#Infographic: Technology Innovation in Public Health, Learning from INDIA via @InnovatioCuris

Infographic Source: Reaching the unreached through Technology Innovation in Public Health Learning from INDIA, Dr. Sanjiv Kumar & Dr. V K Singh – http://innovatiocuris.com/webinars/

Infographic Source

We came across a great presentation on “Reaching the Unreached Technology Innovation in Public Health – Learning from India”, via the InnovatioCuris.com webinar conducted by Dr. V K Singh along with Dr. Sanjiv Kumar. 

In the webinar, Dr. Kumar discussed how Policy and  Technology Innovations can be used to reach the entire population of India for delivery of Public Health Services. 

He spoke about the need to Identify and scale Innovations in India. Dr. Kumar highlighted different ways by which this is being done: 

  • States encouraged to include innovation in Program Implementation Plans
  • National Summits on Good and Innovative practices
  • National Health Innovation Portal – www.nhinp.org
  • Health Technology Assessment Workshops

We have prepared the Summary Infographic of the webinar conducted by Dr. Sanjiv Kumar & Dr. V K Singh, MD, InnovatioCuris and present it here for your reference.

In this webinar, we came across an interesting term, “Indovation” (“Indian Innovations”) used by Dr. VK Singh, while taking about not only learning best practices from across the world, but also have the ability to share the “Indian Innovations” in solving the problems of accessibility, affordability and scale in deliver of Public Health Services.

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


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#INFOGRAPHIC: India’s Unique Challenges in Healthcare Delivery by @iamGuruprasadS

Information sourced from ICTPost.com

The Infographic based on talk India’s Unique Challenges: An Opportunity to Innovate? by Guruprasad S, GM, Healthcare Practice, Robert Bosch Engineering & Business Solutions


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3P’s framework to be Successful by Prashantha Sawhney

All of us look for formulas to climb the ladder of success, we can either invent our own or leverage what others before us have tried. Every industry has well documented practices, frameworks and standards that provide guidance on how to be plan, execute and be successful.

The one framework that has appealed to me and been found useful is called 3 P’s. These are 3 equal pies that help make the circle of what is required to be successful. 

  1. People – relates to “who” does the work
  2. Process – relates to the “how” the work is to be done
  3. Product – relates to the “why” and “what” work needs to be done


Many engineers/ technical/ functional experts sometimes tend to think of this aspect as being HR/managerial related. However this is a really critical part as this is the group with whom we spend most of our waking hours. Without people (whether it is 1 or 100 or 1,000), the wheel cannot exist. It is not just about having people occupying seats, but about having the right people. Having people collaborate with each other helps move in the right direction else there is no tangible progress.


Having appropriate processes in place helps us be predictable in what we do as well as enabling quality aspects to be met in a timely manner. We do not have infinite time, resources or money to try to do things the right way and need to deliver or execute in more defined ways with proper definitions of expectations at each stage of the process. These can evolve or time and get overly complicated but with right attention they can also be simplified Execution cannot be as stated below:

The infinite monkey theorem states that a monkey hitting keys at random on a typewriter keyboard for an infinite amount of time will almost surely type a given text, such as the complete works of William Shakespeare. 


This is the end result that shows what we wish our customers/partners to use. It may be a tangible physical product, Software UI/Mobile App or maybe even just background API’s, but it needs to have a defined state when it can be considered complete. We may think of just being related to specifications of functionality, but it goes beyond that to understand why the product should even exist or is needed.

In short among other things, to be successful we need people who are skilled and motivated, who follow the processes and believe in the product they are working on.

More on each of these aspects in subsequent posts.

The article was first published in Mr. Prashantha Sawhney’s LinkedIn Pulse post. The article is reproduced here with the authors permission. The views shared by the author are shared in his personal capacity.
Prashantha Sawhney

Results-driven engineering professional with ~17 years of experience in leading high performance product teams

#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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Can the Internet of Things #IoT transform Healthcare? by @drvikram

Internet of things continues to dominate the world apparent by the success of the Liveworx16 that recently concluded in Boston. Liveworx is the signature event of Thingworx a PTC company. The event saw a curious mix of CAD/CAM experts who were trying to understand how IoT was going to help them mingling with IoT experts who had already implemented a few projects and were looking to consolidate on their early mover advantage. But one Industry that is looking at IoT very seriously is healthcare. Yes you heard me its healthcare, and may even leapfrog other industries when it comes to IoT adoption.

But then why should healthcare look at IoT?

Well that is a good question that is being asked by many hospitals and rightfully so. Hospitals have a duty towards their patients, community, physicians and staff and the last thing they want to do is to embark on a new technology for the sake of technology. But before we look at why IoT, we should probably try to understand the origin of IoT.

Some might argue that IoT is not new, maybe the patenting of the passive RFID in 1973 was the origin of IoT. By the 1980’s many manufacturing units were already connected. Some others like consumer goods were using a form of IoT. For example Coke was using a similar technology with its vending machines in 1980’s which was invented at the Carnegie Mellon University. 1980 was also the year CERN launched World Wide Web (WWW) and the internet was born. By 1990’s Wal-Mart had mandated all organizations that are displaying their goods to have advanced RFID chips. This had led to the famous spat between P & G and Wal-Mart. I am not sure who blinked first but for a while P & G was off the shelves at Wal-Mart.

By 2000’s we started connecting devices to the internet. Power grids and Energy companies started systems which were talking to each other. Soon cell phones were connected and then by 2008, we saw the inflection point on the number of connected devices. Today we have wearable devices that can send your physiological data to your physician that can help him or her track your health parameters like BP and sugar levels.

IoT in India is not new either. I know for example a hospital in Delhi-NCR region had ambulances with antennas on its top, ECG machines, and monitors along with physicians in the ambulance. This way despite the traffic jams in India, the critical records of the patients would arrive at the ER and the physicians and surgeons would make the necessary preparation for stabilizing the patient and save valuable time that otherwise they would have wasted in these tests. At that time Rajesh Batra who was head of technology, was able to make this work and get the physicians and management on board by demonstrating the value of IoT in an ambulatory set up.

“IoT has the potential to improve care” says Rajesh Batra , “But we need to be careful about security as it very easy for a breach which would be dangerous for a hospital”

He continues the same zeal in Kokilaben Hospital in Mumbai where he currently is the CIO. He is also looking at integrating IoT with emerging areas like Omni Channel with iBeacons to give a truly connected experience at the hospital.

As I have written many times in the past, we in India have this unique opportunity to create a new healthcare model that can help 1.3 billion people manage their health. I think an important component of that is population health.

Now a hypothetical population health program could work on the principle of a hospital enrolling a set of patients who need chronic care, let’s say for example diabetes into a program. The program entails these patients to check their sugar levels regularly and through IoT their sugar levels get updated into a program dash board that the physician can see. If the sugar levels are within the parameter then there is no incident. But if the sugar levels rise or fall outside of the normal range. Then the system alerts the physician. The physician would check if this is one off case or is there is a regular pattern. Based on this he or she can intervene and schedule a checkup and enter the same in the record.

Now this is a simple example, but helps us to understand how a potential IoT solution could work in population health. It would not only help in tackling chronic diseases in India, but could serve as the only option in tier 2 and tier 3 cities where access to hospitals is not available. Having said all that IoT will definitely shape the future of healthcare in the country, the only thing to be seen is the extent of that transformation.

The article was first published on Dr. Vikram’s Blog, it is reproduced here with the authors permission
Dr Vikram Venkateswaran

Dr Vikram Venkateswaran is a healthcare thought leader who writes and speaks about the emerging healthcare models in India and the role technology plays in them.

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

SNOMED CT CSETS – Its Place and Use by @sbbhattacharyya

The Concepts related to CSets are as proposed by Dr. SB Bhattacharyya and presented in the HCITExpert Blog with permission from Dr. SBB – sbbhattacharyya@gmail.com

What is a Constrained Set?

