#DigitalHealth

Healthcare Decoded – The #Analytics Conundrum by Harish Rijhwani, @Harish_Rijhwani

If we want to start using Analytics in India, one of the areas to focus on can be in the area of Diagnostic Analytics. We can leverage Transfer learning in this area as there are many pre-trained models leveraged by others and available. 

Timeline: The History of the EMR/EHR by David Rice @bigdatadavid13


Much of the conversation around healthcare technology is centered on where new developments are taking us. But as the age old adage goes, you can’t know where you’re going until you know where you’ve been.
And when it comes to health IT, few innovations have been more significant or played more of a central role in innovation, than the digitization of medical information in the form of the electronic medical record (EMR) and later, the electronic health record (EHR). To better illustrate the history behind this technology, we’ve created the following timeline to provide you with some context behind the evolution of this technology.


The article was first published here. The article has been republished here with the authors’ permission. 
Author
David Rice

David Rice is the editor of USF Health Online. He covers a wide range of health IT related topics for the University of South Florida’s online informatics and healthcare analytics programs.

Why should standalone Hospitals in India focus on IT enabled productivity by Tirupathi Karthik, @TirupathiKarthi CEO at @NapierHealthit


Fresh out of HIMSS India’s inaugural Digital Healthcare Summit, (2015) in Gurgaon, I lamented over the state of healthcare IT in the country. At the time, we were showcasing our hospital information system and launching our telehealth and patient referral management solutions. I should have been proud to be a part of the innovation on display at the event, and understandably so. But what struck me harder than pride at the event and left me with a lingering sense of disappointment was something else. And that was just how far some parts of India lagged behind the rest of the developed world in terms of healthcare delivery and quality.

Napier Healthcare is a global company headquartered in Singapore, where it manages the development of technologies to world-class standards. My other point of reference is the US. So whenever I consider the industry in India, I am invariably piqued by its difference from the industry in Singapore and the US. Especially the US, since it is a democracy like India and has similar health problems on a large scale.

In the time that has passed since HIMSS India, I have thought through some options that the Indian healthcare should seriously consider moving forward. 
EMR Enforced By Law

The most obvious difference I see between India and the US is in their standards and certification environments. We do business in the US and have to be certain that our solutions meet that market’s most stringent regulatory and certification requirements. They include HIPAA and a few others, but more significantly in the case of hospital information systems, the Meaningful Use Stage 2 (MU2) compliance certification. These certifications create significant entry barriers for non-serious players, and make certain that healthcare IT (HIT) quality is maintained in the market.

The policy framework in the US sees to it that EHRs (Electronic Health Records) are sold with certain features that ensure nearly zero medical errors, well-supported transitions of care and ultimately higher quality care delivery.
India has been working on a national EHR standard since 2013, when the Ministry of Health & Family Welfare (MoH&FW) announced its first set of requirements. The MoH&FW has subsequently made continual enhancements of this set of standards. Translating policy intent into effective outcomes still remains a distant goal in most states as software vendors have an option, not a mandate, to comply with this EHR standard.
I must admit, though, that for a large country such as India, executing that would take quite a few years. Even then it would most likely reach only those under some form of formal insurance, and that too only in the metros and some larger cities. As a result, the majority of the population in the semi-urban and rural sector would be excluded from this. 

Automation to Level the Playing Field

The World Bank tells us that private hospitals account for 67 percent of total healthcare expenditure in India. World Bank numbers also tell us that in 2014, citizens paid for 89.2 percent of their healthcare expenses out of their own pockets[1]. These figures have been rising constantly since 1995, and they clearly show two major trends.
One is that private healthcare is enjoying explosive growth in India, with larger private healthcare providers, such as Fortis and Apollo, gaining the lion’s share of the market, and smaller private hospitals being edged out of reckoning slowly but surely. The other is that healthcare is becoming an increasingly heavier burden on Indian citizens. And on poorer households in India, that only drives them deeper into poverty.
My recommendation is for < 100 bedded hospitals to focus on quality rather than volume, and to leverage HIT and automation in their efforts. Automation helps  improve patient-care coordination and ensure the consistency of patient care across facilities, and foster patients’ (and their families’) engagement in their own care. This all adds up to better care and lower costs of delivery for hospitals, and better health outcomes for patients. Today most healthcare providers think of Billing and Inventory as the key areas for automation to the exclusion of everything else. This myopic vision leaves a lot of value gaps that goes un-leveraged and un-monetised.
From the industry standpoint, smaller private healthcare providers who leverage HIT effectively ensure their survival and success, help bring about a more competitive provider market, and ultimately offer better quality care at lower costs.

Get Over Short Termism

Short-term thinking is holding back progress in the healthcare industry and preventing innovation among HIT vendors. Our studies have shown that hospitals  seldom spend more than 0.5 percent of their revenue on IT. Mostly they tend to source customized software solutions from small time players and the mindset seems to be—“cheap is good but free is better.”
Clearly, they do not see IT as a competitive differentiator that can help reduce cost and improve productivity. Small time IT players seldom invest in R&D and rarely provide yearly updates and upgrades. This means that hospitals need to re-implement every time they need to do a technology upgrade. But instead of seeing the potential loss of patient relationships and revenue opportunities that comes with every implementation, many hospitals stay fixated on just how cheap it is to get a new solution every time.

Compared to a global average of 2-2.5 percent of investments by hospitals, or 6-15 percent by other sectors in India itself,  hospitals are far behind their global peers in recognizing the value of good software. The impulse is always to invest for the quick ROI. For example, instead of investment in IT, many CEOs traditionally have wanted to invest in CT Scan or other equipment, which can generate revenue from the following morning itself.

By extension, this approach of managing the affairs of the hospital stifles innovation among IT vendors and limits their ability to invest in R&D for creating innovative IT solutions.
I strongly urge the healthcare leaders to change their mindset and start looking at generating productivity gains by setting up lean and mean operations. The skilled work force is increasingly hard to come by. Hospitals need such critical resources like Doctors and Nurses in abundance to support the opening of newer facilities and not having them will limit growth, like one of our customers in India is realizing very quickly. With abundant money supply Hospitals can easily raise capital today but not having good physicians and nurses will limit their growth for sure.
The only way to achieve sustainable growth is to focus on enhancing productivity rather than just adding to the labor force alone. And quite simply the most effective approach to enhancing productivity at any organization incorporates the innovative use of good technology.
So my key message here goes directly to senior executives of healthcare facilities:   is to view IT as a competitive differentiator rather than as a cost management tool. And recognize that the right software and other tools are essential to making those gains and sustaining your business growth. Continually benchmark your practices to hospitals globally and not just with peers locally.

Finally, Insurance is coming

Increasingly top hospitals are becoming aware that the Insurance reimbursements are a significant portion of their revenue and rising every year. DRG classifications and reporting are going to become commonplace as Insurer’s seek to reduce their cost by paying for “packages” rather than individual services. This means that Hospitals that won’t or can’t respond to the Insurer’s will be left to address private-pay market that will shrink slowly but surely. If one studies the evolution of the US system you will find a strong parallel to the trends in the Indian healthcare system. This will be an existential question for providers.

Like they say “the best way to predict the future is to invent it”. 


Conclusion

  • Healthcare providers need to implement software and other tools with a view to generate productivity gains – not just to generate bills
  • View IT as a competitive differentiator rather than as a cost management tool

The author is the CEO of Napier Healthcare, a Singapore based software provider of technologies such as HIS, EMR, Portals and revenue generating solutions such a Referral management and CRM. He has personally witnessed smaller Singapore healthcare providers with ~100 beds overcome manpower crunch by using technology.

The Article was first published on Mr. Tirupathi Karthik’s LinkedIn Pulse blog, here, and has been republished with the author’s permission.

Author
Tirupathi Karthik

A leader in the Healthcare IT space, Tirupathi Karthik has extensive business leadership experience across Asia, the Middle East and USA, particularly in the enterprise software space. He is a passionate advocate for the innovative use of technology that turns IT investments into competitive differentiators for their stakeholders rather than using IT as a pure cost containment initiative.

