or medical health professional. Or in fact it could be an assistant (Siri, cortana, or amy from x.ai etc) to the Patient.

    What do you think, do share your thoughts?

    Sundar Pichai, CEO, Google says we are moving from a mobile first world to an AI first world, quite fast.


    1. How to use AI to automatically schedule your appointments with x.ai – TechRepublic http://ow.ly/lSdJ300yH9w 
    2. [1206.1678] A Distributed Optimized Patient Scheduling using Partial Information http://ow.ly/u3A0300yHu3 
    3. Artificial Intelligence in Healthcare: A Smart Decision? | Health Standards http://ow.ly/IR3N300yIep 
    4. Can computers save health care? IU research shows lower costs, better outcomes: IU News Room: Indiana University http://ow.ly/bPWs300yIs6 
    5. Association for the Advancement of Artificial Intelligence http://ow.ly/4aoc300yIxY 
    6. E-registration Facility Soon At SMS HospitaleHEALTH | EHEALTH http://ow.ly/njMx300yJgz 
    7. Handbook of Healthcare System Scheduling – http://ow.ly/cvUn300yLql 
    8. From Scheduling Meetings To Shopping Deals: 14 Early-Stage AI Assistants To Watch http://ow.ly/R9b7301lqjK
    9. Who will turn out to be the better diagnostician? #digitalhealth #ArtificialIntelligence https://t.co/TmzInbDlg5
    10. Robot Takes On Role Of Hospital Scheduling Nurse | Digital Trends http://ow.ly/QTAW100eEgR
    11. This is how the future of hospital operations resembles air traffic control – MedCity NewsMedCity News http://ow.ly/BJh1100eIdv
    12. Can Artificial Intelligence Help The Mentally Ill? https://t.co/e5NEnYOpAL #mentalhealth #AI
    13. On-line Appointment Sequencing and Scheduling – Brian Denton et al, http://ow.ly/RXXm300yLHX
    14. Artificial Intelligence Can Improve Healthcare | EMR and EHR http://ow.ly/MlBy302ur9Q


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    TRIVENI: A remote patient monitoring solution via @msharmas – Part 2

    Introduction to Part 2

    In the part 2 of this series, I will endeavour to define the Business Case and the Timelines for the Research and Development of the TRIVENI framework.

    In putting across the Business Model Canvas, the effort is to present a case study for Medical Device development in India.

    In this blog post I provide the details of the 9 building blocks of the TRIVENI: Business Canvas Model

    In the concluding part of the blog, I will provide the Project Plan and effort estimates for developing the TRIVENI platform to cover the Research & Product Development Phase.

    Suggested Reading

    1. Unlocking the potential of the Internet of Things | McKinsey on Healthcare
    2. 10 most in-demand Internet of Things Skills – CIO – Slideshow
    3. Analyzing Cost Structure for Medical Device Companies – Market Realist 
    4. Lantronix on “Why Every Healthcare Device Should be Connected to the Internet of Things” | Symmetry Electronics

    #infographic: IoT in Healthcare, Types of Opportunities

    Infographic: IoT in Healthcare: Types of Opportunities

    To develop an IoT based solution like TRIVENI, it is important to understand the market opportunity. In this infographic we leverage information from various reports that define the market opportunity that allow for the development and investment in such a solution

    We present the total economic impact of IoT in the Healthcare Industry as also the types of opportunities that can be explored by Healthcare Technology vendors


    Team HCITExperts

    Your partner in Digital Health Transformation using innovative and insightful ideas

    Suggested Reading

    1. Why Integration is Critical to Success in IoT implementations – Smarter With Gartner http://ow.ly/HBxF300BwYI
    2. is not one size fits all
    3. Internet of Things for Healthcare May be Worth $410B by 2022 http://bit.ly/1RpbwMq  
    4.  A Must-Read Overview of the Medical Device Industry – Market Realist http://ow.ly/EjF8300yD9A   
    5. Plug And Play Middleware Integration Solutions Gain In Popularity While Interoperability Stymies Healthcare http://bit.ly/1RjlX3R


    1. 7 Types of Cyber Threats
    2. Healthcare Cyber breaches by numbers – Mar 2016

    TRIVENI: A remote patient monitoring solution via @msharmas – Part 1

    TRIVENI, a remote patient monitoring solution that is a confluence of three aspects of patient information: 

    Data | Medical Devices | Connectivity


    Just the other day we heard the SpaceX rocket zoom off to the space to deliver a satellite to the geospatial orbit, Rosberg won the 2016 russian grand prix & Mars rover continuously transmitted the images and vital parameters from millions of miles away in the space

    The above three scenarios present the ability to stream data in realtime to a base station providing the ability to remotely monitor the performance of a space-craft, a formula 1 car and a remote autonomous vehicle.

    Similarly consider the following use cases in relation to a patient in a Healthcare setting:

    • patient information in a Hospital
    • patient in an ambulance or
    • patient under homecare

    presents use cases that require remote monitoring of patient information. 

    The existing technological paradigms such as IoT, data streaming analytics, connectivity & interoperability allow for a framework to allow for remote patient monitoring in each of the three Healthcare use cases


    I would like to propose TRIVENI, a remote patient monitoring solution that is a confluence of three aspects of patient information

    • DATA

    Triveni proposes to implement a plug-n-play framework that will allow for easy connectivity between healthcare information sources.

    The etymology of the word TRIVENI in Sanskrit means “where three rivers meet”. Similarly, the three aspects of Patient Information need to be integrated to meet the requirements of a remote patient monitoring solution

    Focus areas of TRIVENI

    Initially to showcase the Proof-Of-Concept for the solution, the above three focus areas will be considered to present as the use cases. Each of the three focus areas present the ability to test the confluence of three aspects of Patient Information defined above

    • Cardiology
      • MI
      • Chest pain
    • Neurology
      • Stroke
      • Head Injury
      • Epilepsy
    • Emergency Services
      • Trauma

    Need for TRIVENI

    The Tower of Babel (Pieter Bruegel the Elder, c. 1563), a metaphor for the challenges existing in medical device semantic interoperability today

    Current Landscape

    • Piecemeal integration creating information silos; leading to difficulty in sharing patient information
    • Silos unable to deliver real-time patient data reliably; leading to lack of data synchronization to ensure latest  time-aligned data
    • Vendor Dependent solutions; leading to internal battlegrounds
    • Lack of semantic interoperability between systems; leading to a tower of babel situation in medical device semantic interoperability
    • Captive investments by healthcare facilities in existing medical devices leading to a long time before the medical devices can be replaced with newer systems with easier connectivity features

    The Remote Patient Monitoring Process Flow


    Typical Remote Patient Monitoring process (adapted from Center for Technology and Aging)

    The Center for Technology and Aging indicates a 5 – Step process for Remote Patient Monitoring. The 5 steps are essential to deliver a continuous flow of patient related information to the remote base station monitoring a patient(s) in any of the use cases or the focus areas presented earlier

    The Remote Patient Monitoring Process Flow Mapped with TRIVENI Framework Components

    It becomes imperative for the solution to incorporate these founding principles of a remote monitoring process into any framework/ product of such a nature. The process steps get implemented in the TRIVENI framework, allowing for the continuous monitoring of patient information from the various connected systems.

    The processes allow for a modular approach to the Product Definition of the TRIVENI framework, with the ability for each component of the platform to evolve as dictated by its internal technology and thus enables each component to incorporate newer technology paradigms as and when they present themselves

    The TRIVENI Components are

    1. TRIVENI Connect ®
      1. A programmable Connector that allows the transmission of data from the connected medical device
      2. Supports BLE, Wireless technologies
    2. TRIVENI  Hub ®
      1. A Medical Device Data Aggregator that has the ability to receive data from the TRIVENI Connect and transmit the patient vital data streams to the TRIVENI Exchange
      2. Supports 2G, 3G, Wifi, 4G networks
    3. TRIVENI  Exchange ®
      1. TRIVENI Exchange is a secure, reliable patient vital data store that can seamlessly transmit data received from TRIVENI Hub to TRIVENI Apps
      2. SSL Security, supports interoperability, Data Delivery to TRIVENI Apps or Connected EHR Systems (via HL7)
    4. TRIVENI Apps ®
      1. TRIVENI Apps have the ability to securely receive identified patient’s Medical Data from the TRIVENI Exchange
      2. TRIVENI Apps are delivered on Android, iOS, Web-based platforms

    TRIVENI Connect

    The TRIVENI Connect is a device that acts as a converter that allows any medical device to connect to the TRIVENI system. The Connect device for instance will be connected to a Patient Monitor via the RJ45, RS232-to-USB converter.
    Once connected, the TRIVENI Connect will automatically download the relevant driver from the TRIVENI HUB, that allows for the Patient Data Stream from the Monitor to be streamed. Additional features of the TRIVENI Connect are: 

    • Has the ability to Fetch Data from the connected Device
      • No. of Manufacturers
      • No. of Devices
      • One TRIVENI Connect per Device
    • Convert Data from Device by encoding Device Data with Following information
      • Device ID, Manufacturer ID
      • Device Type
      • Patient ID
      • Ambulance ID/ Hospital ID
    • The TRIVENI Device Should be configurable with the above data. Additional capabilities of the TRIVENI Connect are:
      • Allow for Access Point Configuration
      • Via PC/ Via mobile device
      • Configure the TRIVENI Exchange IP
      • Send Data to TRIVENI Exchange
    • Software Upgrade:
      • Via PC
      • Over the Air
    • Linux Based, WiFi USB Dongle with a RS232 – USB Converter


    The TRIVENI HUB is a device that acts as a data aggregator device at the remote location. All the Patient Data streams from various connect devices are routed to the HUB.