  • The word constrain means “to control or limit something” (Cambridge Online  Dictionary)

  • SNOMED CT makes extensive use of refsets (reference sets), for a wide-range  of purposes, each of which have specific purposes

  • Refsets need to conform to certain specific rules and guidelines regarding their
preparation, distribution and maintenance
  • Takes a long time to design one and the designing entity needs to have a
 namespace assigned to it
  • This makes the rapid and effective use of SNOMED CT in individual systems  cumbersome at best and impractical at worst

Solving this conundrum

  • Since within a system it is pretty much lassiez faire or “anything goes”, it is wise  to use a Constrained Set of the SNOMED CT that suits the purpose

  • For example, for gender or laterality, a small list specially created SNOMED CT code set for that purpose should work excellently (actual list follows)

  • Thus, wherever there is a requirement for a system to have a list presented to 
the user for their selection, this small list serves the purpose
  • This limited list is termed a “Constrained Set” or CSET (a portmanteau of the  two words that it refers to) by Dr Bhattacharyya

CSets for Gender & Laterality

(Created using Cliniclue®)

248152002 | female |  
248153007 | male |  
32570681000036106 | indeterminate sex |  
32570691000036108 | intersex |
407374003 | transsexual |

7771000 | left |  
24028007 | right |  
51440002 | bilateral |


  • This constrained list works very well and suits the purpose of helping users to  fill in the gender or the anatomical side

  • The format of expressions as per the IHTSDO construction rules states that  either of the following is acceptable (only pre-coordinated types are shown here)

    • ConceptID
    • ConceptID | Term|
  • Thus, let’s say, for “bilateral” laterality, either of the following works

    • 51440002
    • 51440002 | bilateral |
  • It is important to debate the merits and demerits of such an approach

  • Not only must the pros and cons be considered but also the end-result should
 justify it
  • For starters, let us briefly study the refset approach

  • It should be noted that refsets are meant to be exchanged with external  entities in their entirety and need to be updated after every release –  international or national

  • It should also be noted that by the term “system” it is meant any system that uses SNOMED CT


  • Namespace required if refsets are shared with external entities/systems

  • Needs regeneration after every release

  • Can be automated using pre-set scripts (e.g., SQL, Perl, etc.) that needs to be  designed in-house


Data Management

  • When data is managed, it is the expressions that are stored and exchanged

  • The expressions have a machine-processable part (ConceptID) and a human-readable  part (Term) of expressions or just the machine-processable part (ConceptID), it is  largely a system designing issue, which is an internal matter

  • Thus, system designers only need to consider that which is necessary to capture,  store, retrieve, display, exchange, processing and querying

  • Anything else is not related to the system functionalities

  • Refsets have largely a governance connotation

Comparing Refsets with CSets


  • Formal, Exchangeable

  • Not easily reproducible – needs  namespace

  • Needs to be adapted for system  use – cannot be used as-is for  data capture, storage, retrieval,  query and exchange


  • Informal, Non-exchangeable

  • Easily reproducible – does not  need any namespace

  • Ready-to-use for data capture,  storage, retrieval, query and exchange

Benefits of CSets


  • Quick to develop and ready-to-  use

  • Can design, create, deploy and re-use as per specific system  requirements

  • Needs a team with properly  trained and experienced  professionals to design and  create

  • Needs updating with every  release – international and national


  • Since most of the data is required to be captured in pre-coordinated expression forms  (the form as available from international or national releases) that is either ConceptID  only or ConceptID | Term | formats, the system designers need to have access to these  for storing in their databases and used as-is

  • For queries, transitive closure tables are required for data aggregation, else, either  only the ConceptID or only the Term need be used to return the proper records

  • The CSets are easy-to-create being mostly built on-the-fly and hardly taking more than  an hour to create moderately complex ones, provided the right domain experts are  available to guide the designers


  • A good SNOMED CT tool like ClinClue® or Snow OWL® is required

  • A terminologist would be ideal but it may be tough for system vendors to hire

  • The next best person to do this type of work is a health informatics professional who  familiar with SNOMED CT

  • Alternatively, the following may be considered as a team since this type of work
cannot be done by one person, it will be too error-prone and consequently risky
    • Someone familiar with the tool being used is usually acceptable

    • Someone well-conversant with SNOMED CT as a whole is required

    • A good DBA who can design the database in such a manner that duplicates are  removed – the way SNOMED CT is modeled, the same term may be present in  different hierarchies

    • A domain expert – specialist, doctor, nurse, dentist, paramedic, etc. – is  required to identify all Terms (preferred as well as synonyms) required for that  domain (clinical finding, procedure, disorder, allergy, etc.) to ensure that all  the necessary terms (both preferred and synonyms) have been incorporated

  • During system use, only the Terms are displayed while the ConceptIDs are  stored and/or exchanged with or without the Terms, with the Term to  ConceptID-to-Term mapping done at the API level
  • The best way is to identify the Term that best describes the domain concept  (marital status, laparoscopic procedure, lipid profile, etc.) and construct the  SQL statement that will extract all the necessary subtype children and  descendants, which will form the required constrained list of values

  • For maintenance purposes, rebuilding the CSets for every subsequent official  release of SNOMED CT, which happens every six months, can be automated by running these scripts to build a new CSet

  • The need to manually check the CSet does not go away though to ensure that  all the required concepts and their corresponding preferred terms as well as  synonyms have indeed been incorporated


CSets Types

Type A

  • Separate tables for each domain  item like Gender, Employment  Status, Drug & Medicament,  Absence findings, etc.

  • No CSetID needed

  • Easy to build and maintain

  • Requires regeneration of separate  tables with every release –  several run cycles

Type B

  • One table where every domain is  uniquely identified through CSetID that is self-determined and self-generated

  • Complicated to build and maintain

  • Requires running several scripts  in series that populates and updates a single table with every release – automated single run cycle


  1. Matter based on ideas formulated by Dr SB Bhattacharyya
  2. Some matter sourced from presentations prepared by Dr Karanvir Singh in
 consultation with IHTSDO on behalf of National Release Centre, India
  3. IHTSDO – http://www.ihtsdo.org/snomed-cta
  4. National Release Center, India – https://www.snomedctnrc.in/ 
  5. What is SNOMED CT – http://www.ihtsdo.org/snomed-ct/what-is-snomed-ct

The Concept related to CSets are proposed by Dr. SB Bhattacharyya and presented in the HCITExpert Blog with permission from Dr. SBB.


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Dr. S B Bhattacharyya

Digital Health Influencer, Medical Doctor with experience in the healthcare industry in the fields of clinical practice, hospital administration, and medical informatics with particular focus on clinical data analytics.

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Case Study: Efficiently Converting Healthcare Data into Information and Intelligence by @uddenfeldt

This article was published by Mats Uddenfeldt, on his LinkedIn Pulse page [ https://www.linkedin.com/pulse/case-study-efficiently-converting-healthcare-data-mats-uddenfeldt ]. The article is republished here with the author’s permission.
Valence Health provides healthcare providers with customized solutions for value based care, helping them better manage their patient populations and accept financial responsibility for the quality of the care they provide. The company offers advisory services, health plan services and a suite of population health technology software as a service (SaaS) products that help their clients transition from a transaction-based approach to a value-based approach to healthcare. Headquartered in Chicago, Valence Health serves 85,000 physicians and 135 hospitals, helping them manage the health of 20 million patients nationwide.

The Challenge

The company’s rapid client growth and the increasing volume of data required to keep up with that growth were straining its existing technology infrastructure. “Our services have a voracious appetite for data. We use that data to inform decisions about improving both healthcare outcomes and operational processes. We knew if we continued to grow, we couldn’t sustain this,” explains Dan Blake, Valence Health Chief Technology Officer. “We had outgrown our Extract Transform and Load (ETL) infrastructure and knew we had to replace it.”
Valence Health looked at various alternative technologies. “We looked at large monolithic technologies like Informatica and point solutions like Syncsort but they did not give us the robustness and flexibility we needed in the long run,” says Blake. “We wanted something very open that would give us the flexibility to choose where to make investments over time. We were drawn to Hadoop and the capabilities those tools provided.”