In various hospital implementations, he has been championing the use of Mobility as a pervasive information delivery channel. His vision led to the use of themFirst approach with the infusion of HTML5 and Apple’s mobility products across the Napier platform. Napier’s leadership in the global marketplace continues to gather momentum on the back of one of the most modern implementations of such a technology stack.

As an Eldercare thought leader, he has been driving productivity agendas for aged care models globally and seen to the expansion of Napier’s product vision to include elderly care services delivery. Applying technology-enabled solutions for senior care providers offering nursing home, home care and activity-centre services, Napier today enables productivity and improved quality of care.

Why India needs Healthcare Information Technology (HIT) by Dr Pramod D. Jacob


India with its vast population of over 1.3 billion firstly has a challenge in keeping a track of this vast population’s health, much less keep them healthy.  One of the major reasons for this is lack of timely, accurate and reliable healthcare information in today’s paper world

State of Health in India

In healthcare India ranks very poorly, even compared to our neighbouring countries. For example in the following health indicators: –

Maternal Mortality Rate (year 2015): defined as number of women who die during pregnancy and childbirth, per 100,000 live births. India has a rate of 174 maternal deaths per 100,000 live births, which is worse than Bhutan (148 /  100,000) or Sri Lanka (30 / 100,000 ). China which also has a large population is much better (27 / 100,000) 

Infant Mortality Rate (year 2017): defined as number of children who die less than one year of age per 1000 live births. In India the figure is 39 per 1000 live births, behind Bangladesh ( 32 / 1000 ) and Nepal ( 28 / 1000 ). China is 12 / 1000.

State of healthcare information collection for events like epidemics in India

Before 2010, it would take about six months for the health information to be collected, collated and analysed to prove that a given region in India had an epidemic as the entire process was paper based. By that time the disease (with most being self-limiting) would have struck, had its toll of morbidity and mortality and run its course. With most data collection being paper based this delay costs India loss of lives and productivity with high morbidity, especially in rural areas ( in urban areas- private hospitals and clinics have a process of notifying the public health authorities for notifiable diseases, hence epidemics are identified earlier in urban areas) .

To top it all there is general disbelief in the official published health statistics in India. For example, official data claimed that Malarial deaths in India was only 1,023 in 2010, however a Lancet published study showed the figure to be actually 46,800. Following the Lancet article, the official data agreed that they had their figures off by twenty to thirty times.  Even for a common disease like Cholera, which strikes every monsoon in endemic areas along the Ganges and Brahmaputra, the official estimate for India is 3,631 cases per year, while research has shown this to be about 22,200 per year.   

While the immediate reaction is to blame the public health authorities and Government in India, one must understand the limitations in a paper world to collect health information of 1.3 billion people across 3,200,000 square kilometres. Compare that to collection of information electronically – an electron can travel around the world in about 19 seconds. 

The solution – Healthcare Information Technology (HIT)

The solution is to produce healthcare information in a timely manner with accuracy and reliability. To achieve speed, it is best to do so with Information Technology – hence HIT. To achieve accuracy and reliability, it is best if the patient’s data is put into the HIT system by the providers of healthcare such as doctors, nurses, pharmacist etc at the point of care. This patient level data can then be collated and processed to get timely, accurate and reliable population-based healthcare information.

 In addition, HIT systems provides the power of IT to healthcare such as giving alerts for drug-drug interactions, duplication in lab tests and bringing about efficiency in processes and workflows in a healthcare setting, producing reports quickly which will help in planning and deployment of healthcare. It is estimated that healthcare doubles in knowledge every few months and it is difficult for doctors to keep up. With HIT it will be possible to keep up with the latest and deploy best practice evidence-based medicine applicable for India.

The proof of HIT bringing exponential improvement in speed and access to important healthcare information like epidemics even in Indian public health, is best exemplified by the IDSP program. The IDSP program has gone digital from district level upwards to state and then to the National Centre for Disease Control (NCDC), Delhi. As a result, the NCDC now publishes data on epidemics and events on a month to month basis and will soon be publishing it on a weekly basis. Will cover the details of this program in a future write up. 

This article has been republished here with the author’s permission. The article was first published here.

Author
Dr Pramod D. Jacob (MBBS, MS- Medical Informatics)

After completing his medical degree from CMC Vellore and doing his Master of Science in Medical Informatics from Oregon Health Sciences University (OHSU) in the US, Dr Pramod worked in the EMR division of Epic Systems, USA and was the Clinical Systems Project Manager in Multnomah County, Portland, Oregon. He has been a Healthcare Information Technology consultant to Benton County, Oregon and Santa Cruz County, California. In 2007 he relocated to India and did consultancy work for the state governments of Tamil Nadu and Himachal Pradesh. He was a member of the HIMSS Global EHR Task Force and the lead for India in the task force.

At present he is the Chief Medical Officer of dWise Healthcare IT solutions, involved in the designing and implementation of Clinical Information Systems and the EHR for the company. He is also a consultant for WHO India in the IDSP project and for PHFI for a Non Communicable Diseases Decision Support Application.

KPIs on fingertips – Healthcare by Jyoti Sahai @JyotiSahai


During a recent conversation with the CEO-Doctor of a multi-specialty hospital our discussion veered towards how data-driven decision-making using analytic insights could benefit the hospital. His response, typical of most of the CEOs (for that matter from any industry) was – Oh! I really don’t need any analytics! All the facts I need to run my organization are on my finger-tips!



My takeaway from that conversation were the two keywords ‘facts‘ and ‘fingertips‘! For running a successful organization, you do always need to have near real-time relevant and critical (may be up to ten, one for each fingertip!) facts on what is happening within the company. However, just the facts (measures) may not always be sufficient to arrive at a decision unless those are benchmarked against the desired performance and/or trends over different periods for those measures. Deployment of analytics enables the stakeholders to have that additional edge over the decision-making, by making the exercise based more on validated data than just a gut feeling.

That set me thinking on what could be those top key performance indicators (KPIs) which if available on fingertips (at the click of a button) could aid a CEO in achieving the organizational objectives more effectively, and what could be the ones relevant for a hospital CEO!   .
I presume that any hospital CEO’s top priority is to strive to earn the patients’ trust, and that is possible only if the hospital could meet and exceed patient expectations.

Meeting the patient expectations

What a patient expects from the hospital is a treatment that is effective, timely and fair. The following KPIs keep the hospital CEO and other stakeholders informed on how effectively that is happening?

Treating the patients effectively …

The top hospital stakeholders should be worried if higher % of patients who have been already discharged (whether out-patients from day-care or inpatients with hospital-care) return to hospital for re-treatment or re-admittance for the same ailment. That will show that either the initial diagnosis was flawed, or some critical elements were missed out while administering the treatment. Either way it would be matter of great concern for the hospital CEO, who should always be aware of the Re-admittance Index – % of discharged patients who required re-treatment or re-admittance.

... and timely …

One of the most critical performance indicator within a day-care hospital is the TAT, the turnaround time – the elapsed time between entry of the patient in the hospital (registration) and start of consultation of that patient by the physician. Other important TATs that are tracked within a hospital include – for a test being conducted, the elapsed time between the ordering of the test till the report collection, and most importantly for an inpatient, the elapsed time between the decision to discharge and the actual vacating of the bed. Inordinate delays in these lead to irritated patients, increased costs, and avoidable queueing issues too. Typically hospitals set internal benchmarks, or compare with any available industry benchmarks, to track the various TATs. In case of inordinate delays, hospitals could carry out a root cause analysis and take preventive and corrective actions.
What any hospital CEO should strive for is that the TAT Index for any given period is less than 5%, that means not more than 5% patient-visits experience a delay beyond a set benchmark in treatment or in discharge.