    The HUB can be configured via a mobile app. Using the mobile app the users will be able to configure various aspects of the TRIVENI HUB like the internet connectivity, TRIVENI Connect linked to the HUB, Username and password configuration of the HUB & Connect devices, Store and forward configuration to name a few.

    The HUB device has the following features: 

    • Is a WiFi Router + Cellular Modem
    • Has the functionality to work as a patient data stream aggregator with a store and forward feature
    • Has multiple SIM slots or Multiple USB ports for Broadband Connectivity
    • In Ambulance:
      • Will Work as a WiFi Router Access Point for the TRIVENI Connect
      • Will work as a Cellular Modem for Transmitting the data to the TRIVENI Exchange
    • In Hospital:
      • Will work as a WiFi Router Access Point for the TRIVENI Connect
      • Will connect with the Hospital LAN to connect to the Internet
    • Has the ability to store and forward patient data
    • Data streams will be prioritized based on the QoS of network connection
    • Ability to send data packets over multiple networks to reduce packet loss
    • Data aggregation from multiple types of sources other than TRIVENI Connects
    • Maintains the security of the data-on-move over wire and when data-stationary when within the TRIVENI Hub by enabling security protocols (SSL) and encryption of data


    The TRIVENI EXCHANGE is a Medical Data+Media Server that can be configured as a Virtual / Physical Server. The EXCHANGE has RTP/ RTSP/ RTCP Capabilities for Live Streaming of the Patient Data Streams from each of the HUBs connected to the EXCHANGE. 
    The features of the TRIVENI Exchange are 
    • Site Configuration: Allows the Creation of an Identity for a Client (Ambulance Services/ Hospital Provider)
    • Identification/ Allocation of IP Address (Destination IP for Medical Data Streams) for the TRIVENI Exchange
    • Allows the configuration of the TRIVENI Connect’s to stream data to the Identified IP Address
    • Has the ability to update the TRIVENI Connect / TRIVENI Exchange Firmware OTA
    • Has the ability to receive Voice and Data Streams
    • Has the ability to enable Live Streaming of Data, Video and Voice to TRIVENI Apps
    • Linux Based system
    • Virtual/ Physical Server
    • 128-bit Encryption, https, 2-factor authentication enabled
    • Can be Configured for each client in a multi-tenant server configuration.
    • Has a Medical Data Controller module to identify the source and destination of the medical data streams
    • Ability to allow store and forward data on demand
    • Allows data push or pull configurations for the TRIVENI Components
    • Maintains the “device” drivers for various types of patient sources


    The TRIVENI APP is an android or iOS based app. There are two APPs that come with the TRIVENI framework. One APP is for configuring the remote configuration for the connect and the hub devices at the location for the client

    Another APP is for configuring the Exchange and for viewing the data being streamed from the various devices connected to the patients in the remote locations

    • Enables Care Anywhere
    • Web-based, Android or iOS based apps
    • Allows for a two way communication between devices
    • Free to download app on the App Store
    • Allows the user to authenticate her credentials
    • Allows two way communication between the Apps between two users
    • Ensures the reliability of the data
    • Security enabled to ensure patient data authenticity
    • TRIVENI Apps will be developed as web-based and subsequently as native apps
    • TRIVENI apps will incorporate the usability guidelines for the healthcare based apps
    • TRIVENI apps can be configured for data push or pull options
    • TRIVENI apps enabled with security and data encryption profiles
    • There are two types of TRIVENI Apps: TRIVENI HUB & TRIVENI EXCHANGE apps to configure remote and base components

    Interoperability Considerations for Medical Peripherals

    If one was to trace the progression of delivery of printer drivers, it presents an interesting case study regarding how hardware-software interoperability has progressed over the years in the IT industry. And studying these aspects help us to, hopefully in the future define the way Interoperability in the Healthcare Industry should be handled.

    Printers have been essential hardware devices that are connected to the software platform (OS) via various types of connectivity platforms, and service the productivity needs of the organisation.

    Lets consider the various Printer installation processes we have seen in the past

    1. CD with OS compatible drivers: Printers started out as peripherals that required a specific driver to be installed on the system (PC/ Laptop/ Server) that was going to be connected to the printer, via a printer cable
    2. OS with Pre-installed Printer Drivers: Then we progressed to the OS itself having a list of compatible drivers that enabled the OS to auto-detect the type of printer or peripheral that was connected to the system. This also allowed for network printers to be installed in the network and allowed for the print server to have all the relevant drivers installed just on that server. PCs in the network wanting to use the printer resource, just needed to send the document to the print server.
    3. Cloud Printers: Now a days, it is possible to connect the printer to the cloud via HP-ePrint or google printer services and access the printer from anywhere in the world.

    Device & Software Interoperability

    Taking learning from the way peripherals interoperability has been handled in the IT industry, Healthcare Interoperability should be a de-facto feature that should be present in most systems

    Interoperability needs to be made as a plug-n-play feature in the Healthcare Services and Solutions. What are the various “Peripherals” that need to be connected in the Healthcare Industry?

    •     Healthcare Information Management Systems
    •     Medical Devices
    •     Laboratory Devices
    •     Radiology Devices
    •     Medical Apps

    Additional Thoughts on Interoperability

    Now the idea for defining the progression of a hardware connectivity w.r.t. The Printer device, is to try and define how medical device connectivity & interoperability should be enabled in the future

    Currently, Interoperability is a “Service” that is offered as part of the implementation process by the system integrator or the vendor of the healthcare software. The point is, why should the customer bear the cost of “connecting” the hardware and software OR two software’s within an organisation
    In Healthcare we are working towards providing such seamless and plug-n-play connectivity between EMRs, medical devices and now a days, additionally the  mobile health applications.

    Suggested Reading

    1. Unlocking the potential of the Internet of Things | McKinsey on Healthcare – http://ow.ly/ykoy300oNJp
    2. 10 most in-demand Internet of Things Skills – CIO – Slideshow – http://www.cio.com/article/3072132/it-skills-training/10-most-in-demand-internet-of-things-skills.html#slide1
    3. 12 Quantified Self Public Health symposium 2014 report: http://quantifiedself.com/symposium/Symposium-2014/QSPublicHealth2014_Report.pdf  (PDF)
    4. Remote Patient Monitoring Lets Doctors Spot Trouble Early – WSJ http://ow.ly/3rHJ10099JP 
    5. What’s New In Indian Hospitals: A Hi-Tech ICU And How It’s Saving http://ow.ly/oPoV300zlpo 
    6. Study: Remote Patient Monitoring Saves $8K Per Patient Annually http://ow.ly/gqy3301Agwh 
    7. Lantronix on “Why Every Healthcare Device Should be Connected to the Internet of Things” | Symmetry Electronics – http://bit.ly/1XC2V0b
    8. #IoT software development requires an integrated DevOps platform – http://ow.ly/eg6p1006N
    9. Remote patient monitoring technology becoming imperative for providers http://ow.ly/xMK4100cAXH #IoT #HITsmIND
    10. Remote patient monitoring: What CIOs can do to make it happen – Health IT Pulse http://ow.ly/w7W3100cAY0 #IoT #HITsmIND
    11. Remote #Patient Monitoring: 8 Trending #Healthcare Infographics https://t.co/drZJmP0fVk
    12. Five innovative examples of #mHealth and #telehealth technologies http://ow.ly/WMFn100cAYk
    13. Big data fuels #telemedicine, remote patient monitoring http://ow.ly/rg3n100cAZ4 
    14. OpenICE – Open-Source Integrated Clinical Environment https://www.openice.info/
    15. Fundamentals of Data Exchange | Continua http://www.continuaalliance.org/node/456
    16. Global Patient Monitoring Devices Market Analysis & Trends – Industry Forecast to 2025 – http://www.researchandmarkets.com/publication/mf3oj2t/3757021

    I am looking for partnerships, sponsors to develop this solution. If interested kindly get in touch via email: manish.sharma@hcitexpert.com

    Manish Sharma

    Founder HCITExpert.com, Digital Health Entrepreneur.