MapR Solution

Valence Health is using the MapR Converged Data Platform [ https://www.mapr.com/products/mapr-converged-data-platform ] to build a data lake that is the company’s main data repository. The company consumes 3,000 inbound data feeds with 45 different types of data including lab test results, patient vitals, prescriptions, immunizations, pharmacy benefits, claims and payment, and claims from doctors and hospitals.
“NFS was a very important feature for data ingestion. It is making our migration much easier,” says Blake. In the short term, Valence is transferring data back to the SQL server database as their portal and analytics expect that format. Once they get through the ETL transformation, they plan to transition from SQL to an HBase solution.
    “We chose MapR [ https://www.mapr.com/why-hadoop/why-mapr ] because they were the easiest company to work with. They were the most receptive and answered questions quickly, honestly and efficiently. On the technology side, we’ve been very impressed with the overall ability to implement and integrate sequential data transformation.” Dan Blake, Chief Technology Officer, Valence Health


Valence Health is already seeing many benefits from its MapR solution including increased performance, better responsiveness to customers, higher quality data and a flexible platform to sustain their growth over time.

Growth requires new data architecture that can scale the business

Valence Health has been on a steep growth path over the last several years. “In the wake of the ACA’s implementation, more and more healthcare providers and organizations like Consumer Orientated and Operated Plans (CO-Ops) are taking on risk. As a result, we have tripled the size of our business in three years and expect do the same next year,” says Kevin Weinstein, Valence Health Chief Growth Officer. “Every year we’re more than doubling the amount of data we are processing. Having a robust data architecture is integral to our success.”
The company’s growth path is tied to client growth and the growth in the data infrastructure that those clients require. “We have to use technology to scale the business. We have to be able to manage more data with the same amount of people,” says Weinstein.

Performance gains increase customer satisfaction

The reliable and high performance of the MapR Platform enables Valence to be much more responsiveness to their customers. “In the past, if we received a feed with 20 million lab records, it would take 22 hours to process that data,” says Blake. “MapR can cut that cycle time down from 22 hours to 20 minutes [ https://www.mapr.com/company/press-releases/valence-health-dramatically-improves-data-ingestion-performance-and ] . And it’s running on much less hardware.”
“MapR gives us the resource efficiency, speed and flexibility to make a huge difference in customer satisfaction. As soon as the data hits our system it’s pushed all the way through,” he says. “It gives our customers much faster feedback about what’s going on with the population they are trying to manage.”

Flexibility serves customers faster

Valence Health is also now able to answer customer requests that were very difficult to answer in the past. “It allows us to do things we could not do in our old world,” explains Blake. “For example, a customer might call and say: ‘I sent you an incorrect file three months ago and I need you to take that file out.’ That’s not something you can do in a normal ETL system on top of a relational database. It could take 3-4 weeks to get that data deleted,” he says. “But with MapR, that is naturally supported, we can just roll it back and take that file out.”
This ease of administration and maintenance means that the company can focus more resources on their core business. “I can spend less on outsourced resources and instead spend money on adding new features, analytics or visualization capabilities or acquiring new types of data. We can do things that truly matter to our customers,” says Blake.

Enriching the data lake with new data sources enhances data quality

The MapR Platform also makes it much easier for Valence Health to enrich their data lake with new data sources. “It’s not just the volume of data, we’re looking to integrate new types of data like socioeconomic and demographic information, or immunization records. With our old architecture it was painful to do so,” says Blake. “Our data scientists are looking at new sources of data. The data can tell you things you don’t even know about. If we can augment our data, we can build new types of analytics that allow our client and our company to successfully invest in areas we have not been in before.”

Data acquisition and integration capabilities enable differentiated services

Valence Health believes that their new data acquisition and integration capabilities will give them a leg up over their competitors. “Other startups are selling software solutions in spaces we operate in,” explains Blake. “But the hard part is getting the data into the system and into formats where it can be truly useful. Our twenty years of hands-on practical experience in working with provider organizations that have taken on all sorts of risk-arrangements coupled with our effective and efficient infrastructure to get data flowing and keep it flowing is hugely powerful. The data acquisition infrastructure is very important to our ongoing success and to our customers.”

Recommended Reading

Want to learn more about Big Data for the Healthcare industry? Please check out the links below:
  1. How Health Care IT Diagnoses Data Pain Points, CIO Insight – http://www.cioinsight.com/case-studies/how-health-care-it-diagnoses-data-pain-points.html
  2. Stepping Up to the Life Science Storage System Challenge, HPC wire – http://www.hpcwire.com/2015/10/05/stepping-up-to-the-life-science-storage-system-challenge/
  3. Health Care Emerges as Hadoop Use Case, Datanami – http://www.datanami.com/2015/10/08/health-care-emerges-as-hadoop-use-case/
  4. Big Data and Apache Hadoop for Healthcare and Life Sciences, MapR – https://www.mapr.com/solutions/industry/big-data-and-apache-hadoop-healthcare-and-life-sciences
Join our more than 700+ paying customers and discover why MapR [ https://www.mapr.com/ ]  is the clear market leader for production ready Big Data applications by reading about the Top 10 Reasons Customers Choose MapR [ https://www.mapr.com/top-ten-reasons ].
This article was published by Mats Uddenfeldt, on his LinkedIn Pulse page [ https://www.linkedin.com/pulse/case-study-efficiently-converting-healthcare-data-mats-uddenfeldt ] . The article is republished here with the author’s permission.
Mats Uddenfeldt

Big Data Thought Leadership ♦ Enabling As-It-Happens Business

Booking a doctor appointment online – Whats the big deal? – @AshwinNaik

This blog was first published in Dr. Ashwin Naik’s LinkedIn Pulse.  


Now you can you book an appointment with a doctor online. I know, i know – not a big deal. 

I meant, you can now book an appointment with a doctor in a government hospital online Or in a couple of years – you can book an appointment with a doctor in any government hospital in the country – online (http://ors.gov.in/copp/appointment.jsp) !

Now that’s something. With a country of a billion+ people, mostly on mobile and with 1000s of government hospitals & clinics across the country – now this IS A BIG DEAL. 

The government has silently launched the Online registration system (http://ors.gov.in/copp/) on which you can book appointments with government hospitals using your aadhar card. It early days, but since July 2015, close to quarter of a million appointments have been taken online. And multiple hospitals are now using the e-hospital system (with over 2 million appointments) 

Now this is a really big deal.

+ has a mobile app. And portal to check availability of blood in the hospitals

First – how this works

If the patient provides Aadhaar number on his first visit to the hospital then he would be given same preference for online appointment as is given to the patient who stands in queue in the hospital and UHID will be provided to the patient. In future, patient would be able to print E-OPD card after making online payment.

If patient is a follow up patient with hospital, then also he should try to link his Aadhaar with existing UHID which will facilitate in maintaining Electronic Health Record (EHR) in the hospital for better treatment.

Patient’s UHID get linked to Aadhaar card so that EHR across the Hospitals can also be facilitated in future.

In case patient has aadhaar number but mobile number is not registered with it, then name of the patient appearing in aadhaar card must be known. After verification, patient needs to enter other personal details.

While this is a great technology and adoption achievement, i am excited that this has an even more incredible impact – transparency! If every government hospital data on appointment available and booked is captured in a single system along with reports from lab and pharmacy – boom – everything is out in the open. 

Doctors who dont show up as per their appointment are up for scrutiny, medicines prescribed if not in the pharmacy show up, lab test which should have been done in house – now being diverted to private labs – stick out like sore thumb. 

And that’s why i think this is a really big big big big deal.

This blog was first published in Dr. Ashwin Naik’s LinkedIn Pulse.
Dr. Ashwin Naik

Founder – Vaatsalya, Ashoka Fellow & Young Global Leader of World Economic Forum

C.A.U.S.E Methodology for Healthcare Organization Change Management by @pankajguptadr

Please note: The Author of this article is Dr. Pankaj Gupta. The article was first published on Dr. Gupta’s blog.

For Boot-Strapping Healthcare Organisation Change Management, I follow my proprietary CAUSE Methodology for managing change in people, process and technology. This has emerged out of our collective experience of managing change in healthcare organisations.