… and fairly …

I remember once a CEO of a hospital was concerned about if any of the eleven consultants in the hospital were at any time prescribing investigations and/or medicines that were not warranted for the observed symptoms and the medical condition of the patient. Periodic audit of all prescriptions comparing those prescriptions with a defined set of rules (lines of treatment) for corresponding symptoms will give a fair idea of the deviations if any. What a CEO has to do to control it, is to always ensure that the Unfair Treatment Index (% of possible deviations from an appropriate line of treatment) is kept below the minimum acceptable tolerance benchmark.

… and thus earning patients’ trust!

A hospital may expect that it has earned a patient’s trust by providing treatment that is effective, timely and fair, but it can really know that for sure by arriving at the Patient Satisfaction (P-SAT) Index only. P-SAT can be derived by analyzing the feedbacks received from the patients, results of internal surveys, and the comments (adverse or commending) on the social media. A prudent CEO always depends upon the P-SAT Index to accurately gauge the extent of the hospital’s success and reputation.
We have now understood that patients’ trust can be earned by providing effective, timely and fair treatment. However none of that is possible unless the hospital itself is run efficiently and profitably.
How does the CEO keep track whether the hospital is run efficiently?

Managing the hospital operations efficiently

For meeting and exceeding the patients’ expectations it is imperative that the hospital operations including administrative and clinical processes are efficient and stable. Primarily it means that the all the hospital resources are used optimally, and are available for use when needed. The above-mentioned TAT Index is one such KPI. The following other KPIs too provide an indication of a hospital’s operational efficiency.

Are the resources and infrastructure used optimally?

Hospital resources and infrastructure, if not used optimally, lead to lost opportunity, frittering away of resources, and most importantly increase in operating costs. The Management has to ensure that the various Wards, Operation Theaters, Labs, and various equipments, and even the service providers (human resources) are available for providing service to the patient when needed. Out of these various parameters, tracking of the bed utilization (% of hospital beds occupied at any given time) is considered very critical for any large hospital as it has a direct impact on the efficiency of that hospital. A consistently low bed utilization could mean among other things, either faulty planning (resulting in over-investment) or a low P-SAT. On the other hand a consistently high bed utilization could lead to severe strain on resources and maybe result in declining quality of service.
Thus it is imperative that the hospital CEO constantly monitor the Bed Utilization Index.

Are the patients kept in hospital for a period that is necessary and sufficient?

One of the most critical KPIs for a hospital is the Average Length of Stay (ALOS) of inpatients for specific types of ailments or procedures carried out. The hospital could compare its such averages with either the industry benchmarks, or internally set benchmarks. For example assume that for a specific operation procedure (including the pre-operation and post-operation in-hopsital care) the ALOS is 6 days. If elsewhere in the industry the ALOS for the same procedure is 7 days, that will mean either your administrative and/or clinical processes are more efficient than others or you may be missing out on some necessary hospital-care (a point not in your favor). On the other hand if the ALOS elsewhere is 5 days, that will mean either you are providing some additional necessary services that others are not offering (a point in your favor) or your treatment more often is less efficient (your processes take extra time and/or resources for the same procedure).
Either way the CEO should keep a close watch on ALOS to optimize the services provided under the various procedures offered by the hospital.
However, even an efficiently run hospital having earned it patients’ trust to may fail if it is financially weak.

Monitoring the financial health of the hospital

For a hospital to ensure efficiency in its operations, it is imperative that its finances are stable and profitable. Without that the hospital will not be able to sustain its efficient operations for a longer period. It is the hospital CEO’s prime responsibility to ensure that that does not happen. The hospital CEO can depend upon the following KPIs to keep a check on the financial health of the hospital itself.

What is the hospital’s margin on an average for each patient-visit?

Whether you are an individual or an establishment, the universal fact remains that you cannot consistently spend more than what you earn if you have to sustain financially in the long-term.
What is critical for the hospital Management is to know what is the hospital earning on an average for each visit that a patient makes to it for treatment. Once ARPV is known for a period, and is compared with the average cost of operations for that period (ACPV), the hospital CEO knows whether the hospital operations at the current levels are sustainable or not.
Trends of ARPV and ACPV over a period give sufficient insights to the CEO to arrive at fair pricing of services, and take steps to manage optimal utilization of resources.
However a strong ARPV or a manageable ACPV alone will not be sufficient for financial stability unless the cash management is also strong.

Are the insurance claims being settled in time by the insurance companies?

Once a CEO of a 100-bed hospital was complaining that though he knew that the hospital had been having a strong revenue stream during that period, he was finding it difficult to pay on time for even the relatively small purchases made for materials and services. Why was that? A quick look at the hospital accounts revealed that (as is typical of all medium-large hospitals) almost 75% of the hospital revenue was derived thru insured patients, provided care under cash-less treatment schemes. It was also found that a substantial portion of that money was blocked in over-due claims submitted to the insurance companies and remaining outstanding for various reasons. That meant that the cash-flow was heavily dependent upon the timely settlement of insurance claims.
Any prudent CEO keeps a tight watch on the number of days claim outstanding (DCO) with the insurance companies; monitoring closely the TPAs – Third-party Administrators – ensuring that the claims are settled by the insurance companies as per agreed contractual terms. Timely settlement of insurance claims results in improved and predictable cash-flows and strengthens financial stability.
A hospital CEO may track the above-mentioned KPIs and ensure that the hospital is earning patients’ trust, and is operationally efficient and is financially stable too. But the litmus test of a hospital’s reputation and success is when its performance is compared with its peers, the other similar hospitals in the geography or with the same specialization.

Where does the hospital stand when compared with its peers?

Several independent agencies periodically rank the participating hospitals based on various performance factors, and the ranking could be geography-wise, type of hospital-wise, or specialty-wise.
For a CEO it is imperative that whichever ranking is most important for the hospital is thoroughly analyzed, and a proper strategy to improve/maintain the ranking in future put in place.

In conclusion

How does the CEO keep track of the above-mentioned top KPIs? The CEO’s Dashboardcould display the current status of the KPIs, available at any time at the click of a button (literally putting those on fingertips). A typical dashboard containing the critical KPIs could look like as shown below:
(The numbers and the traffic-light shown against each KPI in the dashboard are for illustration purpose only and do not represent any industry benchmark or desired value)
The above list contains the typical KPIs critical for gauging any hospital’s performance on various operational and financial parameters. However depending upon the criticality for a particular hospital, different and more relevant KPIs could replace those less relevant for that hospital.
By design, I have not included any KPIs or insights produced by clinical analytics, as those will be specialized and specific to each individual hospital.
My suggestion is that let the CEOs use their fingertips for recalling critical tricks of their trade and expertise only, and let an analytics system recall the KPIs for them whenever needed for reference!
[Glossary:
ACPV – Average Cost per Patient-Visit; ALOS – Average Length of Stay; ARPV – Average Revenue per Patient-Visit; DCO – Days Claims Outstanding; KPI – Key Performance Indicator; P-SAT – Patient Satisfaction; TAT – Turn-around Time]

Note: A version of this article also appears in my blog gyaan-alytics and more…

Author
Jyoti Sahai

Jyoti Sahai has over 42 years of experience in banking and IT industry, and is currently the CMD of Kavaii Business Analytics India. Kavaii provides analytic solutions in Healthcare and IT Services domains.

#DigitalHealth as a tool to Protect the National Health Protection Scheme by Dr. Oommen John @oommen_john


Author: Dr. Oommen John, Date: 12/02/2018

Digital Health would have a pivotal role towards efficient implementation of the National Health Protection Scheme announced in the #budget2018.


Healthcare related costs is one of the leading cause of impoverishment in India. In recent times, there has been a growing “trust deficit” between the consumers of healthcare services and the care providers.