    Additional Articles by the Author

    1. Health ID as Patient IDs unifier in India  by Manish Sharma  
    2. 5 Steps towards an Integrated Digital Health Experience in Indian Healthcare in 2016 
    3. Top Healthcare & Digital Health Predictions for 2016
    4. Zen Clinicals: An Activity & Workflow based solution (1 of 3)
    5. RFID in Healthcare: Usecases from Hospitals
    6. 10 Solutions for the Healthcare IT Fringes

    From More Paper to More Checkboxes, Whats Ideal in Health IT?

    Was in a tweetchat sometime ago on the Need for Time Management for Practitioners (physicians, nurses, allied health professionals) in Healthcare, by the HealthXPh communities Weekly Tweetchat, Every Saturday.

    During the conversation it was really interesting to hear from the practicing doctors regarding how they have to manage their time and work towards scheduling themselves around their HealthIT systems and their patient care activities.

    It was really interesting because, aren’t the Healthcare IT solutions supposed to ease the workload of the users? Arent the solutions supposed to be developed around providing the Time Management activities of the healthcare practitioner?

    Which again brings me back to my earlier question, arent the Healthcare IT solutions help the Healthcare Practitioner Manage their time? After all we have taken the paper records and replaced them with the feature rich and innovative healthcare IT solutions.

    But then why do we hear the doctors say that they are losing direct face time with the patients?

    Why are the nurses unable to find time to keep up with the IT and non-IT related work they are supposed to be doing daily?

    In the multiple product development lifecycles that I have been through (and the experience of the reader might be the same or vary) I have found during the requirements phase there are two types of users, the first category are the ones who have perhaps not used a system earlier but would like to implement a healthcare solution. The second category are the ones who have had prior experience working on a solution and would provide their requirements that incorporates the enhancements or the lacunae that the earlier solution had.

    I think the EHR systems are in this conundrum right now, wherein they need to fit into these two categories of users and fast. Building products is a capital intensive enterprise and the ‘project management’ practices are always focussed on gathering requirements and completing the project.

    But during this ‘Delivery’ process are the requirements of the two categories of users been analysed in a way to deliver solutions that will take into account the needs of the users and come up with a solution paradigm that helps each of these users to ‘Manage’ their time.

    Should the solution make a Healthcare Professional work their way around the solution, or should it be the other way.

    I think it is this need for the solution to now work around every Healthcare Professional to help them manage their time better that will bring about the version 3.0 of the EHR solutioning.

    In the version 3.0 of EHR solutioning multi-disciplinary teams will come together to develop the solutions that work around each users life-at-work and helps them to Manage their tasks in their workplaces.

    As indicated in the recently concluded ArabHealth a message went out indicating that “One size does not fit all”


    Extending the analogy to an EHR solution: If there is a uniqueness in treating each patient, it is obvious that the activities that a Doctor or a healthcare professional would do would be unique. At this point I do agree, that the process would perhaps stay same for the 80% of the time, but the datapoints to be presented or captured would perhaps be different from patient to patient. 

    I therefore think that the next generation of EHRs should be able to incorporate these variations as part of workflows that allows the solutions to be adoptive to the end-user requirements across specialities. 

    Some feature considerations for the next gen EHRs. 

    1. Incorporate Task and Workflow oriented frameworks. The workflow in the hospital is not stationary, it evolves as often as a patient’s condition
    2. Incorporate the Healthcare Practitioner’s daily activities in the workflow, help them manage their time a, and not they working around what the system has to offer. 
    3. OK, so we converted all the paper forms into electronic formats and now have the ability to analyse them. Its now time to bring in cognitive platforms that present to a doctor generated pages that are relevant to a patient. 80% of the forms are not filled in 80% of the patient visits. Then why should all this data be ‘presented’ to be filled for each patient?
    4. At the design time consider the time and motion analysis for each category of user, develop solutions to incorporate their activities. 
    5. EHRs should adopt a multi-form factor delivery approach. Now its clear, the desktops and PCs are here to stay. Go back to the drawing board and develop ‘for-each’ form-factor. A one size fits all or a responsive approach perhaps will not work in the case of the healthcare multi-form factor solutions approach. After all you cannot expect a 5 page form to be answered on a mobile device, just because we can make it responsive. 
    6. Make EHRs with the analytics first approach. Since the first systems, its always been the need to capture the infomation on systems so that we can analyse the data later. Today there should be the need to revise the data structures to meet the demands of analytic and cognitive computing.
    Am sure there are more that can be collated, but will keep that for the Zen Clinicals series that I have been working on to define what a next generation EHR should have as core feature set and that is different from what it is today. 


    Workflow and Interoperability approach to National eHealth Authority (NeHA) in India

    Author: Manish Sharma

    24 April 2016, Bangalore, India

    The Ministry of Health and Family Affairs in India recently published a Concept note on the National eHealth Authority and called for comments and feedback on the formation of NEHA, India. All comments and suggestions can be emailed to jitendra.arora@gov.in on or before 20th April 2016.

    NEHA is envisioned to be, to quote from the concept note, “a promotional, regulatory and standards setting organisation to guide and support India’s journey in eHealth and consequent realisation of benefits of ICT intervention in Health Sector in an orderly way”

    Workflow Optimisation

    While considering the implementation of DigitalHealth Solutions in India, its is very important to understand the “Workflow” of the patients and understand the Information requirements within the Identified workflows.

    Since Healthcare has always been considered to be the “last bastion” to be Digitised for many years, the approach to Digitize Healthcare Workflows has always taken the “Traditional” approach, i.e., Go to the hospital, Study their workflows, gather all the current paper being generated and Digitize IT. And hence we came up with the “Paperless Hospital” approach.

    But the flaw in the paperless approach, in my opinion is the approach that caused the creation of Information silos. We Digitised the Paper, and not the workflow.

    Take for instance the workflow of a Doctor in a hospital. She is inundated with information which her training is able to Streamline as a workflow, but give the doctor a system, she is faced with a daunting task of having to “feed” the system with the information, because the system is not designed to help her streamline her workflow in her specialty.

    The problem in the usecase of the doctor is that we have Digitised the feeding the information part, but not the workflow of the doctor-patient relationship and by that extention the care provider-doctor-patient relationships.

    There have been many recorded and unrecorded cases of HIT implementations wherein the Clinical workflows are the last to be IT-enabled and at times not even enabled, due to this very reason.

    World over the learnings of other National eHealth Implementations are definitely pointing towards the absence of patient and healthcare professional workflows being digitised, leading to dissatisfaction with the current Digital Health solutions.

    Suggestion 1: 

    NEHA should consider “Workflow Digitisation” in a Healthcare Facility as the driving force instead of Data Generation or Data Capture. It is important to identify and define the workflows across the healthcare organisation considering each care providers role and responsibilities. And to endeavour incorporating these workflows into the HIMS of the future.

    Major and Minor workflows need to be identified and incorporated within the ambit of the pragmatic workflow optimisation, to ensure the relationship model between the care providers and the patients are well documented.

    The Interoperability Red-herring

    Most often than not, the main premise of setting up a National Level eHealth Authority in most countries has been to provide for “Interoperability” of information between the “Silos of Information” within and outside of the hospital.

    As the report points out, Lack of Interoperability leads to “Ineffective Results”. 

    In the discussion about Interoperability, I would like to for the need of discussion define “Exchange of Information” to be subcategorised as two specific areas

      INTRA-operability:  between Digital Health systems within the Hospital. Most vendors are contracted with the hospital and hence there is more control for the hospital management in this particular aspect, from a solutioning point of view.

    INTER-operability: between Digital Health systems within the Hospital and “External” Digital Health systems that could be government bodies, patients, Digital Health Apps, etc. 

    The above sub-categorisation can help in identifying areas of information flow and help the NEHA define the standards for each of the presenting usecases.

    Consider the various Digital Health solutions within a Healthcare Organisation and you will realise the presence of “Standards” that each are specific to the type of Digital Health solution

    For instance, 

    • a Laboratory equipment exchanges information via the RS232 port or RJ45 port in a ASTM format. 
    • A Radiology imaging platform deals with DICOM standards. 
    • The Patient Monitoring system in the hospital is a fortress of information, “Designed” to “Lock-in” the information that is “Proprietary” to the vendor that has supplied the system.