Consciousness of need to change: The people must be informed by the Head of the organization again and again until they are very clear in their mind about why the change in needed. There is no over communication for this. Treat the organization like an anxious child about to undergo a surgery and will need a lot of reassurance.
Aspiration to support change: The organization must Aspire to support the changes. Since the organization is going through a transition this is an opportunity for the organization to redefine itself across the organization. The Aspiration must come from within not without.
Understanding how to change: Once the organisation is conscious of the need to change and they aspire for the change from within then they are ready to be trained. Before this stage any trainings will be futile. Now train the team on new processes and technology extensively, again and again till it becomes second nature to them. Keep Checking for gaps in knowledge between expected and achieved.
Strength to over come hurdles and implement change: It is important to realize that processes will break and problems will happen when such a major implementation is done. Trick is to recognize the problem areas before it is too late to avoid big failures. Top management should be ready to cope up with the hurdle and internal resistance and not buckle down under pressure.
Ecosystem to support, sustain and adopt change: Lot of support is required in terms of hand holding and training till the change gets adopted by the users and is irreversibly embedded into the ecosystem. Unless you support the change till it becomes an ecosystem the change will not last. It will swing back to zero as an elastic and throw the organization into chaos.

Dr. Pankaj Gupta’s experience spans Organization change management, Business transformation, Clinical transformation, Knowledge management, Transition management, eHealth Consulting, mHealth Consulting, Chronic Disease Management, Solution design, Implementations. Due to his background and experience he is interested in Healthcare Operations, Pharma, R&D Labs, Medical Devices, IoT, SMAC, next generation technology platforms for Digital Hospitals.

CAUSE Methodology is an outcome of having done organization change management over and over again. Dr. Pankaj Gupta has successfully applied this framework to many healthcare organisations in terms of IT, Process, Quality and Management changes.
Please note: The Author of this article is Dr. Pankaj Gupta. The article was first published on Dr. Gupta’s blog.


Article By: Dr. Pankaj Gupta

Digital Health Influencer & SMAC / IoT Speaker | Healthcare Business Executive, Chief Medical Informatics Officer at ProMed Network AG | Managing Partner at TAURUS GLOCAL CONSULTING | Director at Taurus Globalsourcing Inc.
Additional Articles by the Author

  1. Top #DigitalHealth Trends to expect in 2016 by @pankajguptadr @AmandaShaffer14 http://ow.ly/uTSp300Bhyw
  2. New Healthcare Aggregators: SMAC and IoT by @pankajguptadr http://ow.ly/UCzO300BD7y

From Mere Health Statistics to Real Health Data by @AtulVB

The Health Statistics play a major role in deciding the Health Policies of Nations, no doubt they provide the insights into the health parameters in question and health statistics such as Rates, Ratio, Incidence, Prevalence and Life Tables are needed to be formed into indicators of progress of the nation in terms of improvement of the factors in consideration.

The question is – is mere statistics enough or is there something more to it?

As we move from Millennium Development Goals (MDGs) to Sustainable Development Goals (SDGs) – this question becomes more imperative!

According to WHO, Health is defined as “Health is a state of complete physical, mental and social well-being and not merely the absence of disease or infirmity”. 1

Health is also identified the state of “not well”, “ill “or “morbidity” or “sickness”. Further “death”, which is caused by illness or sickness, reflects the condition of Health. Hence measurement of “Mortality” and “Morbidity” reveals of Health condition of a community.2

Statistics definitely provide a macro-level / micro-level understanding of the situation and brings in quantitative pointer to a qualitative, exhaustive and comprehensive activity. Year-on-year the quantitative pointer is kept as the reference. Any deviation from it is representative of the growth or decline of the parameters in consideration.

Such laser sharp focus on quantitative data is the hallmark for Population Census, Surveys and even Market Research – where absolute number, a figure in percentage is the gospel truth.

What about Health / Medical Data of the population? What about the Medical History? What about the Medical Condition – improvement / degradation?

The last point gets easily converted into an explainable number or a percentage as an indicator, but what about the relapse or repeat condition of the same person – it’s again… just a number!  

Limitations of data especially in developing countries are a real concern, as available data is not reliable and post-2015 presents an opportunity to think beyond what data is available so that countries can invest in capacity building to get it.3

Alongside the number comes a lot of health and health-related data, but with the focus being statistics, basic essential health data is obviously missed out.

Non-communicable disease continues to be an important public health problem in India, being responsible for a major proportion of mortality and morbidity. Surveillance of NCDs and their risk factors should also become an integral function of health systems. Evidence based clinical practice and appropriate use of technologies should be promoted at all levels of health care, including tertiary services.4

With the focus on Non-Communicable diseases (NCDs) – it is imperative we focus on the Healthcare & Medical Data for Clinical outcomes and not mere Health Information for Management Systems.

Ageing Population is one of the major concern globally, more so in India. It is now recognized that while both developed and developing countries are experiencing growing proportions of elderly, developing countries currently are ageing faster than developed countries. In India, the proportion of the population aged 60 years and above was 7 per cent in 2009 (88 million) and is expected to increase to 20 per cent (315 million) by the year 2050. 7

As per a study conducted 5, among the most significant findings that emerged was the incompleteness of data on the burdens of access and affordability among elderly populations in India. A major reason for this is that routine health data collection in India is not designed to reflect or characterize pathological progression. Many routine data collection procedures (National Sample Surveys, Census data, or death certificates) in India do not capture pathological progression nor do they disaggregate morbidity and disability outcomes among the elderly. 5

Further research, especially qualitative research, is needed to explore the depth of the problems of the elderly. 6

With a rise in the Ageing Population, it is all the more important to look at the efficacy of the health data collected than mere health statistic data and a Longitudinal Study along with Cross-Sectional Study is needed for an efficient health data repository.

With the advent of new age technology: connected technology, Connected Health has become pervasive and with embedded systems and IoT taking center-stage, it is all the more essential to focus on the Data and not mere Number! And when I say ‘Data’ it is ‘Health Data’.

And last, but not the lease – the necessity for increased clinical / medical research in today’s evidence based approach makes it is all the more important to focus on the fundamental health data collection, collation, transformation and consolidation to begin with leading to Analysis, Research and building the knowledge base for Healthcare / Medical Data Management.

Looking at the underlining need for Health / Healthcare Data, we need to move from just Statistical Data to Meaningful Data – not to mistake ‘Meaningful use of Data’!

The article was first published on Mr. Atul Bengeri’s – LinkedIn Pulse. The article is republished here with the authors’ permission

  1. CIGI, TISS, KDI, Post-2015 Development Goals, Targets and Indicators: Indian Perspectives, Mumbai, India / Meeting Report, August, 2012
  2. An Overview of the Burden of Non- Communicable Diseases in India – R Prakash Upadhyay. Iranian J Publ Health, Vol. 41, No.3, 2012, pp.1-8 http://www.ncbi.nlm.nih.gov/pmc/articles/PMC3481705/pdf/ijph-41-1.pdf
  3. Health of the Elderly in India: Challenges of Access and Affordability. Subhojit Dey, Devaki Nambiar, J. K. Lakshmi, Kabir Sheikh, and K. Srinath Reddy. National Research Council (US) Panel on Policy Research and Data Needs to Meet the Challenge of Aging in Asia; Smith JP, Majmundar M, editors. Washington (DC): National Academies Press (US); 2012. http://www.ncbi.nlm.nih.gov/books/NBK109208/
  4. Health and Social Problems of the Elderly: A Cross-Sectional Study in Udupi Taluk, Karnataka A Lena, K Ashok, M Padma,1 V Kamath, and A Kamath. Indian J Community Med. 2009 Apr; 34(2): 131–134. doi:  10.4103/0970-0218.51236 PMCID: PMC2781120
  5. Demographics of Population Aging in India. Subaiya, Lekha and Dhananjay W Bansod. 2011. Demographics of Population Ageing in India: Trends and Citation Advice: Differentials, BKPAI Working Paper No. 1, United Nations Population Fund (UNFPA), New Delhi.


Atul Bengeri

Digital Health Influencer & Evangelizing Digital Transformation across verticals, Strategic Planning, Leadership, Program Management, Partnerships / Alliance Management

Incorporation of Health Informatics in the curriculum for Healthcare Professionals by @Supten

The  article was first published in Dr. Supten’s Blog. The article is published here with the authors permission.