The Budget 2018 announcement of ” #Ayushman Bharat ” aimed at financial risk protection from catastrophic healthcare expenses is a clearly articulated strategy towards providing Universal Health Coverage and India’s march towards achieving the UN sustainable development goals #SDGs.
Government sponsored health insurance schemes in India have run into the risk of becoming scams in the past, where the availability of insurance cover have been an incentive to perform investigations and procedures that were perhaps clinically unnecessary and in some cases physiologically impossible, such as males having their uterus removed ( procedure called hysterectomy, when one thinks of a male undergoing the same would roll hysterically !) and worse still these procedures being reimbursed by the insurance providers under the government sponsored schemes. 
There is an urgent need to empower the citizens to make informed choices and participate in shared decision making process. The National Health Portal has a wealth of information around health conditions and tools that aim to empower the citizens towards informed choices around health, there has also been concerted effort to make these available in regional languages.
Also, since a significant provision of secondary and tertiary care is in availed in the private sector, seamless referral mechanisms between the primary healthcare systems (which are mostly in the public sector and closer to where majority of the rural communities live) and the specialized private healthcare establishments would be fundamental to the successful implementation of the National Health Protection Scheme #NHPS.
The frontline healthcare workers empowered with #electronic health records of the populations they serve and using #clinical decision support tools could serve as the gatekeepers to triage and refer those needing higher level services into the healthcare delivery institutions. #electronic tracking of the referral would not only ensure that the healthcare delivery systems are not overwhelmed with sudden influx of a large number of patients wanting specialized services that the current healthsystems are ill-equipped to deliver but also serve as a regulatory mechanism for these well intended schemes from being misused and protect the vulnerable citizens from being exploited and their organs being sacrificed at the alters of greed (akin to the killing of the golden goose). Any well intended scheme is a potential scam unless robust mechanisms prevent them from being misused.
Health Systems generated Electronic health records or better still patient held electronic health records such as MyHealthRecord as envisaged by the ministry of health and family welfare along with functional regional and central health information exchanges would be the backbone for the national health protection scheme to be efficiently operationalized.
Currently, most insurance linked health care provision is administrated through third party agencies, while few of the government insurance schemes are cashless, Ayushman Bharat is an immediate opportunity to scale up #digitalhealth based real-time health insurance handshakes that enable citizens to avail the benefits of this scheme without being pulverized in bureaucratic pain in addition to their physical pain from undue delays for “preauthorization” before they can avail essential healthcare services.
The implementation plan of the #NationalHealthProtectionScheme is an opportunity to leverage #designthinking concepts and establish thought leadership towards integrated people centered healthcare systems
While we have several islands of excellence in #mhealth, many of them still at national level pilot stag , a national Digital Health Platform would also help connect these islands and help navigate through the muddy waters towards a well-functioning digital health ecosystem with an aim to ensure a level playing field for all the stakeholders in the healthcare delivery space, thereby paving the path for more efficient and transparent healthcare delivery.
More over a national digital health platform / grid backed by a robust health information exchange would also create an enabling environment for “start up entrepreneurs” to plug in and contribute to the transformative vision articulated by the government towards achieving universal health coverage for all Indians.

The article was first published in Dr. Oommen John’s LinkedIn Pulse page, its been re-published here with the authors’ permission

Author
Dr. Oommen John

is a Consultant Physician, Public Health Research and Policy Expert. He is the current President of the Indian Association for Medical Informatics and a Senior Research Fellow at the George Institute for Global Health

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#DIGITALHEALTH AS A TOOL TO PROTECT THE NATIONAL HEALTH PROTECTION SCHEME BY DR. OOMMEN JOHN @OOMMEN_JOHN


Healthcare Summit – Disruptive Indian Healthcare Innovations for the World


Press Release: Healthcare Summit, held on 23rd December 2017 at Dayananda Sagar University, Hosur Road campus; discussed the future of the fast-evolving Healthcare sector and is of relevance to healthcare start-ups, academicians, policy makers, NGOs, social healthcare entrepreneurs and industry building innovative solutions in the healthcare space. 

The event was organised by World Economic Forum’s Global Shapers Bangalore Chapter in collaboration with Dayananda Sagar University & Autodesk.

Summit Agenda
To showcase applications of new age technologies in the field of Healthcare. How digital and hardware technological adoption in the field of healthcare, is making patient treatment better, therapies more effective and extending human longevity.


Summit Takeaways for audience

Event registration was via an online registration link and we had attendees from leading hospital management teams, healthcare professionals, startups, academic researchers, students and industry leaders. Audience learnt about the efforts being taken to create Make in India products for the global market and about Healthcare innovations globally and in India that will positively impact our lives in the next decade.


Welcome Speech

Role of academia in creating innovative thinking and programs run towards bridging the academia – industry divide

by Mr. R Janardhan – Pro Vice Chancellor, Dayananda Sagar University

  • DST Funded Startup Incubation centre
  • GE Healthcare, Nvidia, Autodesk and Bosch few of the many companies that have already set up labs within the Innovation centre on campus (DS University, Kudlu Gate, Hosur Road)
  • Set up of a privately funded Innovation Centre at Dayananda Sagar Innovation Campus to instil the spirit of entrepreneurship amongst students

Keynote
Precision Medicine and growth of personalized medicine in the 4th Industrial Revolution Era – creating policy and ecosystem to keep pace with innovation
by Dr. Vijay Chandru, CEO Strand Life Sciences and World Economic Forum Technology Pioneer Awardee

  • 1/3rd of India’s Biotech companies in Bangalore – Study by ABLE
  • Ecosystem is ripe for disruption in the field of personalised medicine
  • Discussion about the growth story of Strand Life Sciences, an independently held private company
  • Strand Life Sciences working towards creating affordable genomics solutions
  • Bioinformatics is today helping early screening for cancer and providing testing methods to determine probability for occurrence of a hereditary disease
  • World is moving towards personalised treatments and neo-natal gene modification is leading to a future where we will have “designer babies”
  • Strand has 30% market share in its segment and currently has both local and international clientele


Panel Discussion
Healthcare solutions for the masses. Indian Healthcare innovations for the World.

Dr. Vijay Chandru (CEO – Strand Life Sciences, World Economic Forum Technology Pioneer Awardee); 
Dr. Jagadish Mittur (Head – Biotechnology Facilitation Cell – KBITS, Department of IT BT and S&T, Government of Karnataka); 
Mr. K Chandrasekhar (CEO, Forus Health); 
Dr. Dheepa Srinivasan (Additive Manufacturing, General Electric); 
Mr. Anurag Ramdasan (Global Shapers Bangalore and VC at 3one4 Capital)


Key Highlights

Gene editing (CRISPR technology) has lots of potential in this fourth industrial revolution era and policy is being framed with Indian Council for Medical Research (ICMR) and Department of Biotechnology (DBT), to enable Indian innovators to stay ahead of the curve and innovate in the space of genomics – Dr. Vijay Chandru

Government of Karnataka was the first state to come up with a biotechnology policy (circa. 1999) and last month released the third updated version of the policy. Gov. of Kar is focussed towards creating clusters for innovation in healthcare (Bangalore Bio innovation Centre, IBAB); deploy funds for early/ growth stage start-ups via their Idea2PoC and Elevate funding programs; create quality human resource personnel (Bioinformatics graduate students from IBAB centre are in global demand for their skills). Government is also focusing on creating new clusters of innovation across the state – Hubli / Dharwad Agri-Tech cluster, Mangalore Marine Biotech cluster being some of the many to be set up. – Dr. Jagadish Mittur

3D Printing in Healthcare is a 3 Billion Dollar opportunity. GE is focused on utilising the power of additive manufacturing (3D Printing) to create affordable healthcare devices. Work with certifying aerospace grade parts similar to what needs to be done by medical sector to certify medical grade implants. Various advantages of using additive manufactured in designing medical grade implants, equipment and lab testing tools (3D Bioprinting). Solutions to cater to needs of India’s large diabetic population can come from 3D Printing. – Dr. Dheepa Srinivasan

Inspired by the Aravind Eye Hospital chain, Forus Healthcare set forth on their journey in 2010 to develop an affordable eye screening device with the goal to eradicate avoidable blindness. Their key product is 3nethra. Forus has sold products in 26+ countries and truly represents the Make in India for the World dream of our country’s Prime Minister. Ecosystem was supportive to provide inputs and collaboration, when they started off. Challenged faces along the way to building a global product company include lack of support from government run regulatory bodies, slow time from prototype to product. 
– Mr. K Chandrasekhar