    Just take the above three scenarios, and try and get a quote from a vendor to build you a system that “Integrates” all these three data streams (or information silos) into a patient’s EHR. It will be considerable. I would guesstimate 10-20% of the cost of ownership of a enterprise Digital Health solution.

    Now, lets say you have been able to take up the implementation of such an “integrated” system, it took you a good year to stabilise your system with “INTERoperable” solution. And after the year of stability, you need to start sharing all this Information with the new app that has become famous with the patients.

    Lets assume, that the new app is built on a standard that is different version (or perhaps proprietary) from the one that you have implemented during the past year. The entire process begins again to now “INTERoperate” with the new app.

    Suggestion 2: 

    I would suggest that the NeHA identify Digital Health information sources and fix the VERSION of messaging formats for each of these Digital Health Information sources for a period of 7 years so that all the sources of Digital Health Information are talking the same language without the need to constantly keep changing the standards of information exchange.

    There should be a clear roadmap for version upgrades within the NEHA framework to allow for newer usecases but avoid changing the messaging format altogether year on year.

    Streamline and standardise the INTERoperability and INTRAoperability standards for Digital Health Information sources.

    As an additional step, it is important to mandate the implementation of common Digital Health Standards in all the Medical Devices that is OPEN and can be easily extracted from existing and new Medical Device implementations. 

    Ideally, solutions, EHR products, medical devices and any other patient information generation device or software solution should adhere to a fixed set of standards, that allow for easy exchange of information.

    Finally, NEHA can provide an Infrastructure to provide Open and Secure Digital Health Exchange Services/ APIs”. This will definitely remove the cost barrier to interoperability of Digital Health information.

    I would suggest the use of “a Pragmatic approach to Interoperability” that helps NeHA identify and enable Interoperability of Digital Health information that provides the context in patient care. Physicians, Specialists and Chronic and palliative care experts should be consulted to define the usecases for patients need of Digital Health information. 

    Questions to consider for Patient Information Inter / Intra Operability : 

    • Does the Doctor really need the “Womb to Tomb” record of a patient
    • What percent of patients need a “Womb to Tomb” record? 
    • Is it really possible to have such a record available, if one version of the HIMS is different than the other?
    • What percent of Patient’s benefit from Digital Health Interoperability?

    To remove the boundaries between information silos in a Hospital workflow are the key aspects that should be identified and addressed in a pragmatic interoperability approach for an optimised workflow approach rather than a paperless or less paper approach


    Manish Sharma

    Founder HCITExpert.com, Digital Health Entrepreneur.

    Additional Articles by the Author:

    1. Health ID as Patient IDs unifier in India  by Manish Sharma  
    2. 5 Steps towards an Integrated Digital Health Experience in Indian Healthcare in 2016 
    3. Top Healthcare & Digital Health Predictions for 2016
    4. Zen Clinicals: An Activity & Workflow based solution (1 of 3)
    5. RFID in Healthcare: Usecases from Hospitals
    6. 10 Solutions for the Healthcare IT Fringes

    Suggested Reading:

    1. CHIME Calls for More Transparent, Uniform Interoperability Standards for Medical Devices
    2. The future of depends upon the secure exchange of electronic data – Deloitte Healthcare
    3. Pragmatic interoperability: Interoperability’s missing workflow layer | Health Standards – Dr. Charles Webster ( @wareflo on Twitter)

    Health ID as Patient IDs unifier in India

    Health ID as Patient IDs unifier

    06.Feb.2016, Bangalore, India

    The post discusses how a Health ID can be linked to Aadhar Number

    Unique Identifiers, Health ID & Aadhar Number

    A unique identifier from a database technology standpoint, is the ability to create a primary key and link all the data in the database using a primary key (parent record) & foreign key (child records) concept.
    Keeping this concept in mind using Aadhar Number as a Health ID offers a very compelling opportunity to uniquely identify a patient across multiple episodes and visits, in a single facility or across multiple facilities (that may be located in same geographical location or multiple geographic locations)
    In most Health Information systems, the records of a patient are tied to a Unique Patient Identifier, a Patient ID or a UHID.
    Let’s consider what are the various use cases of the Aadhar Number and a Patient ID.

    Aadhar Number

    The Aadhar Number has been planned to be used by the government for various welfare and direct benefit transfer schemes. There have been many instances that the Information that has been recorded in the Aadhar ID may or may not have the latest information of the person carrying the Aadhar Card. The purpose for which the Aadhar Card has been created is to identify a person for various government schemes and also has been deemed to be used to be provided at the time of opening of a bank account. Hence there are quite many financial transactions that might be linked to the Aadhar Card.

    Patient ID or UHID Number

    The Patient ID in various Healthcare information systems, is generally used to uniquely identify a patient so as to deliver various services for the patient at the right place and the right time and to the right person. And also link all the healthcare information about the patient to this unique identifier.
    Keeping in mind the need to uniquely identify a patient and to avoid duplicates becomes a very important factor in the Hospital Information Systems.
    In a specific system ( and these obviously vary from one HIMS to the other) the Patient ID is utilised to keep track of various types of patient related information or healthcare events. In addition to the Patient ID, there is the Episode ID and the Visit ID information that is used to store specific visit related and diagnosis based information in the Health Information System. In these systems, the Episode ID and the Visit ID are used as the child records of the Patient ID.
    Most Health IT systems employ an algorithm to identify patient duplicates based on various data points creating a complex key.

    Using Aadhar as a Health ID

    In various countries around the world, the use of a single identifier as a universal identifier has never been successful due to the complexity & security concerns of the various use cases.
    Take for example the case of the SSN (Social Security Number) in the US. The SSN is recorded for the patients in the Healthcare Information Systems but is never utilised to uniquely identify a patient due to the issues of Security and Identity theft. There are a lot of instances in which the SSN has been stolen and leads to the person suffering from stolen identity.
    Healthcare Information systems have been hacking targets and currently the losses estimated in every hacking incident runs into millions of dollars.
    Now take the example of Aadhar ID as a Health ID. We might land up having similar issues of the healthcare information system at a hospital/ clinic being hacked into and the Aadhar information being misused by the hackers.
    Obviously, the security levels of an IT infrastructure at a hospital or clinic will not be as superior as the competent authorities security and IT infrastructure.
    The government agency will be able to ensure the security of the Aadhar number, by providing robust and secure systems, but the same may or may not be expected of the Hospital Information System vendor or the hospital or a clinic that has implemented the solution or for that matter a Health Information Exchange authority. 
    1. Use Aadhar to validate the Identity of the Patient, Only

    The Aadhar number must be used only and only to validate and authenticate the Identity of the person who has come to the hospital. Aadhar Authority could provide a service that could be called to authenticate a person.
    1. Use Health ID to be the Primary Key, Patient IDs to be the Secondary Key

    In the absence of standards as to how the Patient information is to be stored within a Healthcare Information Management System or EHRs, it is more advisable to maintain the Health ID as a Primary Key, the ownership remains with the Health Authority. However, each visit that a patient makes into any healthcare facility, the HIMS/EHR/EMR vendor generates a care summary record (using Patient ID) as a “Secondary Key” information for the patient.
    This is akin to how each bank might have different banking information systems, but the PAN number is a unifying information to understand how many bank accounts a tax payer might have (since PAN number is mandatory for every transaction done).
    In this bank scenario, the PAN is the Primary Key, and every transaction done against the PAN card is the secondary key.
    The authentication of the PAN is done by the competent authority who develops robust systems to safeguard the PAN card information of the PAN Card holder.
    1. Patient ID/ Health ID should be maintained by the Health Authority (e.g., the National Health Portal)

    We propose the Health ID should be maintained by the Health Ministry in the government and the various aspects of Health Information should be defined by this authority. Since the Health Information of the patient needs to interoperate between the Hospitals/ clinics (which comes under the Health Ministry) and the Insurance Companies (which is another government department), maintaining a separate Health ID with its own security and interoperability guidelines is an appropriate approach.
    The interoperability between the various government departments is more easier than any other third party vendor implementing such a interoperability system. The government therefore becomes an enabler of interoperability between various consumers of the healthcare information (in this case, the insurance companies and the Hospitals)
    For instance, the Health ID could have a one-to-one relationship with the Aadhar Number. But the contents of the Health ID related information can be dictated by the Health Ministry or the National Health Portal Authority.