The art and science of processing “information” is informatics, where “information” is the processed “data” (anything that is observed and recorded). Just as we get information by “data processing”, using informatics tools, we condense information into “knowledge” that can be applied to real life situations 

When the informatics tools are applied to the “biomedical” field, it is called “biomedical informatics” which is a very broad term encompassing the study and application of computer science, information science, informatics, cognitive science and human-computer interaction in the practice of biological research, biomedical science, medicine and healthcare. Other fields, including bioinformatics (proteomics, genomics, and drug design), clinical informatics (including clinical research informatics), public health informatics and medical informatics (including imaging informatics, nursing informatics, dental informatics, pharmacy informatics, consumer health informatics, healthcare management informatics and veterinary informatics) are commonly counted as sub-domains within biomedical informatics

Health or Healthcare informatics is an alternative term that has been defined: “If physiology literally means ‘the logic of life’, and pathology is ‘the logic of disease’, then health informatics is the logic of healthcare. It is the rational study of the way we think about patients, and the way that treatments are defined, selected and evolved. It is the study of how clinical knowledge is created, shaped, shared and applied. Ultimately, it is the study of how we organize ourselves to create and run healthcare organizations.”It deals with the resources, devices, and methods necessary for optimizing the acquisition, storage, retrieval, and optimal use of information in health and biomedicine. The health informatics tools include not only computers but also clinical guidelines, formal medical terminologies, and information and communication technology (ICT)

Biomedical / Health Informatics can be applied to diagnostic procedures, imaging, decision-support systems, patient records, financial and administrative systems, educational systems (for healthcare delivery students, practicing professionals and patients), patient monitoring (e.g., anaesthesia control), and accessing health knowledge

The National eHealth Authority (NeHA) is in the process of being set up through an Act of Parliament. Under such circumstances, for the smooth adoption of eHealth throughout Digital India, there would be a tremendous requirement for formally trained health informatics professionals in India very soon. It will be prudent to incorporate health informatics as a part and also as a speciality for healthcare professionals in India. Ministry of Health and Family Welfare has notified Standards for Electronic Health Records since August 2013 and India has been a country member of IHTSDO that develops and maintains a terminology standards SNOMED-CT. It is essential to make healthcare professionals at all levels aware of such initiatives and adopt standards for health information exchange

Source: Connectathon India – http://ow.ly/ve8t300Qa3M

In the USA, all ABMS (American Board of Medical Specialties) member boards have agreed to allow their diplomates to take the clinical informatics subspecialty examination if they are otherwise eligible. The ABPM (American Board of Preventive Medicine) website provides information about eligibility for the exam and online application.Certification in Clinical Informatics is a joint and equal function of the ABP (American Board of Pathology) and the American Board of Preventive Medicine (ABPM)

CDC, Atlanta, Georgia, USA, offers PHIFP (Public Health Informatics Fellowship Program) as a 2-year, competency-based training program in public health informatics. The fellowship provides a problem-based learning environment in which fellows apply information and computer sciences and information technology to solve public health problems

They have the opportunity to: learn about informatics and public health in an applied setting work with teams involved in research and development of public health information systems lead an informatics project design, develop, implement, evaluate, and manage public health information system

The  article was first published in Dr. Suptens’ Blog


1 Sarbadhikari SN, Medical Informatics: A Key Tool to Support Clinical Research and Evidence-based Medical Practice (Ch 15), In, Babu AN, Ed, Clinical Research Methodology and Evidence-based Medicine, 2nd Ed, 2015: 179-191. 
2 Abdel-Hamid T, Ankel F,…Sarbadhikari SN, et al, Public and health professionals’ misconceptions about the dynamics of body weight gain/loss, Syst. Dyn. Rev. 30, 2014: 58–74 
3 Ahmed Z, Sarbadhikari SN, et al., Using online social networks for increasing health literacy on oral health, Intl. J User Driven Health, 2013, 3: 51-58. 
4 Karishma SH,…, and Sarbadhikari SN, Creating Awareness for Using a Wiki to Promote Collaborative Health Professional Education, Intl. J User Driven Health, 2012, 2:18-28. 
5 Sarbadhikari SN, Unlearning and relearning in online health education, (Ch 21) In, Biswas R, and Martin C M, Ed, User Driven Healthcare and Narrative Medicine, IGI Global, Hershey, USA, 2011: 294 – 309. 
6 Sarbadhikari SN, How to Make Healthcare Delivery in India More “Informed”, Education for Health, Volume 23(2), August 2010: 456. 
7 Sarbadhikari SN and Gogia SB, An Overview of Education and Training of Medical Informatics in India, IMIA Yearbook of Medical Informatics, 2010: 106-108. 
8 Sarbadhikari SN, Applying health care informatics to improve student learning, Really Good Stuff, Medical Education, 2008; 42: 1117–1118. 
9 Sarbadhikari SN, How to design an effective e-learning course for medical education, Indian Journal of Medical Informatics. 2008; 3(1): 3: http://ijmi.org/index.php/ijmi/article/view/y08i1a3/15 
10 Sarbadhikari SN, The State of Medical Informatics in India: A Roadmap for optimal organization, J. Medical Systems, 2005, 29: 125-141. 
11 Sarbadhikari SN, Basic Medical Education must include Medical Informatics, Indian J Physiol. Pharamcol., 2004, 48(4): 395-408. 
12 Sarbadhikari SN, Guest Editorial on “Medical Informatics — Are the Doctors Ready?”,J.Indian Med. Assoc. , 1995, 93: 165 – 166. 
13 Mantas J,et al, Recommendations of the International Medical Informatics Association (IMIA) on Education in Biomedical and Health Informatics – 1stRevision, IMIA, 2009 
14 Burnette MH, De Groote SL, Dorsch JL. Medical informatics in the curriculum: development and delivery of an online elective. Journal of the Medical Library Association : JMLA. 2012;100(1):61-63. doi:10.3163/1536-5050.100.1.011. 
16 NHP, EHR Standards helpdesk: http://www.nhp.gov.in/ehr-standards-helpdesk_ms 
17 IHTSDO, SNOMED-CT: http://www.ihtsdo.org/member/india 
18 American Academy of Family Physicians, Recommended Curriculum Guidelines for Family Medicine Residents on Medical Informatics: http://www.aafp.org/dam/AAFP/documents/medical_education_residency/program_directors/Reprint288_Informatics.pdf 
19 AMIA, ABPM, ABP, Clinical Informatics Subspecialty Board Examination: https://www.amia.org/clinical-informatics-board-review-course/board-exam 
20 CDC, Public Health Informatics Fellowship Program:http://www.cdc.gov/PHIFP


Dr. Supten Sarbadhikari

Digital Health Influencer & Project Director at Centre for Health Informatics of the National Health Portal; President IAMI (2016)

#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


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)

Strategies to Foray into Digital Health by @JPpattanaik

Author: JP Pattanaik, Sr. Business Analyst & Akanksha Rajeev, Business Consultant

in this article, provide an insight to various strategic options for Indian IT product-centered organisations to consider foraying into healthcare industry

The article was first published in Express Healthcare, Feb 2016 Edition. The article is republished here with the authors’ permission
24 Mar 2016, India


The lucrativeness offered by the healthcare IT industry has brought significant attention worldwide. Healthcare industry is considered ever green and healthcare IT has attracted the attention of global players for investments. There are a section of players who are pioneers in the industry and have recorded significant growth. At the same time there are laggards who want to build such capabilities and tap the untapped market following the recent industry trends and success stories. Healthcare IT organisations have to cope with transforming business model while adhering to strict regulatory demands of the industry. They need to carefully adopt strategies based on the organisational maturity, capital and the time they have for go-to-market. In pursuit of quick success, often organisations commit mistakes choosing the right approach while building potential health IT product capabilities. This article highlights different strategic options for Indian IT product-centered organisations thinking of foraying into the healthcare industry
Global Healthcare and Healthcare IT spending trends

According to industry estimates, the global healthcare spending is expected to grow at an average of 5.2 per cent year on year during 2014 – 2018 to a total of $9.3 trillion. In spite of its vastness, both developed and emerging nations are dealing with issues like ageing population, rising incidences of chronic diseases, rapidly increasing cost of healthcare, disparity in quality of care, infrastructural challenges, workforce shortage, non-uniform distribution of healthcare facilities across the community locations etc. The burden faced globally today has never been so challenging than ever it was.