Private VC firms already working with government to help their portfolio start-ups tackle various on ground challenges and to deploy technology to improve government efficiency in fields ranging from agriculture to IT. Most VC funds have a shorter life cycle than a deep tech focused life sciences company that is looking at 10-year plus gestation period. This requires exploring other routes for VCs to be able to work better with startups in this space with special structures, incentives and better liquidity through proposed SME exchanges. VC community will continue to better engage with the healthcare ecosystem with the goal of supporting novel Make in India Healthcare companies. – Mr. Anurag Ramdasan


We also had the following Healthcare companies and start-ups showcase their work through 10-minute presentations followed by audience Q&A

1. DocsApp: Doctor consultation and chat via Mobile Application
https://www.docsapp.in/

2. Niramai: Pre-screening AI tools for Breast cancer 
http://niramai.com/

3. Next Big Innovation Labs 3D Bioprinting: 3D Skin Tissues for cosmetic R&D testing & Maxillofacial Models for use as pre-surgical guides
http://nextbiglab.com/

4. Gangagen: Developing Drug Resistant Bacteria
http://www.gangagen.com/

5. Biodesign Innovation Labs: New age ventilator for emergency rooms accessible to the bottom of the pyramid 
http://biodesigninnovationlabs.com/

An event by Global Shapers Bangalore (World Economic Forum Chapter), Dayananda Sagar University and Autodesk

Event Photoshttps://goo.gl/HNJS2m


For Further Details regarding the event, please contact –
Mr. Alok Medikepura Anil -alokanil@gmail.com, +91 8971909120
Member of 3D Printing Expert Network
World Economic Forum & Global Shapers, Bangalore

Team HCITExperts

Your partner in Digital Health Transformation using innovative and insightful ideas

Artificial Intelligence #AI Could Add $957 Billion to Indian Economy, According to New Research by @AccentureIndia


In a recently published report by Accenture, they have highlighted the need for india to invest in AI, we bring you the excerpts of the report. (The following content is sourced from the Accenture report).

Artificial intelligence (AI) has reached a tipping point. The combination of the technology, data and talent that make intelligent systems possible has reached critical mass, driving extraordinary growth in AI investment. Across the world, G20 countries have been building up their AI capabilities. The power of AI starts with people and intelligent technologies working together within and across company boundaries to create better outcomes for customers and society. But India is not fully prepared to seize the enormous opportunities that AI presents. Even with a tech-savvy talent pool, renowned universities, healthy levels of entrepreneurship and strong corporations, the country lags on key indicators of AI development. Much work remains. 


The report, ‘Rewire for Growth,’ estimates that AI has the potential to increase India’s annual growth rate of gross value added (GVA) by 1.3 percentage points, lifting the country’s income by 15 percent in 2035. To avoid missing out on this opportunity, policy makers and business leaders must prepare for, and work toward, the AI revolution. 


The era of AI has arrived. Established companies are moving far beyond experimentation. Money is flowing into AI technologies and applications at large companies. The number of patents filed on AI technologies in G20 countries has increased at a more than 26 percent compound annual growth rate since 2010. Funding for AI startups has been growing at a compound annual growth rate of almost 60 percent.

AI is a new factor of production that can augment labor productivity and innovation while driving growth in at least three important ways:

Mobilize Intelligent Automation
Automate complex, physicalworld tasks that require adaptability and agility.

Empower Existing Workforces
Complement and enhance the skills and abilities of workforces.

Drive Innovations
Let AI be a catalyst for broad structural transformation of the economy. Do things differently, do different things.


The report points out AI is expected to raise India’s annual growth rate by 1.3 percentage points—in a scenario of intelligent machines and humans working together to solve the country’s most difficult problems in 2035

AI TENDING TO INDIA’S HEALTH
India’s healthcare providers have embraced artificial intelligence, recognizing its significant value in better diagnostics with data intelligence and in improving patient experience with AI-powered solutions.

Take Manipal Hospitals, headquartered in Bengaluru, which is using IBM Watson for Oncology, a cognitive-computing platform, to help physicians identify personalized cancer care options across the country.

In cardiac care, Columbia Asia Hospitals in Bengaluru is using startup Cardiotrack’s AI algorithms to predict and diagnose cardiac diseases, disorders, and ailments.

And in eye care, Aravind Eye Hospital is working with Google to use AI in ophthalmology for diabetic retinopathy screening. Also, the government of Telangana is planning to use Microsoft Intelligent Network for Eyecare (MINE), an AI platform, to reduce avoidable blindness, which would make it the first state in India to deploy AI for eye care screening as part of the Rashtriya Bal Swasthya Karyakram program under the National Health Mission.

Accenture, for its part, has developed an AI-powered smartphone solution to help the visually impaired improve the way they experience the world around them and enhance their productivity in the workplace. The solution, called
Drishti, was initially developed and tested through a collaboration with the National Association for the Blind in India.


AI has the potential to have a broad-based disruptive impact on society, creating a variety of economic benefits. While some of these benefits can be measured, others, such as consumer convenience and time savings, are far more intangible in nature. Our analysis focuses on measuring the GVA impact of AI.

Read the press release here >> 
https://newsroom.accenture.com/news/artificial-intelligence-could-add-957-billion-to-indian-economy-according-to-new-research-by-accenture.htm

Read the complete report here >> 
https://www.accenture.com/in-en/insight-ai-economic-growth-india

Author
Team HCITExperts

Your partner in Digital Health Transformation using innovative and insightful ideas

A collection of Potential Usecases for #Blockchain in Healthcare

Every once in a while a new technology finds its way in the Gartner Hype Cycle for Technologies (in Healthcare) and its effectiveness and usability is applied to the management and interoperability of Healthcare Records. For instance, access to the Healthcare records by various stakeholders in the care continuum: care providers and patients. 



Gartner in their recent report defines Blockchain as a Digital Platform. And healthcare industry has been perennially on the lookout for a Digital Platform that will allow for an efficient and secure way to share patient data. Providing access to the healthcare data involves providing access to the patient data to relevant stakeholders at the right time and to the right person, not only ensuring the privacy but also providing the patient control of their data. 

Another problem that remains evasive in healthcare is driven by privacy of the patient data, and has been at times been seen to be impeding the flow of patient data between disparate systems, (i.e., Interoperability). 

We now have the Blockchain Technology and various companies are working to apply the technology to help solve not only the interoperability problem but also applying the same technology to solve various usecases in the Care Continuum, to save costs, improve efficiency, ensure privacy.

So what are the problems Blockchain is being applied to in the Healthcare context? What are the benefits one would accrue by applying Blockchain to Healthcare and what are the pitfalls.

The past august, ONC in the US setout a Blockchain challenge with the objective, 

The goal of this Ideation Challenge is to solicit White Papers that investigate the relationship between Blockchain technology and its use in Health IT and/or health-related research. The paper should discuss the cryptography and underlying fundamentals of Blockchain technology, examine how the use of Blockchain can advance industry interoperability needs expressed in the Office of the National Coordinator for Health Information Technology’s (ONC) Shared Nationwide Interoperability Roadmap, as well as for Patient Centered Outcomes Research (PCOR), the Precision Medicine Initiative (PMI), delivery system reform, and other healthcare delivery needs, as well as provide recommendations for Blockchain’s implementation. In addition to a monetary award, winners may also have the opportunity to present their White Papers at an industry-wide “Blockchain & Healthcare Workshop” co- hosted by ONC and NIST.”

As part of the Ideation Challenge, the following papers were the declared winners:

1. Blockchain and Health IT: Algorithms, Privacy, and Data: This papers discusses the need to create a peer-to- peer network that enables parties to jointly store and analyze data with complete privacy, based on highly optimized version of multi-party computation with a secret-sharing. An auditable, tamper-proof distributed ledger (a permissioned blockchain) records and controls access through smart contracts and digital identities. We conclude with an initial use case of OPAL/Enigma that could empower precision medicine clinical trials and research. 
Authors:  Ackerman Shrier A, Chang A, Diakun-thibalt N, Forni L, Landa F, Mayo J, van Riezen R, Hardjono, T.
Organization:  Project PharmOrchard of MIT’s Experimental Learning “MIT FinTech: Future Commerce.”