    In Conclusion

    1. Health ID should be used to maintain a persons’ Health Record across the care continuum.
    2. Health ID can derive the Demographic information from the Aadhar ID and use the Aadhar ID for Identity matching, duplicate check and person authentication services.
    3. There should be a one-to-one relationship between Health ID and Aadhar ID.
    4. Each time a patient makes a visit to a healthcare facility, the Health ID information regarding the patient will be updated. Mechanism to be worked out if the current and latest information gathered from the patient regarding the demograhics should be updated back to the Aadhar Information.
    5. For Healthcare Related information, Healthcare Information Exchange purposes, Health Insurance purposes; the Health ID should be the unique and Primary Key.
    6. The Patient ID or UHID captured in each of the system should be treated as the Secondary key or the child records that will help put together the patient visit related information.
    7. We can now move to a National Level Health Information Exchange to store health data for the Patient’s clinical events across healthcare facilities, against a Health ID


    1. Limiting the Use of the Social Security Number in Healthcare – http://library.ahima.org/doc?oid=104465#.Vz_5EJN95E4
    2. Patient Identification and Matching – Final Report – http://ow.ly/2ZAE300qT1Z
    3. National Patient ID System: Debate Stoked – InformationWeek – http://www.informationweek.com/administration-systems/national-patient-id-system-debate-stoked/d/d-id/1109314?
    4. HIMSS Asks Congress for Patient Identity System–Again – InformationWeek – http://www.informationweek.com/healthcare/patient-tools/himss-asks-congress-for-patient-identity-system–again/d/d-id/1106498?
    5. National Patient Identifiers | Practice Fusion  – http://ow.ly/XwfTj
    6. Identity Crisis: An Examination of the Costs and Benefits of a Unique Patient Identifier for the U.S. Health Care System | RAND – http://ow.ly/Xwg2I 
    7. Creating Unique Health ID Numbers Would Facilitate Improved Health Care Quality and Efficiency | RAND – http://ow.ly/Xwg6v 
    8. Patient Identification in Three Acts – http://ow.ly/Xwgab
    9. National patient identifier struggles for life | CIO – http://ow.ly/Xwgd5 
    10. White Paper on Unique Health Identifier for Individuals http://ow.ly/XwgfI
    11. The Imperative of a National Health Identifier | HL7 Standards – http://ow.ly/Y0KHz
    12. Are we ready for national patient IDs? | HIMSS Future Care – http://ow.ly/Y0KSn

      Suggested Reading

      1. Unique Identification Authority of India – https://uidai.gov.in/faq.html
      2. Aadhar: A number to facilitate the lives of the next billion | Dr. Pramod Varma | TEDxBangalore – YouTube http://ow.ly/pX4K300AsO8
      3. Linking Aadhar to better Healthcare – http://www.thehindu.com/news/cities/mumbai/news/linking-aadhaar-to-better-healthcare/article8288043.ece
      4. Authenticating Indian eHealth System through Aadhar: A unique identification – http://www.ijser.org/paper/Authenticating-Indian-E-Health-System-Through-Aadhaar-A-Unique-Identification.html
      5. A secured model for Indian eHealth System – http://www.softcomputing.net/ias27.pdf
      6. The Aadhar for mass health insurance – http://www.thehindubusinessline.com/opinion/the-aadhaar-of-mass-health-insurance/article4644193.ece



      Manish Sharma

      Founder HCITExperts.com, Digital Health Entrepreneur.

        5 Steps towards an Integrated Digital Health Experience in Indian Healthcare in 2016

        In 2016, we expect Interoperability, Move to the Cloud, Connectivity Data and Analytics Trifecta, Personalised Digital Health Services will dominate the Digital Health Landscape in India


        Fard Johnmar, describes 2016, as the “Age of Implementation”. Bringing the inflection point of providing services to customers of healthcare; by moving from treating the ‘patient’, to providing  services to the ‘customer’ across the continuum of care. In my opinion the Indian Healthcare Providers should be focussing on these areas in 2016

        Efficiency in Workflow, Speed in Communication will be the key implementation factor


        Indian healthcare providers have implemented solutions that have the ability to capture the patient demographic, test results, clinical summaries and financial data. This data resides in the Hospital Information systems as silos and there is a need to implement interoperability solutions that allow for the exchange of the patient data between the healthcare information systems and Digital Health solutions like a patient CRM, mHealth solutions, medication reminders apps, appointment scheduling solutions, telehealth etc.

        Absence of interoperability between existing solutions in the hospital and other connected solutions required to enable an Integrated Digital Health experience for the patient, causes duplication of work, information silos and data information errors. Interoperability should become a de-facto feature provided by the vendors with APIs and interface capabilities using Standardised formats, i.e., HL7, CDA.

        Since the billing and insurance information is being captured by most of the providers, we believe there can be paperless electronic claims processing capabilities that can really drive the adoption for interoperability in Healthcare in India.

        Move to the Cloud

        More enterprises and specialty clinics will put into place strategic partnerships towards enabling a cloud infrastructure. The needs of each of the Healthcare providers is different and varies from specialty to specialty.

        With the need to orchestrate between multiple systems the Healthcare Providers will have to work on putting in place long term strategic partnerships with Solution Developers and system integrators.

        Such partnerships will allow for a continuous evolution of their Digital Health solutions that will enable the Healthcare Providers to Innovate in the “Agile” way, while delivering a personalised experience and always operating in the real time for service delivery requirements

        Connectivity, Data and Analytics Trifecta

        Digital Health solutions will be implemented providing connectivity to the customers with the range of services offered by the Healthcare Providers.

        With the availability of the Data, the Healthcare Providers will be able to personalise the offerings for each customer, since the requirements for a customer in need of a Health checkup is completely different from a patient in need of chemotherapy.

        With the availability of the data, the Healthcare Providers will be able to continuously improve the offerings to each segment of the customer by utilising actionable intelligence.

        Personalised Digital Health Services

        The patient of today wants faster access to services, personalised experiences, 24/7 access and connectivity and access to these services from a host of devices. To meet these expectations Hospital providers in India will start to engage the patient via multiple channels by implementing  Patient Engagement Services with a focus on a Multi-channel approach required to deliver alerts, messages, video visits, email.

        More and more hospitals have started having their presence on the Internet and Social Media. In 2016, the hospitals will leverage this presence and offer a real Integrated & personalised Digital Health experience to their customers.

        Integrated Digital Health platforms can provide specialised, focussed and personalised solutions for curative care and preventive care.

        Healthcare Apps

        Indian Healthcare providers will offer their services via Healthcare Apps to provide an integrated Digital Health experience to their customers. These apps will be used to provide medication reminders, personalised healthcare advice, appointment scheduling for doctors and services, telehealth for followup care. The Healthcare Providers will work towards implementing mHealth 3.0 services, the next level of mHealth capabilities.

        From Indian Experts

        Some of the experts too chimed in on their strategic opinions for Digital Health in 2016:

        Dr. Ruchi Dass @drruchibhatt, MD Healthcursor Consulting Group, stated her priority areas as, “Get “Healthcare delivery” – a fundamental reset. Brings a dash of frugality to medical innovations.”

        Dr. Supten Sarbadhikari,  ‏@supten  Project Director at the Center for Health Informatics of the National Health Portal, stated his priority areas as, ‘National eHealth Strategy / Policy for India; Health Informatics as a formal discipline; Capacity building’

        Dr. Vikram Venkateswaran ‏@drvikram   Healthcare Influencer & Marketing Leader, stated his priority areas as, ‘reduce #infantmortality introduce  #universalcare increase #preventivecare.’

        Dr. Sunita Maheswari, Chief Dreamer, RxDx and Teleradiology Solutions, in a recent article in Deccan Herald, opined the growth of the Home Health Services such as medicines, pathology, nurse & physiotherapy visits. She also has indicated the need for more funding in other aspects of Digital Health services.

        Dr. Pankaj Gupta, @pankajguptadr, Founder Taurus Glocal Consulting, stated his top three areas to focus in 2016 as SMAC, IoT and CRM

        Dr. Aniruddha Malpani, MD Malpani Infertility Clinic , stated his top three priorities as, prescribing information therapy for patients, productivity solutions for doctors and Indian Language content

        Srikrishna Seshadri, Healthcare IT Consultant, stated his top three areas to focus as telemedicine, IoT and Digital Health Platforms

        Dr. Suresh Munuswamy, Assistant Professor, Program Coordinator, Indian Institute of Public Health- Hyderabad is an academic arm of Public Health Foundation of India

        1. Standards and Structure- For digital health care to even start, India needs standardized treatment schedules, standardized documentation (as EHR), standardized job roles, standardized continuous education and standardized social networking procedures for health care. Lack of standards and structure will lead to poorly inter operable and overlapping systems and procedures.
        2. Digital Health needs reliable supporting infrastructure ecosystem.
        3. Digital Health should focus on developing innovative, smarter, smaller and usable devices that can deliver quality health care…with lesser emphasis on (big or small) data analytics.
        I would like to thank all the experts for sharing their opinions.