An estimate by the Economist Intelligence Unit (EIU) the regional healthcare spending during the year 2015 is expected to be as given in the table.
Globally, most nations have been challenged to improve quality of care while reducing the cost of healthcare by means of inventing cost effective methods for an optimal outcome. The challenges described above have led to adoption of healthcare IT solutions such as Electronic Medical Records (EMR)/ Electronic Health Records (EHR) for safe storage of healthcare information and to make more informed decision.
According to an estimate by MarketsandMarkets, a leading research organisation, the global healthcare IT market is estimated to reach $56.7 billion by 2017 — up from $40.4 billion in 2012 — due to the demand for clinical information technology, administrative solutions and services. Among the various healthcare IT solutions offered, EMR/ EHR segment dominates the sector.
Gartner estimates healthcare providers in India are likely to spend $1.2 billion on healthcare IT products and services in 2015, a seven per cent growth over 2014. Software spending is likely to grow 6.2 per cent to reach $103 million in 2015, up from $97 million in 2014, led by growth in vertical specific software. An estimate by Frost & Sullivan, healthcare information technology market in India is expected to reach $1.45 billion in 2018 mainly due to fast adoption of technology by stake-holders. India being a developing nation, the health IT spending is still much less than that of the developed nations. The rest of the paper discusses various drivers for healthcare IT initiatives, its attractiveness and approaches for Indian health IT organisations for an effective go-to-market strategy.
Drivers of Healthcare IT in India 

Some of the major factors contributing to the growth of healthcare IT globally are listed below:

  • The continuously growing pressure to cut healthcare costs
  • Need for care coordination and management demanding integrated healthcare systems
  • High rate of return on investment in healthcare systems
  • Financial support and incentives from the government
  • Growth of medical tourism
  • Government initiatives, conducive policies for the sector
  • The rise in the ageing population
  • Growing demand of health IT products to reduce medication errors
  • Rise in incidences of chronic and lifestyle disorders
  • More informed and engaged patients.

Why do more and more Indian IT organisations want to venture into Healthcare Industry?  
Healthcare has a huge addressable market. India as a country has witnessed a rather steep growth trajectory only in the last decade with the advent of the private sector. The influence of technology has been an important growth driver, with healthcare models based on IT intervention now becoming a reality. The accessibility of healthcare today is more than it ever was, consequently increasing the opportunity for new players. Emergence of new delivery models which are scalable, less capital intensive and yet promise better earnings is one of the major reasons the healthcare sector has lured the investors. Diagnostic chains, single speciality clinics, wellness centres, primary care set-ups etc. are all emerging models of healthcare and it is still evolving. In a nutshell, healthcare industry provides array of opportunities for new experiments at a promising return on investments. The penetration of healthcare IT is still in its infancy providing ample opportunities to all competent healthcare IT solution providers. With increased importance to healthcare needs, the adoption of modern healthcare IT systems is bound to grow.

Approaches for Go-to-Market  

In order to tap the business opportunity presented by the IT enablement of healthcare institutions, the IT organisation should evaluate options and consider one that suits the best. A single approach may not fit all. In pursuit of quick success, often IT organisations opt for suboptimal options, which may not meet their long term objectives. Following are the three strategic options to realise the business opportunity presented by healthcare IT market:
  • Approach 1: MODIFY Enhancing an open source software
  • Approach 2: CREATE Building a greenfield system
  • Approach 3: ACQUIRE Acquiring a licensed product

The table below provides the advantages and disadvantages associated with each of the approaches.
An organisation should evaluate the functional, technical and business capabilities while prioritising a strategic approach. Each of the approaches can be evaluated based on the following parameters:

Cost and effort
Total cost of ownership (TCO): Total cost of ownership refers to the cost to the organisation for sustaining a product line. This includes the license fee for the product and cost of the application maintenance and support.
Effort: This is the effort that needs to be put in by the organisation to meet the desired product criteria driven by Customer/ Market needs.
Potential Revenue: This refers to the revenue that would be generated by the organisation on entering the market with the stated product.

Market factors
Time to market: This is the time taken to launch the product in the market for customers.
Market acceptability risk: The risk that the product launched into the market is not accepted by the clients. This is particularly high for a new product launch.

System related factors
Customisability: The capability of a system to be easily customised for desired features. Creation of a greenfield system offers the highest amount of flexibility as it can be designed keeping product expansion in mind.
Scalability: The capability of a system to be easily scalable for larger implementations. While a greenfield system can be designed to be scalable an open source or acquired product may have limitations.
Skilled resource availability: The major constraint of a system is the technology stack that it is built on. Having technically sound resources trained exclusively on the same platform is one of the major factors for system selection.
Legal/ IP Risk: Enhancing and commercialising existing open source systems would give rise to potential legal risks. Some systems are covered under various public licenses which prohibit the commercial use for profit.
Security risk: With the ever growing population that is being catered through the IT enabled system, security of the healthcare data plays a vital role in the evaluation of a system. Many laws of the land mandate patient privacy and prohibit the transfer or usage of the healthcare data and thus require utmost authorisation and protection for the same. Any shortcomings in the system that compromises patient data security would pose a security risk.
The evaluation of each of the approaches based on the above mentioned parameters are summarised in Figure 2.

Key Considerations  

A greenfield system though requires investments, is a safer approach as it minimises some the risks demonstrated in other two approaches. However, all organisations may not be in a position to have proprietary systems to exploit the immediate market opportunities presented. The pioneers always have the advantage to exploit the market opportunities with less competition. New players should carefully choose the market segment they want to make an entry. When an organisation lacks significant market presence and experience, it may be recommended that the organisation should take baby steps and stay profitable yet. A big bang approach may not support the ultimate objectives of the organisation. In this context it may be recommended to health IT vendors that the
Approach –‘MODIFY’ can be considered as a short term strategy with an objective of learnings, small scale implementations and R&D.
Approaches – ‘CREATE’ and ‘ACQUIRE’ can be considered as long term strategies with an objective of achieving the vision of the organisation.
Approach – CREATE demands investment in terms of time and ensuring the product exceeds expectations than a competing product while 
Approach – ACQUIRE enables the organisation a quicker go-to-market for realising the opportunities. However, the risks associated with the approach must be given due consideration.


The lucrativeness of the healthcare IT market has received significant attention. It is an obvious choice to exploit the opportunities presented. The pioneers and the laggards are equally keen to make the best of the opportunities. An approach that works best for a pioneer may not be of same value to a beginner. In pursuit of quick success, organisations should not commit the mistakes of engaging in a wrong approach to make a foray in hurry. It has been rightly said, “There is no shortcut to success.” Organisations need to carry out a risk and return tradeoff before formulating and executing any strategies for the best possible outcome.


i. 2015 Global Healthcare Outlook. Common Goals and Competing Priorities By Deloitte, Whitepaper, 2015.
ii. Global healthcare IT market estimated to reach $56.7B by 2017 By Ashley Gold, News Article, FierceHealth IT, May 10, 2013.
iii. 2014 Global health care outlook: Shared challenges, shared opportunities By Deloitte, Whitepaper, 2014.
iv. Overview of International EMR/EHR Markets: Results from a Survey of Leading Health Care Companies By Accenture, Whitepaper, August 2010.
v. Healthcare IT market in India may touch $1,454 million: Study
vi. IT spending by Indian healthcare providers may rise 7 per cent in 2015, Gartner says

Disclaimer: The ideas and opinions shared in this article are personal views of the authors and have no bearing or impact on the official policy or position of United Health Group or its entities


JP Pattanaik

Healthcare Management and IT Consulting
Akanksha Rajeev

Healthcare Management and IT Consulting

Top #DigitalHealth Trends to expect in 2016 by @AmandaShaffer14 @pankajguptadr

Author: Amanda Flowers & Dr. Pankaj Gupta

The article was first published in Healthcare-IT Business Strategy. The article is republished here with the authors’ permission
17 March.2016, India

The Technology has transformed healthcare around the world at a faster rate in the last few years than at any other time in history. There are many exciting innovations poised to help improve patient outcomes and the landscape of healthcare as a whole over the next few years. For 2016, we can expect to see the following IT driven changes in India:
Expanding Telemedicine Services

The telemedicine market in India is expected to reach a valuation of about $18.7 million by 2017, according to Deloitte. Since telemedicine makes it possible to provide needed medical services from a distance, this may be particularly helpful for individuals in rural communities that do not have access to the larger hospitals and centralized facilities. Medical professionals can provide advice to patients and can even consult with patients about specific issues using video chat options.
Greater Integration of SMAC

SMAC, standing for Social, Mobile, Analytics, and Cloud technologies have transformed every business in India and around the world and healthcare is no exception. As medical facilities get on board with using social options, patients will be able to interact with their doctors and obtain information about their health and well being in new and convenient ways. Analytics in healthcare will allow information to be analyzed and cross referenced, assisting with research and outcome improvement.