2. Blockchain: Securing a New Health Interoperability Experience: Blockchain technologies solutions can support many existing health care business processes, improve data integrity and enable at-scale interoperability for information exchange, patient tracking, identity assurance, and validation. This paper suggests these processes can be supported by three most important applications: Creating secured and trusted care records, linking identities and recording patient consent decisions and patient directives within the secured patient record.
Authors:  Brodersen C, Kalis B, Mitchell E, Pupo E, Triscott A.
Organization:  Accenture LLP


3. Blockchain Technologies: A Whitepaper Discussing how Claims Process can be Improved: Smart contracts, Blockchain, and other technologies can be combined into a platform that enables drastic improvements to the claims process and improves the health care experience for all stakeholders. The healthcare industry suffers from an inability to clearly communicate costs in a timely and easy-to-understand format. This problem is a symptom of interoperability issues and complex agreements between providers, patients, health plans/payers and government regulators. These agreements are encoded in legal language with the intent of being defensible in court. However, the focus on legal enforceability, instead of understandability, creates problems resulting in hundreds of billions of dollars spent annually to administer an inefficient, outdated and complex process for adjudicating and paying health plan claims. 

The process results in errors and often leaves the patient unclear on how much they need to pay. If these agreements were instead translated into computer code (smart contracts) leveraging Blockchain technologies, the claim process would not only be interoperable, but also drive standardization, research and innovation. Transparency and trust can be injected into the process when both the logic and the data driving these decisions is stored permanently and made available to all stakeholders through a peer-to- peer distributed database like blockchain. The result will be a paradigm shift toward interoperability and transparency, enhancing the speed and accuracy of cost reporting to patients. This paper discusses how smart contracts, blockchain and other technologies can be combined into a platform that enables drastic improvements to the healthcare experience for all stakeholders.
Author:  Culver K. 


4. Blockchain: A new model for Health Information Exchanges: Presentation of an implementation framework and business case for using Blockchain as part of health information exchange to satisfy national health care objectives.


Authors:  Krawiec RJ, Barr D, Killmeyer K, Filipova M, Nesbit A, Israel A, Quarre F, Fedosva  K, Tsai L.
Organization:  Deloitte Consulting LLP

5. A Case Study for Blockchain in Healthcare: “MedRec” Prototype for Electronic Health Records and Medical Research Data: A long-standing focus on compliance has traditionally constrained development of fundamental design changes for Electronic Health Records (EHRs). We now face a critical need for such innovation, as personalization and data science prompt patients to engage in the details of their healthcare and restore agency over their medical data. 

In this paper, the authors propose MedRec: a novel, decentralized record management system to handle EHRs, using blockchain technology. The system gives patients a comprehensive, immutable log and easy access to their medical information across providers and treatment sites. Leveraging unique blockchain properties, MedRec manages authentication, confidentiality, accountability and data sharing—crucial considerations when handling sensitive information. A modular design integrates with providers’ existing, local data storage solutions, facilitating interoperability and making our system convenient and adaptable. 

MedRec incentivize medical stakeholders (researchers, public health authorities, etc.) to participate in the network as blockchain “miners”. This provides them with access to aggregate, anonymized data as mining rewards, in return for sustaining and securing the network via Proof of Work. MedRec thus enables the emergence of data economics, supplying big data to empower researchers while engaging patients and providers in the choice to release metadata. 

The purpose of this paper is to expose, in preparation for field tests, a working prototype through which we analyze and discuss our approach and the potential for blockchain in health IT and research.
Authors:  Ekblaw A, Azaria A, Halamka J, Lippman A. 
Organizations:  MIT Media Lab, Beth Israel Deaconess Medical Center


6. The Use of a Blockchain to Foster the Development of Patient-Reported Outcome Measures (PROMs): This paper suggests the use of Cognitive Behaviour Therapy as a modality to treat Mental Health disorders. This the author suggests is achieved by the use of various applications that allow the patient to record information using SMS or applications. These applications keep track of any emergencies, provides patient coaching and guidance, recording of daily progress and medication adherence. While many patients feel ashamed of their mental state and feel a stigma associated with conditions such as depression and anxiety, the anonymous nature of these applications may make it more likely for them to seek help. 

These types of use cases are the first step in implementing blockchain technology as they help identify the system requirements and looks at the interactions between users and systems. In this case, the focus would be on personal health information that is highly sensitive and coming from mobile applications that require direct interaction between the patient and providers, as well as those involved in the care of the patient. 

Each scenario that involves a transaction, or data being transferred from the application to those who have “signed” the transaction would be documented so the information flow and usage is understood. In this manner, the appropriate permissions would be granted and provenance could readily be established. Use of the Internet of Things in combination with Blockchain technology for Patient Reported Outcome Measures (PROMs).
Author:  Goldwater JC.
Organization:  National Quality Forum

7. Powering the Physician Patient Relationship with ‘HIE of One’ Blockchain Health IT: ‘HIE of One’ links patient protected health information (PHI) to Blockchain identities and Blockchain identities to verified credential provider institutions to lower transaction costs and improves security for all participants. 

HIE of One, (Health Information Exchange of One) shifts the trusted intermediary role away from the hospital and into the blockchain. The blockchain can also provide the link between physician credentials and patient identity.
Author:  Gropper A.

8. Blockchain: The Chain of Trust and its Potential to Transform Healthcare – Our Point of View: This paper talks about Potential uses of Blockchain technology in health care including a detailed look at health care pre-authorization payment infrastructure, counterfeit drug prevention and detection and clinical trial results use cases. The paper also highlights what Blockchain is not. Some of the additional usecases as presented in the paper are listed below:


Organization:  IBM Global Business Service Public Sector

9. Moving Toward a Blockchain-based Method for the Secure Storage of Patient Records: Use of Blockchain as a novel approach to secure health data storage, implementation obstacles, and a plan for transitioning incrementally from current technology to a Blockchain solution. The author suggests a practical first step towards moving towards a blockchain enabled world, here is a suggested workflow by the author, from the submission: 

Author:  Ivan D.

10. ModelChain: Decentralized Privacy-Preserving Health Care Predictive Modeling Framework on Private Blockchain Networks:   ModelChain, to adapt Blockchain technology for privacy-preserving machine learning. Each participating site contributes to model parameter estimation without revealing any patient health information (i.e., only model data, no observation-level data, are exchanged across institutions). 

We integrate privacy- preserving online machine learning with a private Blockchain network, apply transaction metadata to disseminate partial models, and design a new proof-of-information algorithm to determine the order of the online learning process. 

We also discuss the benefits and potential issues of applying Blockchain technology to solve the privacy-preserving healthcare predictive modeling task and to increase interoperability between institutions, to support the Nationwide Interoperability Roadmap and national healthcare delivery priorities such as Patient-Centered Outcomes Research (PCOR).
Authors:  Kuo T, Hsu C, Ohno-Machado L.
Organizations:  Health System Department of Biomedical Informatics, University of California San Diego, La Jolla, CA Division of Health Services Research & Development, VA San Diego Healthcare System.


11. Blockchain for Health Data and Its Potential Use in Health IT and Health Care Related Research: A look at Blockchain based access-control manager to health records that advances the industry interoperability challenges expressed in ONC’s Shared Nationwide Interoperability Roadmap.
In this usecase the authors discuss the use of blockchain technology with a data lake for scalability. All medical data would be stored off blockchain in a data repository called a data lake. Data lakes are highly scalable and can store a wide variety of data, from images to documents to key- value stores

When a health care provider creates a medical record (prescription, lab test, pathology result, MRI) a digital signature would be created to verify authenticity of the document or image. The health data would be encrypted and sent to the data lake for storage. Every time information is saved to the data lake a pointer to the health record is registered in the blockchain along with the user’s unique identifier. The patient is notified that health data was added to his blockchain. In the same fashion a patient would be able to add health data with digital signatures and encryption from mobile applications and wearable sensors.