        To provide an Integrated Digital Health experience the Hospital Providers need to enable agility in innovation, create the infrastructure to ease the interoperability of patient information, establish connectivity with the patient and continuously engage with the customer in the care continuum.

        Please share your views with me on LinkedIn or Twitter @msharmas or via email: manish.sharma@hcitexpert.com

        The article was also featured on the February 2016 issue (pg.40-41) of Healthcare Radius


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        Manish Sharma

        Founder HCITExpert.com, Digital Health Entrepreneur

        Connect with me via any of my Social Media Channels

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        Wishing you a Happy and Prosperous New Year 2016


        To dream the impossible dream
        To fight the unbeatable foe
        To bear with unbearable sorrow
        To run where the brave dare not go

        To right the unrightable wrong
        To love pure and chaste from afar
        To try when your arms are too weary
        To reach the unreachable star

        This is my quest
        To follow that star
        No matter how hopeless
        No matter how far

        To fight for the right
        Without question or pause
        To be willing to march into Hell
        For a heavenly cause

        (From Man from La Mancha)
        So here’s to a New Year that yearly inflection point, 
        in the timeline called life, 
        that allows us to redouble our efforts in our respective quests.

        Wishing You a very Happy and Joyous New Year 2016

        Best Wishes & Regards

        Team HCITExperts 

        Top Healthcare & Digital Health Predictions for 2016


        Its end of the year, and time to predict and prepare a wishlist for the new year. Even though its the time for ring out the old and ring in the new, according to HCITExperts, there are quite a few things we need to review and go back and take a new and fresh look at existing healthcare technology before we can go ahead and take up new challenges.

        However, we start here with the predictions made by some of the most popular resources for Healthcare and Healthcare Technologies in 2016.
        The organizations Include: 
        1. Forbes
        2. CIO
        3. Fortune
        4. IDC
        5. Forrester
        6. PwC
        7. Perficient Healthcare (for analytics focus)
        8. Palo Alto Networks (for cyber security focus) 
        9. Dr. Bill Crounse 
        10. DirectTrust’s list via HealthITNews.com (for interoperability focus) 
        The forbes Top 10 predictions for 2016 in partnership with Frost and Sullivan and thought leaders were: 
        • wearables, 
        • retail care goes mainstream, 
        • NDB (new developmental bank) invests heavily in healthcare and wellness services for underserved populations, 
        • rapid expansion of private insurance in india, 
        • population health opportunity drives healthcare M&A, 
        • less expensive and point of care testing enables new diagnostic care models, 
        • free preventive care services available to over 90%  in US, 
        • healthcare IoT solutions spur venture capital investments for startups, 
        • Hospitals investing heavily in overhauling and retooling outdated facilities to avoid closure trends, 
        • The global regenerative medicine market to reach $30 billion in 2016. 
        You can read the complete report here
        The CIOs list of top 5 healthcare technology trends for 2016 were: 
        • Interoperability will continue to be the top priority, 
        • Healthcare consumerism will gain ground, supported by digital technologies
        • Big Data will struggle to prove its value, 
        • More healthcare startups will run afoul of regulators and several healthcare apps will shut down
        • Healthcare technology will be increasingly be run by non-CIO executives
        You can read the complete report here
        The Top 10 predictions by Fortune were
        • FTC will stop major hospital mergers
        • Wearables become ther-ables
        • End of life care grabs headlines, and hospice usage doubles among ACOs and capitated doctors
        • A major hospital system will divest itself from its employed doctors
        • The insurance innovation craze of 2015 will be a bust in 2016
        • Precision medicine cools
        • Pop Health goes Pop
        • In-person on-demand flops
        • PCSK9 cholesterol drugs make Solvaldi look cheap
        • Employers start to treat healthcare costs as seriously as travel expenses       
        You can read the Fortune report here
        published a report with the trends for 2016

        • Demand for advanced analytics and new data sources;
        • Movement in the direction of personalized medicine;
        • Security and the effect of breaches in health care;
        • The availability of third platform technology — which includes mobile, social, big data and cloud computing — and innovation accelerators to enable digital transformation; and
        • Ubiquitous access to mobile technology (Burghard et al., IDC report, November 2015)
        • Cyberattacks will compromise information on one-third of individuals;
        • Third platform acute health information systems and electronic health records will start to come to market, with early adopters beginning transformation efforts in 2017-2019.

        You can access the report summary here and detailed report here.

        The forrester report highlights that, 2016 will introduce healthcare organizations to the following issues:

        • empowered patient, triggering changes across technology and business models 
        • interoperability
        • security
        • infrastructure updates related to mergers and acquisitions (M&As)
        • improved business technology (BT) agenda. 

        This brief gives CIOs an overview of the major issues that healthcare CIOs will face in 2016 in the realms of data, patient expectations, and where and when patients get care.

        You can access the report here

        came out with the trends to watch for in 2016, these are: 

        • Consolidation
        • Drug pricing
        • Care in the palm of your hand
        • Cybersecurity
        • Consumerism
        • Behavioral healthcare
        • Care moves to the community
        • Databases improve health
        • Biosimilars
        • Total cost of care

        You can access the HRIs complete report of issues here
        There is also another summary on the HRIs report by the electronic health reporter here

        Perficient Healthcare: 
        predictions for Analytics for 2016 are:

        • Align Clinical, Quality and Financial Analytics to Enable Value-Based Care
        • Integrate Clinical and Claims Data to Enable Population Health Management Insight
        • Leverage Cross-Continuum Data Analysis for Improved Patient Care and Outcomes
        • Grow Enterprise Intelligence to Measure and Improve Patient and Organizational Health
        • Utilize Reusable Accelerators to Quickly Achieve Actionable, Data-Driven Insights
        • Use Predictive Analytics to Reduce Readmissions and Improve Outcomes
        • Leverage New Tools and Skills to Transform Large Volumes of Data into Meaningful Information
        • Increase Level of Understanding and Control Over ACO Data and Analytics
        • Develop and Implement a Strong Governance Strategy and Organization
        • Position Big Data Technologies to Enable the Everyday 

        You can access the complete report here 

        Palo Alto Networks: 
        predictions highlighted the top concerns to be cybersecurity related. 
        • The number of breached healthcare records caused by sophisticated cybersecurity attacks will continue to increase 
        • The IoT revolution will take off in the healthcare industry 
        • Healthcare organizations will begin to move critical applications and infrastructure to the cloud 
        • Attackers will look to mobile devices as the next best vector into healthcare networks 

        You can read the complete report here

         Dr. Bill Crounse: 
        presents his Top three priorities for the new year for healthcare organisations, these are: 

        • Put as much emphasis on improving and modernizing communication and collaboration in clinical workflow as you have on the electronic health record
        • Include digital natives and patients/consumers in your planning departments and board room discussions
        • Embrace the cloud

        You can read Dr. Bill Crounse’ blog post here

        DirectTrust via HealthcareITNews.com: 
        Presented a focus on the interoperability issues due to the move towards a more patient centered focus. Their list of guidance were:

        • Patients and consumers will participate in electronic health data exchange. 
        • ‘Freed’ data will provide unimagined personal and professional enrichments
        • Federal and state agencies will move toward increased interoperability
        • Meaningful use will face forced, early retirement
        • Security, privacy and identity will reign
        • Direct exchange reliance will continue to increase     

        You can read the report at HealthcareITNews.com

        Additional Reports: 

        1. 22 Big Data & Data Science experts predictions for 2016

        2. 10 Technology Predictions by Gartner a Storify by HCITExpert

        3. Gartner’s Top 10 Predictions Combine People And Machines – Forbes

        4. Why 2016 Will Be The Year Of Mass Wearables Adoption

        5. Healthcare Data Breaches Top Concern in 2016, Says Experian

        6. IoT, Big Data to Spur Health Data Interoperability in 2016 via  

        7. HIE and interoperability trends to watch in 2016 via  

        8. HIE and interoperability trends to watch in 2016 via @HIEWatch

        9. From AI and data science to cryptography: Microsoft researchers offer 16 predictions for ’16

        10. CIOs target population health, patient engagement in 2016, see investments pay off via Healthcare IT News

         Keep coming back here to reference these predictions as we will keep updating the list with more information from the various research organisations and thought leaders.