Mobile integration puts health information at the patient’s fingertips in a way that was not possible in the past. This may help improve outcomes and communications between medical providers and patients in countless ways as the shift to mobile is embraced. The movement from client server to cloud is shifting the industry IT vendor landscape, with many smaller and newer vendors beginning to replace large vendors that have traditionally assisted with IT needs.
Increased Use of Medical Wearable Devices

The use of health and fitness wearables has increased substantially over the past few years and is expected to continue to increase at an ever-faster rate until about 2020. Start-up companies are experimenting with creating wearables featuring health IT features. We may see prototypes emerge this year that allow patients to instantly send remote information about biometric data that is obtained using sensors in various medical wearables. This could allow physicians to spot medical issues much faster.

Improved Mobile Access to Health Insurance

Private health insurance covers about three percent of India’s population. The government health plan covers about eight to nine percent of India’s population, while the rest is paid out of pocket. In 2015 the Parliament passed the Insurance Bill where the FDI in Insurance was raised to 49 percent and health insurance has been declared as a separate business. Also 100 percent FDI was allowed in medical devices. These two policy changes will bring a boom to the mHealth and health insurance market in 2016-2017.We predict Insurance support for mHealth solutions including outpatient visits and chronic disease management or non-communicable diseases [NCD] as it is called in India.

Many companies now also allow individuals to apply for health insurance using mobile apps. In 2016, we can expect to see even greater competition in the industry with more mobile access and improvements in automating the claims process.
More Complete Patient Histories with EHRs

EHR and MDDS for health domain standards were notified in September 2013 and approved in December 2013, respectively. As medical facilities adjust to using systems to keep electronic records, we can expect to see more complete patient histories begin to affect outcomes and standards of care. This is especially true across borders, as many developed nations are now employing the same standards for coding and keeping EHRs. We may see 2016 bring forth improved software that simplifies electronic record keeping, transitions of care, coding, and billing.

Widespread Adoption of Surgical Robots

India has been behind the ball in adopting surgical robots for some time now, but we may see many more robots flood the hospitals this year. Intuitive Surgical, the creator of the U.S. based da Vinci surgical systems, considers India an important market. The Vattikuti Foundation plans to increase the number of surgeons trained to perform robotic surgeries from about 147 currently to 300 by 2020.

IoT Revolutionizing Patient Care

The Internet of Things is an extremely beneficial addition to the medical industry. We expect IoT platforms to emerge that will enable integration of all healthcare applications, devices, and things. Health monitoring devices can track vital patient information such as blood pressure, heart rate, and blood sugar levels every single day and communicate this information to medical professionals. Pacemakers and other medical devices can also be connected so that information is transmitted daily and not just during doctor visits. Medical professionals can directly communicate when information is worrisome and can save time from running unnecessary tests when health signs are good.
CRM Improving Patient Relations

Customer relationship management has always been important, but is now easier than ever because of SMAC technologies and EHRs. Doctors can communicate more freely with patients and can track all interactions for future review. These options will help make doctor/patient relations more personalized. A personalized approach will improve patient satisfaction and may also help to improve outcomes.

Article By: Dr. Pankaj Gupta

Digital Health Influencer & SMAC / IoT Speaker | Healthcare Business Executive, Chief Medical Informatics Officer at ProMed Network AG | Managing Partner at TAURUS GLOCAL CONSULTING | Director at Taurus Globalsourcing Inc.
Amanda Flowers

a graduate in Psychology, with minor in English Literature and Public Health. She draws on her knowledge of these subjects to create online content that addresses human needs in a simple way. Flowers is currently a freelance health blogger and working for Blue Cross Blue Shield of NC

#Infographic : 7 Types of Cyber Threats

  • 61% of business leaders see cyber as a serious business threat, 
  • 140 countries business leaders say cyber threats us highest concern
  • $445B estimated annual toll of cybercrime on global economy
  • 67% of enterprise organisations believe that the threat landscape is worse today than it was 2 years ago – ESG: Threat Intelligence as part of Cyber Situational Awareness
Cyber Threats have been increasing over the past years. It is important to therefore understand what are the types of Cyber Threats that one must guard against, personally and as an organisation.
We prepared this Infographic from an article that appeared in Healthcare IT News, by @SullyHIT titled ‘7 cyber threats worst than PHI a summary of Richard Clark’s talk’


Team HCITExperts

Your partner in Digital Health Transformation using innovative and insightful ideas

The Formula of Driver and Demand- Indian Startups story via @drruchibhatt

Author: Dr. Ruchi Dass

Health Innovator (HIT, BigData, IoT, Analytics and Cloud) | TED Speaker | Investor and Mentor
15.Feb.2016, India

The healthcare industry is currently experiencing change at an unprecedented rate. Change is not only occurring in the technology used in diagnostics and care delivery, but this change is so fundamental that it could, and likely will, fundamentally alter the business model of the industry.
Today we have fitness bands, healthcare apps, appointment schedulers, health chats and several such means to access healthcare but one thing that all of this does not necessarily correlate with high quality of care or better outcomes.
We need to understand that “Not even a Ferrari will get us to our destination without a driver.”
Formula of Driver:
Driver = (Need + Incentive) where;
Incentive = (Value + Reward)
Need = (Gap + Demand)
To define the best drivers, we need to first address the need. Need might not make economic or business sense but it is the best opportunity to leave an impact. No one remembers how much business a “Mughal-e-Azam” or “Usual suspects” did but everyone remembers that these were great movies with splendid performances.
In India, we have several such needs today. A survey conducted by HCG on several pressing issues in the field of health and safety highlighted the following:
  1. Women safety
  2. Elderly concierge services
  3. Child safety
  4. Personalized nutrition
  5. Health Insurance for OPD services
  6. Cancer support/ early detection
  7. Infertility
  8. Fitness (scientifically monitored) and performance 
This list is not exhaustive. I don’t need to look at statistics to confront the horrid truth. News stories of women from all over India being raped, beaten, killed are flashed across us day after day – and we all are aware of it. The fatal Nirbhaya gang-rape saw an outpouring on the streets of Delhi – protests decrying the fragile status of women in India. Candle light marches, editorials examining the patriarchal and sexist traditions of our country, an awakening on social media – even conversations on streets revolve around the night they cannot forget: the night that took Nirbhaya. We need to do something about women safety. Devices, trackers, processes, helplines- whatever little or more we can do. 
 If you are an innovator in this area, please get in touch with me.
For elderly even small accidents can be deadly. While simple falls, such as slipping while walking off a curb, may seem relatively harmless, they can actually lead to severe injury and death in elderly individuals, according to a new study published in The Journal of Trauma: Injury, Infection, and Critical Care. As the population continues to age, it is important for physicians and caregivers to be aware of and prepared to deal with this issue, which could significantly impact the overall health and wellbeing of older adults. 
In addition to it, low blood pressure, low blood sugar, heart attack and other things can be very worrisome and need constant monitoring. Innovators call to action here is to come out create and raise awareness about such bracelets, devices and jewelry that can be adorned for a purpose.
Without calorie count possible, limited heart rate tracking and availability of other vitals; performance management and fitness efforts are less effective. Measuring your heart rate using a heart rate monitor is a good way to gauge the effectiveness of your workout because as you strengthen your body through exercise, you also strengthen your heart.
Measuring the rate of your heart during exercise can help you determine when you’re pushing your body too hard or need to push it harder to achieve the level of fitness you are seeking. I love the work Hexoskin and Kenzen are doing. I am looking for something more affordable and focused for Indian market.
Health tech is blazing hot right now and there’s no shortage of companies working on innovative products designed to change the face of healthcare as we know it. That’s a good thing, considering Indians are as unfit as ever and bureaucracy continues to muck things up for physicians and patients alike. As technology evolves, it could upend some of these problems. One thing that’s certain: Consumer-driven healthcare is coming. And these companies are helping make it happen.