Authors:  Linn L, Koo M.

12. A Blockchain-Based Approach to Health Information Exchange Networks: 
Sharing healthcare data between institutions is challenging. Heterogeneous data structures may preclude compatibility, while disparate use of healthcare terminology limits data comprehension. 

Even if structure and semantics could be agreed upon, both security and data consistency concerns abound. Centralized data stores and authority providers are attractive targets for cyber attack, and establishing a consistent view of the patient record across a data sharing network is problematic. 

In this work we present a Blockchain-based approach to sharing patient data. This approach trades a single centralized source of trust in favor of network consensus, and predicates consensus on proof of structural and semantic interoperability.

The authors describe the Healthcare Blockchain as: 

Because a blockchain is a general-purpose data structure, it is possible to apply it to domains other than digital currency. Healthcare, we believe, is one such domain. The challenges of a patient record are not unlike those of a distributed ledger. For example, a patient may receive care at multiple institutions. From the patient’s point of view, their record is a single series of sequential care events, regardless of where these events were performed. This notion of shared state across entities, inherent to the blockchain model, is congruent with patient expectations. Also, it is reasonable to assume that each patient care event was influenced by one or more events before it. For example, a prescription may be issued only after a positive lab test was received. The notion of historical care influencing present decisions fits well into the blockchain model, where the identity of a present event is dependent on all past events.

Much like the Bitcoin approach, our block is a Merkle Tree-based structure[21]. The leaf nodes of this tree represent patient record transactions, and describe the addition of a resource to the official patient record. Transactions, however, do not include the actual record document. Instead, they reference FHIR Resources via Uniform Resource Locators (URLs). This allows institutions to retain operational control of their data, but more importantly, keeps sensitive patient data out of the blockchain. FHIR was chosen as a exchange format not only because it is an emerging standard, but also because it contains inherent support for provenance and audit trails, making it a suitable symbiotic foundation for blockchain ledger entries. FHIR in conjunction with the blockchain can serve to preserve the integrity and associated context of data transactions.


A Blockchain-based approach to sharing patient data that trades a single centralized source of trust in favor of network consensus, and predicates consensus on proof of structural and semantic interoperability.
Authors:  Peterson K, Deedvanu R, Kanjamala P, Boles K.
Organization:  Mayo Clinic


13. Adoption of Blockchain to enable the Scalability and Adoption of Accountable Care:  A new digital health care delivery model that uses Blockchain as a foundation to enable peer-to-peer authorization and authentication.

The recent trends in Accountable Care based payment models have necessitated the adoption of new process for care delivery that requires the co-ordination of a “network” of care providers who can engage in shared risk contracts. In addition, the need for sharing in the savings generated equitably is key to encourage the network providers to invest in improved care paradigms. 

Current approaches to digitize healthcare focus on improvement of operational efficiency, like electronic records as well as care collaboration software. However, these approaches are still based on the classical centralized authorization model, that results in significant expense in implementation. These approaches are fundamentally limited in their ability to fully capitalize on the peer-to-peer digital work- flow revolution that is sweeping other segments of industry like media, e-retail etc. 

In this paper the author formulates a new digital health care delivery model that uses block chain as the foundation to enable peer-to-peer authorization and authentication. The author will also discuss how this foundation would transform the scalability of the care delivery network as well as enable payment process via smart contracts, resulting in significant reduction in operational cost and improvement in care delivery. 

In addition, this block-chain based framework can be applied to enable a new class of accountable tele-monitoring and tele-medication devices that would dramatically improve patient care adherence and wellness. Finally, the adoption of block chain based digital-health would enable the creation of varifiable “personalized longitudinal care” record that can form the basis of personalized medicine.

Author:  Prakash R.



14. A Blockchain Profile for Medicaid Applicants and Recipients: A solution to the problem churning in the Medicaid program that illustrates how health IT and health research could leverage Blockchain-based innovations and emerging artificial intelligence systems to develop new models of health care delivery. The solution envisions a Smart Health Profile by thinking of the blockchain profile simply as a broker that can answer questions about you as the need arises, your identity remains distributed. No one can ever see everything about you at once, including yourself. 

What makes the profile smart is that the services it provides can be quite intelligent. It can make sophisticated queries and actually trigger an action when certain conditions are met. For example, suppose you had a smart drug dispenser that recorded every dose you take as a transaction on the blockchain. A profile service might check everyday to see if you’ve taken your pill and automatically order a refill when you’ve used up all the pills. Over time, however, an AI service might become much more sophisticated to use a combination of information about your vital statistics from your wearable device and population studies of people using the various medications for your condition and either recommend a different regimen to your physician or simply cut out the middleman and direct your pharmacist to deliver you a new prescription.

The solution goes on to discuss the use of Blockchain in a medicaid scenario and a much more comprehensive solution as a distributed infrastructure for health.
Authors:  Vian K, Voto A, Haynes-Sanstead K.
Organization:  Blockchain Futures Lab – Institute for the Future


15. Blockchain & Alternate Payment Models:  Blockchain technology has the potential to assist organizations using alternative payment models in developing IT platforms that would help link quality and value.
Author:  Yip K.


References
The content provided in the examples above have been collated from the various submissions to the ONC’s Blockchain Ideation Challenge. You can write to me or connect with me, in case you are interested in receiving the copy of the documents.

In my previous article on Blockchain I shared whats Blockchain and types of Blockchain. I also discussed some of the usecases companies and startups have focussed on developing Blockchain based solutions. In this article I will share some of the usecases based on Blockchain technology, in healthcare. 

Alternatively, you could follow the links here

You can also review the various articles on Blockchain on the HCITExpert Blog.

[1]: Blockchain Articles by David Houlding:
https://www.linkedin.com/in/davidhoulding/detail/recent-activity/posts/

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Manish Sharma

Founder HCITExpert.com, Digital Health Entrepreneur

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The Return of the Wearables, in a New Avatar by @msharmas

IDC: Smartwatches accelerate in the second quarter, Device shipments grew 10.3% year over year to hit 26.3 million units during the second quarter of 2017; smartwatches grew 60.9%.


We are seeing the transformation of the wearables market with the total shipment volumes expected to maintain their forward momentum. According to the International Data Corporation’s (IDC) Worldwide Quarterly Wearable Device Tracker, vendors will ship a total of 125.5 million wearable devices this year, marking a 20.4% increase from the 104.3 million units shipped in 2016From there, the wearables market will nearly double before reaching a total of 240.1 million units shipped in 2021, resulting in a five-year CAGR of 18.2%. [1]


The wearables market is entering a new phase


In the first phase of the market development, it was about getting the product out, to generate awareness and interest and getting the customers accustomed to the idea. This opportunity remains to be explored by the traditional and fashion brands as the scale of consumer electronics market evolves. Now, the wearables market is entering a new phase, opines IDC’s Ramon T. Llamas.

Now it’s about getting the experience right – from the way the hardware looks and feels to how software collects, analyzes, and presents insightful data. What this means for users is that in the years ahead, they will be treated to second- and third-generation devices that will make the today’s devices seem quaint. Expect digital assistants, cellular connectivity, and connections to larger systems, both at home and at work. At the same time, expect to see a proliferation in the diversity of devices brought to market, and a decline in prices that will make these more affordable to a larger crowd.” [1] 


The phase 2 of the wearables development appears to be about taking the user data and provide analytics around the data to provide insights to the user, like step counts translate into a healthier heart. In this phase its about getting the customer to see the devices that actually augment the abilities to make lives easier, healthier and more productive, rather than another screen for the user. [3]

    Top Wearable Products [1]


    Watches: account for the majority of all wearable devices shipped during the forecast period. The report however shows that the basic watches (devices that do not run third party applications, including hybrid watches, fitness/GPS watches, and most kid watches) will continue out-ship smart watches (devices capable of running third party applications, like Apple Watch, Samsung Gear, and all Android Wear devices), as numerous traditional watch makers shift more resources to building hybrid watches, creating a greater TAM each year. The report suggests that the Smart watches, however, will see a boost in volumes in 2019 as cellular connectivity on the watches becomes more prevalent on the market.