        Here’s to a very Happy Christmas and a wonderful and a prosperous New Year 2016 for you, your family and your teams!!

        Zen Clinicals: An Activity & Workflow based solution (1 of 4)

        Part 1 of 4:

        Recently, during the Gartner Symposium, it was predicted that cognitve platforms would take over a lot of activities. Keeping this future at the back of our minds, its important for the EHRs of today to metamorphosize to the Cognitive Computing platforms of tomorrow, and fast.

        With social media, predictive and bigdata analytics become more central to the discussions; the current EHR systems are woefully lagging behind in the ability to catchup with the technology of today. Newer EHRs or healthcare based platforms too are lagging behind in the adoption of these technologies. Most often have observed the similar functionality being rolled out on newer technology.

        In most cases I have found the solutions to be non-workflow, i.e., non-BPM, enabled solutions that have the inability to adapt to a new healthcare scenario faced by the solution in the next implementation. With the advent of the Software as a service platforms and the proliferation of the cloud based services in other industries, healthcare solutions have generally gone for the traditional (non-BPM based) approach to delivering a solution. 

        So, One needs to then ask, “What should the future of a patient health record (PHR) or the electronic health record look like?” 

        Will we really see the advent of SMART solutions in healthcare, or are the changes to difficult too incorporate into the solution because that’s how the solutions had been developed?

        In this series I present some thoughts on what should the solutions of today morph into to meet the needs of the users and hopefully make it more user-friendly in the process.

        And to develop the solution, Zen Clinicals (this is a fictitious name of a solution any resemblance is purely a coincidence), we need to answer a few questions upfront:

        • who do you build it for? 
        • Who are the actors? 
        • And what do they need? 
        • What are their activities? 
        • What do they do daily?
        “User Experience strategy lies at the intersection of UX design and business strategy. It is practice that, when done empirically, provides a much better chance of successful digital product than just crossing your fingers, designing some wireframes, and then writing a bunch of code”

        UX Strategy by Jamie Levy (O’Reilly)

        Lets explore the actors in a small clinic. And list out the answers to the questions.

        The Actors: 

        • Physician
        • Nurse
        • Billing Person
        • Customer Service Person
        • Customer (Patient)

        The Activities:

        Its is important to understand the way each of these people work. Its a mix of their training (the way each of these people perform their tasks) and the requirements of their roles. 

        We define an Activity as 

        Lets take them up one by one. 

        The Physician Activities:

        The Physician is the focal point from the operations perspective. What does she need? 

        For this lets consider Dr. Jane’s typical day. She gets ready and heads out for work. Reaches her office, marks her attendance at the biometric scanner. She then heads out to her office and logs into her system.

        On the way to her office, the nurse Jenny informs her of the number of patients that are scheduled for the day and the number of patients that have already arrived.

        Dr. Jane, checks out her emails before starting to see her patients. She then heads over to the system to view the list of patients that are waiting to see her. Before she calls on the first patient, she reviews the patient records from the previous visit to bring herself upto the current status of the patient.

        She calls her first patient.

        The Nurse activities: 

        The nurse is a master tactician who works as the floor manager in the clinic. She handles the multiple schedules, that of the physician and the patient. While the doctor focuses on treating the patient, the nurse handles not only the administrative work related to that patient, but also the clinical preparations that a patient might need pre or post seeing the doctor. 

        Nurse Jenny, started her day by arriving at the clinic about half and hour before the clinic was to open. She checks up on the list of appointments scheduled for the day and orders the relevant medical records as per the way the patients are scheduled to arrive for their appointments.

        Dr. Jane arrives at the clinic and Nurse Jenny informs the doctor about her appointments for the day and any other Administrative aspects that needs the Doctors attention.

        Meantime, the first patient scheduled for the appointment, calls the nurse to inform if the doctor will be able to consult her via video conference. Nurse Jenny schedules the video conference for the patient with Dr. Jane.

        The Billing Person’s Activities: 

        The billing person arrives at the clinic and decides to check on the status of the outstanding dues, the patient ledger of the patients visiting the clinic today to review their insurance details and the plan of processing first time patient insurance details.

        The billing person also completes the coding activity for the bills that are to be processed. The billing person sends the billing statement to the uninsured patients who owe a balance for their visit. The billing person also issues the billing statement to the insured patients once the insurance company processes their claim.

        The Customer Service Person

        Elaine starts from her home to the clinic and is immidiately alerted by the customer relationship management system regarding the various appointments that are scheduled for the day. She selects the option to bulk message reminding each of the customers regarding their appointments and the time the customer should arrive at the clinic to attend to the appointment.  

        Before, she reaches her office, all the reminders messages to the patient have been sent on their way. And of course, yesterday she had already called each of the customers reminding the customers regarding their visit and the documents the customer should bring along with them for the visit.

        The customer service person is responsible for taking care of the patient appointment reminders, customer satisfaction surveys, patient engagement via social media and many other activities as required by the clinic.

        The needs of the clinic will define the various campaigns that the clinic runs for their patients to develop an in-premise and off-premise customer relationship management processes. 

        The customer service person is also responsible for maintaining a constant conversation with the patient to enable a superlative customer experience.

        The Patient Activities

        The customer Jennifer logs into her portal and schedules an appointment with Dr. Jane. She uploads her insurance details as part of her appointment details

        Jennifer, attaches the latest reports, relevant for this doctor visit and the medications she is currently taking.

        One day prior to the date of her appointment, jennifer gets a call from the clinic confirming her appointment and updates on any other documents she needs to carry with her)
        The patient is the most important aspect of the entire healthcare workflow. Each of the activities and the processes within the hospital are moving towards a patient (customer) facing than being hospital or doctor facing.

        The Patient starts her journey by anyone of these scenarios:

        • booking that first appointment with a doctor in a facility
        • booking for a health-checkup
        • booking for a radiology or pathology service, as referred to by a GP
        • and many others…   


        Activity Interactions

        Now that we have identified the various actors in a clinical setting it is important to understand the interactions between these actors. There is a need to consider the interaction between the actors to be connected to other actors and at other times the activities could be limited to a single actor.
        However, the interactions between various actors also define another dimension to the entire workflow. For instance, the doctor – nurse interaction could have the nurse as the focal point and at other times the doctor as a focal point of interaction. Hence the activities that will be delivered to the user based on her role will depend on the interaction context.

        Using the activity interaction map, the system will be able to setup the base set of activities and then progress from there to learn about any new interactions and activities to be performed. 

        Newer activities are coded into the system by defining newer objects and the front end definitions will result in the generated page engine to present to the user the screen in which they need to enter the information. This will be achieved by using a combination of an object creator, rules engine and front end designer.

        Additional Considerations

        To develop a solution of this nature we present a list of features that should be included into the framework of the solution
        Generated Pages: Using cognitive computing, the system will be able to present the doctor a Patients Health Record as a generated Generated Page which displays the details of the patient record on the basis of the current visit and diagnosis. Included in this generated page are actionable intelligence inputs presented to the doctor by the underlying congnitive computing enabled analytics platform.

        Activities presented to the care provider on the basis of the Appointments, ward rounds, patient interactions via virtual visits – doctor is presented with the patient information when the visit is started.

        The doctor should be able to type in regular statements and the system responds by pulling together relevant information regarding the patient. For instance, the doctor queries, “display the list of active medications the patient is on and display the list of lab tests that have been ordered in the past three months”. 

        Speech Recognition and NLP: The Zen clinicals will heavily employ the speech recognition and NLP capabilities to allow the doctor to perform the following activities. It is important to get the doctor to move away from the system and focus on the patient treatment

        • The doctor will be able to dictate the details of the visit as a recording. While dictating, the system will alert the doctor regarding any mandatory information that is required for the visit, that had been missed out in the dictation. 
        • Secondly, the system will allow the doctor to see the mandatory form that needs to be filled for the patient visit or his ward round and indicate by voice commands the values that need to be selecteddeselected or chosen from a list of values etc  

        Digital Assistant: The Zen Clinicals solution will have a digital assistant available for the doctor to help in performing any of the activities. These activities could be a resulting microinteraction or they could be statements submitted by the doctor to the system. Activities can be performed
        Data Analytics: At the time of prescribing the medication for the patient, the doctor is presented with the list of medications sorted by their administration to other patients under similar parameters, by cost and availability at the patient location. The Zen Clinicals solution will be developed with a analytical data structure at its core.

        Microinteractions: The system should have the ability to allow the users to define microinteractions as a set of rules and trigger criteria to generate activities or alerts based on the rules and trigger criteria. 