All the best !


Article By: Dr. Ruchi Dass

Digital Health Influencer & Health Innovator (HIT, Big Data, IoT, Analytics and Cloud)| TED speaker | Investor and Mentor

New Healthcare Aggregators: SMAC and IoT via @pankajguptadr

Author: Dr. Pankaj Gupta

Digital Health Influencer & SMAC / IoT Speaker
15.Feb.2016, India

The old paradigm of business as a linear value chain is now facing extinction. Businesses are now ecologies and not merely producers and sellers ! That requires a change in thinking. Customer Relationship Management (CRM) needs to be a mission at every step of the process. This is hard to overemphasize! The internet is clearly the medium that allows such integration across time and space. It is time to take a more accepting look at Cloud and Social Media technologies. This offers the only universal layer of engagement across stakeholders. The investment in IT hardware as we new it in the past has been greatly optimized by mobile. It has brought a tactile feel to life and work for all of us. Mobile mirrors the nature of Healthcare in terms of immediacy and continuity so well. Healthcare needs to embrace it wholeheartedly. Healthcare can only profit from it.

There is a huge Vacuum in Indian Healthcare-IT space. Large Healthcare-IT vendors have exited the market. Either they lost interest and exited or got bought out e.g. TrakHealth, iSoft. Also the market is moving from client-server to cloud and from Capex to Opex models. New cloud based players are small in size and yet to reach enterprise class. Existing players are not able to shift out to cloud because of their long term negotiated contracts in client-server model. The time is now when full conversion of Enterprise class to SMAC will happen anyways. Healthcare CIOs can keep eyes closed or tighten the belt and ride the Digital wave.

Recently I spoke to a Director of State NHM in India. He said we are doing HMIS and Public health through ANM/ASHA. How do we benefit from SMAC IoT platform? Hard for many to imagine SMAC is a unifying force across enterprises and IoT breaks the silos. This can be quite unnerving for many. 

The era of hierarchical command and control is over. Now is the time for horizontal networking across Communities of Practice [CoP]. Whatever gets the maximum likes becomes the In Thing. Whatever is the In Thing gets used the maximum. Students are learning more from the online networking than from the formal classroom and professors. Research will reach the point of use as soon as it gets published. Primary care Providers in semi-urban and rural areas will have access to latest therapeutic recommendations. The old Adage that ‘Knowledge is the only form of power that is not expendable but grows when shared’ has become true.  

The movie Avatar has beautifully depicted the concept of Small data ^ = Big Data where small knowledge base of each living being [App] is contributing towards the collective consciousness [Big Data] of Eywa. Now the question is will the future of SMAC/IoT be driven by technology or biotechnology?

Anyways for now – The time has come when you don’t need big monolithic HIS software to run hospitals. Now you can do everything with small mobile based Apps for every function. Though I am already seeing many of these Apps in the market but what is lacking is a unified platform on which the Apps should be built such that the data can be seamlessly collated. Also it gives the provider the flexibility to select from a bouquet of Apps. 

IoT integration platforms are emerging that will integrate at the App level, Data level and Semantic level. Anyone in the ecosystem can slice, dice, run reports on the collated data.

Successful Cloud models have dug the grave for the Enterprise Hardware. Capex has got converted to Opex. Now you can pay for the software on the cloud like you pay your monthly electricity bill.

SMAC coupled with IoT has a potential to bring the Aggregator Business model to Healthcare. Soon the unorganised and fragmented primary care, secondary care and supporting care market will begin to get Aggregated. I see these Aggregators becoming larger than established capital intensive Enterprise market similar to what happened in the Automobile market. It will be in the interest of Insurance, Pharma and Govt to go all out and support this emerging SMAC/IoT driven Healthcare Market Aggregation.    


Why Healthcare must Re-imagine itself – and how
Why All Indian Hospitals IT is in Bad Shape
Global HIS/EMR vendor nightmare outside US
Thick client vs Thin client
There is no Market for EMR in India
Size of Healthcare-IT Market in India

Please note: The Author of this article is Dr. Pankaj Gupta. The article was first published on Dr. Gupta’s blog. And also on Dr. Gupta’s LinkedIn profile :New Healthcare Aggregators: SMAC and IoT | Dr Pankaj Gupta | LinkedIn

Article By: Dr. Pankaj Gupta

Digital Health Influencer & SMAC / IoT Speaker | Healthcare Business Executive, Chief Medical Informatics Officer at ProMed Network AG | Managing Partner at TAURUS GLOCAL CONSULTING | Director at Taurus Globalsourcing Inc.

Revolution In Healthcare via @SelfCareGuru

Author: Joao Bocas 

Digital Health Influencer & Wearables / IoT Speaker
10.Feb.2016, London, UK
The emergence and increased severity of chronic illnesses around the world has grown to exponential heights in comparison to the last fifty years of medical analysis. The existence of chronic diseases are crushing the Healthcare sector and the resources therein, and subsequently creating socioeconomic issues within the diaspora as the government, patients and insurers are faced with the burden of paying higher costs for medical services. We have a major crisis on our hands, one which not only declines the population’s status of health, but also lowers the potential productivity of said populace. In light of the aforementioned, it is in the best interest of all to revolutionize the current Health Care systems in hopes of changing the trajectory of the potentially disastrous outcomes. 

Around the world, unhealthy lifestyles and aging populations have strongly influenced the constant recurrence and prevalence of chronic diseases. This category of illnesses place a strain on healthcare providers and the healthcare system at large, due to the high volume of hospital visits and admissions by ailing patients. Strategically speaking, healthcare providers have what may be considered as a normal range of activity within which patients are anticipated to operate. However, those who require long and resource-intensive treatments undoubtedly use up intensive care resources that were initially set aside for the interest of other insured patients. This growing problem has led to the drastic reduction in available resources and the imposition of limitations in regard to certain treatments.

Tactics employed to protect health care systems and their resources have sufficiently lessened the availability of the once prevalent resources, and in direct proportion, have increased the growth of people with chronic diseases. In the near future, it is clearly foreseeable that if no radical intervention is initiated, this downward spiral will only increase the intensity of the detrimental effects suffered by all involved. 

Sadly, despite the wondrous advances in medicine and technology, health care continues to fail as it is unable to provide what its customers truly need. Regardless of the increasing complexity and best intentions of doctors and nurses involved, they can no longer guarantee the provision of the best care practices to ailing patients. Fixing health care will most definitely require a radical shift from current health care practices that are individual based, to a strategic approach that embraces a team-based way of work.  Although many physicians are anxious about the reduction of money, autonomy and respect; accepting new organizational structures, payment models and performance goals; could possibly create a level playing field for both insurers and patients. 

To catapult this change, leaders from all sub-divisions of health care must draw on their reserves of courage, resilience and optimism; and stand up for what they believe in. They must make it a point of duty to be aware of the economics and social capital relations which define how they are paid, and be willing to cut ties with companies who are solely driven by monies acquired as opposed to the improvement of outcomes and efficiency of service.

Conclusively, in the writings of sociologist and economist Max Weber, four major considerations of social action which have been adapted for healthcare improvement includes: shared purpose, self-interest, respect and tradition. These levers may be manipulated to bring about the changes, which the system so desperately needs

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Please note: The Author of this article is Mr. Joao Bocas. For resharing the article, please contact Mr. Joao Bocas or the HCITExpert Admin via our contact us page.

Article By: Joao Bocas

Digital Health Influencer & Wearables / IoT Speaker

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.

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