        Alerts Engine: At the core of the Zen Clinicals framework is also an alerts engine that takes keeps track of all the results generated from any microinteraction and has the visibility of delivering these alerts via multiple channels (desktop alerts, mobile notifications or wearable notifications). The alert engine uses the presence definitions from the unified communications framework component to deliver the alerts to the user

        Workflow Engine: The Zen Clinicals framework incorporates a workflow engine at its core to define the various workflow activities, such as authorizations, digital signatures and sign-offs for authorization activities, co-sign actions for activities, peer review and sign-off, order process workflows and many other such definitions.
        Unified Communications Platform: The Zen Clinicals solution has a unified communication platform integrated into the core of the framework to enable the presence identification and communications framework from within the application. The users will be able to make use of multiple communication channels using this capability to share information seamlessly with their peers.
        Face Recognition: 50 Face Recognition APIs – Data Science Central http://ow.ly/VNvhI

        4 Steps to setup a push Notifications/ Alerts System

        In the last 5 minutes, how many times have you looked at your phone?

        In the past hour, how many times did you review the updates on your phone? 

        In the past 24 hours, can you remember the reasons you picked up your phone?

        By latest estimates and studies, people are consuming looking up at their phones upwards of 76% of the time to recieve calls, review the notifications or probably just catchup on the #HITSMIND and @HCITExpert twitter feed. 

        Ok the last one, just a plug, but hope you are doing that !!

        To receive the latest #HIMSS16 Bulletin your mobile, follow these steps: 

        1. Download Pushbullet app (iOS, Android)
        2. Login using your google or facebook account
        3. “Follow” the channel HCITExperts channel
        4. Start receiving our daily bulletin your mobile
        You can also use pushbullet to create a notification system for your Hospital, read on below to know how you can enable that. 
        It is therefore clear that we are reliant on the number of times we receive notifications to “ACT” upon an update or to review an email, cause of course we want to be prompt in our replies and up-to-date with the new-age information deluge.

        With the availability of wearables, the attention to the notifications has now been more incorporated within our lives, with the wearables being used to buzz on our wrists to let us know of a new notification or in some cases letting us know which turn to make, left or right.

        It becomes therefore quite apparent that we are getting more reactionary to the information deluge we face, so that we react to the more important messages, news, chats etc from the millions, if not thousands points of data we receive on our phone, i.e., Notifications or the BUZZ.

        Getting an understanding of this behaviour, I felt the hospitals can make use of new technologies available to push information directly to their customers. And at the same time leaving the choice to the customer, to be the consumer of these notifications. 

        A Scenario: Lets say there is a hospital that wants to quickly setup a notification system, for hospital based notifications, regarding holidays, healthcare reminders, quality updates, hospital operational updates and many other such “notifications”. 

        Presenting, Pushbullet. Using Pushbullet, the hospital IT department does the following:
        1. Create a Pushbullet account, here
        2. Create a Pushbullet Channel, here. Channels can also be linked to a RSS feed.
        3. Advertise to, patients & employees to “Follow” the channel, e.g., HCITExperts channel
        4. Start publishing updates

        And voila, in four steps you have your own “Notifications” system right into the hands of your customers and employees. A Direct-to-Customer notification system.

        Since pushbullet is available for all mobile, desktop and as a browser plugin you can be rest assured your notification will be delivered direct to the intended audience. 

        Further scenarios can be Disease Based Channels, Public Notification Boards, Hyper-Local disease surveillance to suggest a few.

        Head on over to our HCITExperts channel to get a feel of how it works. We are using our channel to share updates from some of the Top Health IT blogs in healthcare.

        Until the next Buzz then.

        (PS: You can also use Instapush, Pushalot and Pushover)

        RFID in Healthcare: Usecases from Hospitals by @msharmas


        RFID is being used in healthcare to provide Innovative solutions for enabling quality in care, reduce costs & improve patient safety.
        Some years back while on a visit to New Zealand, I had found an interesting usecase of RFID being used for sample collection. The person going from location to location on his route, was identifying the sample containers using a RFID tag. The RFID tag was reusable and I found the problem of smudging of a patient identification label, not being a problem in this case.

        I found this to be quite an interesting scenario for using RFID in sample collection to ensure sample tracking and identification. Definitely there will be a cost reduction from the point of view of not printing/ re-printing sample labels. Once the sample has been processed, the RFID tag can be reused. There has been a considerable reduction in the cost of passive and active RFID tags.

        While reviewing the recent research around the use of RFID in Healthcare, I found RFID is being in the following usecase scenarios: 

        • used to shorten outpatient waiting times, 
        • countinuous temperature monitoring for kids, 
        • patient tracking, 
        • mother-infant cot matching
        • Infant safety 
        • Inventory tracking
        • Asset tracking in hospitals
        • RFID cabinets for surgical devices 
        In our Storify for RFIDs in Healthcare, we have shared some of the Case Studies via Wireless Healthcare Blog., and some other sources. We hope to keep updating this storify with additional scenarios from other countries and hospitals.

        You can also look up the latest examples and scenarios during the following conference: RFID in Health Care 2015 | RFID Journal Events

        Share more stories with us via the comments or the Twitter Hashtag : #HITSMIND

        Additional resources:

        1. An RFID-Reading Wristband Tracks Hand Hygiene to Reduce Hospital-Acquired Infections | MIT Technology Review 

        2. In the recently concluded SuperBowl 50 RFID was used to gather player data.

        RT Hi-tech inspiration 4#healthcare? Sensors convert every player to a LIVE data node!  

        3. Mother-infant RFID tagging to check lifting of newborns in hospitals – The Hindu http://ow.ly/Yj2P301CMKE

        4.  HEALTH TECHNOLOGY: Radio Frequency Identification in Healthcare – Manish Sharma | World Health Innovation Summit Blog (this article was also published in the World Health Innovation Summit Blog)

        Read the storify in this post to review the various usecase scenarios. You can click on the links to get to the source articles and review the scenarios in detail.

        Whats’ "Trending" in Health IT Today?

        Its an interesting trend of a great many Social Media Analytical tools that are being used for Analytics. And using these tools in Healthcare is also becoming a welcoming trend.

        In this post I discuss two tools (am sure there are many more, do share them in the comments section)

        1. Infomous
        2. Symplur

        About Infomous:

        We While reviewing some of the social media tools, I came across an interesting tool called Infomous.

        Now this tool allows you to log in and create a cloud of words that are “Trending” based on the various inputs you give to the tool. For instance, we registered ourselves on their website and went about giving the list of various hashtags I tweet with.

        I also tried other option of providing the tool a combination of twitter hashtags, RSS feeds, facebook posts, linkedin posts and many other options.

        I finally settled on the list of hashtags that I tweet out with while sharing tweets on HealthIT on the @HCITExpert twitter account.

        Infomous allows you to do the following:

        • define the “search” criteria
        • create a widget that you can go ahead and embed in your website.
        • define the color,
        • the size of the widget,
        • allows you to create a button link to your word cloud
        • hover above any of the words displayed on your cloud, and Infomous cloud displays the associated Tweets
        • Allows the user to select the words to be hidden for that proverbial spammer during your conference, tweet chat 😉

        Head out to Infomous and create your own cloud of words that you tweet, blog, share with on social media. We would love to see the cloud you came up with, share it out with the hashtag #HITSMIND

        About Symplur

        Healthcare folks should check out the Healthcare Hashtags Project: SYMPLUR

        “The goal of the Healthcare Hashtag Project is to make the use of Twitter more accessible for providers and the healthcare community as a whole.” – Symplur

        There are great many case studies listed there how the experts are using the information being shared on Twitter using hashtags.

        Symplur can be used for the following aspects: (to name a few)

        • Hosting Healthcare Tweetchats (plug: we have a Health IT Social Media INDia hashtag : #HITSMIND )
        • Healthcare Conference Hashtag Analysis: Organising a Healthcare Conference? Head over to Symplur and register your hashtag with them. Post conference Transcripts and Tweet analysis from the conference are displayed in the various reports Symplur provides.
        • Disease Hashtags
        • Ontologies
        • Regular Hashtags
        • Symplur Signals: promotes deep understanding of healthcare as seen by patients, doctors and other stakeholders with real-time access to insights from over a billion healthcare social media data points

        Please review their blog “Connecting the dots in healthcare social media”  for the various ways in which Social Media Analytics is being used.

        Look forward to hearing back from you with your thoughts and insights.


        [content title=”About Manish Sharma” icon=”fa-heart”]

        Manish Sharma

        Founder HCITExpert.com, Digital Health Entrepreneur

        Connect with me via any of my Social Media Channels

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