    Wrist Bands: The report indicates a slow down in the market for the wristbands from 2016 onwards, but the market will be propped up with low-cost devices with good enough features for the mass market. However, the trend seems to focus on the users transitioning to watches for additional utility and multi-purpose use.

    Earwear: (this excludes the bluetooth headsets) are not counting. Instead, the report focusses on those devices that bring additional functionality, and sends information back and forth to a smartphone application. Examples include Bragi’s Dash and Samsung Gear Icon X. The report, also suggests the increase in the uptake of smarter earwear that centers on collecting fitness data about the user, real-time audio filtering or language translation.

    Clothing:  The smart clothing market took a strong step forward driven by the chines vendors providing connected apparel. The growth in this segment is seen to be driven by the adoption of the connected clothing by the professional athletes and organizations have warmed to their usage to improve player performance. For instance, the upcoming release of Google and Levi’s Project Jacquared-enabled jacket.

    Others: include lesser known products like clip-on devices, non-AR/VR eyewear, and others into this category. It will include vendors catering to niche audiences with creative new devices and uses.

    Top Wearable Devices by Product, Volume, Market Share, and CAGR [1]
    Product Shipment Volume 2017 Market Share 2017 Shipment Volume 2021* Market Share 2021* CAGR (2017-2021)*
    Watches 71.4 56.9% 161.0 67.0% 26.5%
    Wristbands 47.6 37.9% 52.2 21.7% 1.2%
    Clothing 3.3 2.6% 21.6 9.0% 76.1%
    Earwear 1.6 1.3% 4.0 1.7% 39.7%
    Others 1.6 1.3% 1.4 0.6% -16.0%
    Total 125.5 100.0% 240.1 100.0% 18.2%
    Source: IDC Worldwide Quarterly Wearables Device Tracker, June 21, 2017

    Global wearables market to grow 17% in 2017, 310M devices sold, $30.5BN revenue: Gartner | TechCrunch http://ow.ly/YFVu30eWQHL

    Like any technology market, the wearables market is changing [2]
    “Like any technology market, the wearables market is changing,” noted Ramon Llamas, research manager for IDC’s Wearables team. “Basic wearables started out as single-purpose devices tracking footsteps and are morphing into multi-purpose wearable devices, fusing together multiple health and fitness capabilities and smartphone notifications. It’s enough to blur the lines against most smart wearables, to the point where first generation smartwatches are no better than most fitness trackers, he says.

    Beyond the top 5 vendors of the wearables market, new entrants like fashion icons Fossil along with their sub-brands and emerging companies like BBK and Li-Ning, are tapping into niche segments of the wearables market. Fossil, is coming up with a luxury/fashion device, BBK focuses on child-monitoring devices and Li-Ning on step-counting shoes.

    “With the entrance of multiple new vendors with strengths in different industries, the wearables market is expected to maintain a positive outlook, though much of this growth is coming from vendor push rather than consumer demand,” said Jitesh Ubrani senior research analyst for IDC Mobile Device Trackers. “As the technology disappears into the background, hybrid watches and other fashion accessories with fitness tracking are starting to gain traction. This presents an opportunity to sell multiple wearables to a single consumer under the guise of ‘fashion.’ But more importantly, it helps build an ecosystem and helps vendors provide consumers with actionable insights thanks to the large amounts of data collected behind the scenes.”

    Top Five Wearable Device Vendors, Shipments, Market Share and Year-Over-Year Growth, 4Q 2016 (Units in Millions) [2]
    Vendor 4Q16 Unit Shipments 4Q16 Market Share 4Q15 Unit Shipments 4Q15 Market Share Year-Over-Year Growth
    1. Fitbit* 6.5 19.2% 8.4 29.0% -22.7%
    2. Xiaomi 5.2 15.2% 2.6 9.1% 96.2%
    3. Apple 4.6 13.6% 4.1 14.1% 13.0%
    4. Garmin 2.1 6.2% 2.2 7.6% -4.0%
    5. Samsung 1.9 5.6% 1.4 4.7% 37.9%
    Others 13.6 40.1% 10.3 35.5% 32.1%
    Total 33.9 100.0% 29.0 100.0% 16.9%
    Source: IDC Worldwide Quarterly Wearable Device Tracker, March 2, 2017

    Implications of Wearables in Healthcare


    Llamas, IDC. “Health and fitness remains a major focus, but once these devices become connected to a cellular network, expect unique applications and communications capabilities to become available. This will also solve another key issue: freeing the device from the smartphone, creating a standalone experience.”

    Its important to note here the scalability of wearables in a clinical setting requires Intention, Education and collaboration[7]. Some of the usecases highlighted for wearables in healthcare: 

    1. Managing Chronic Conditions of patients who might develop a secondary or tertiary complication because of a pre-existing condition (diabetic undergoing hip replacement surgery)
    2. Tracking vital signs
    3. Manage patients recovery at home (defensive medicine) instead of the recovery in a general ward, with help of remote monitoring
    4. Detecting Alzheimer’s, most common form of dementia
    5. Monitoring patients with chronic diseases and after hospitalization or the start of new medications for a decline in daily activity may help detect medical complications before rehospitalization becomes necessary
    6. Clinical Trials: Monitoring of recruits
    7. Smart Stethoscope for patients with cardiovascular disease
    8. Ear device to track body temperature fluctuations
    9. Temporary tattoo that senses vital signs
    10. Smart Glasses with AR enabled patient records and physician information system


    Finally, here is an interesting Infographic on Wearable Technology. 

    References

    1. Worldwide Wearables Market to Nearly Double by 2021, According to IDC: http://www.idc.com/getdoc.jsp?containerId=prUS42818517
    2. Wearables Aren’t Dead, They’re Just Shifting Focus as the Market Grows 16.9% in the Fourth Quarter, According to IDC 

    3. Xiaomi and Apple Tie for the Top Position as the Wearables Market Swells 17.9% During the First Quarter, According to IDC: 

    4. EXCLUSIVE: Fitbit Working On Atrial Fibrillation Detection | Time.com http://time.com/4907284/fitbit-detect-atrial-fibrillation/
    5. The 8 Best Fitness Trackers You Can Buy Right Now: http://time.com/4553111/best-fitness-trackers-fitbit-jawbone-2016/
    6. Can Your Fitness Tracker (Fitbit®) Save Your Life in the ER?: http://www.prnewswire.com/news-releases/can-your-fitness-tracker-fitbit-save-your-life-in-the-er-300246408.html
    7. Advocating for clinical wearables, the new normal in healthcare http://medcitynews.com/2017/08/advocating-clinical-wearables-new-normal-healthcare/?rf=1
    8. Global wearables market to grow 17% in 2017, 310M devices sold, $30.5BN revenue: Gartner: https://techcrunch.com/2017/08/24/global-wearables-market-to-grow-17-in-2017-310m-devices-sold-30-5bn-revenue-gartner/?ncid=rss
    9. What smartwatches and other wearables can’t track today— but might in the future – https://www.cnbc.com/2017/11/05/wearables-future-track-glucose-blood-pressure-mental-health.html

    Author

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

    Manish Sharma

    Founder HCITExpert.com, Digital Health Entrepreneur

    Connect with me via any of my Social Media Channels

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    #AI in Healthcare by @deveshrajadhyax


    There are some subjects that invoke sharp and contrasting emotions in the society. In present day India, the GST tops the list of such things that are considered boon by some and curse by others. New technology usually does this to people. The steam engine, the telephone and the computer all have been greeted both as the savior and the nemesis of the mankind. 


    Using Artificial Intelligence in Healthcare is one such subject. If you have to believe what the media says, AI is going to transform healthcare in the near future. In fact, the services of the doctor may not be needed very often, if at all. AI will do everything in medicine including diagnosis, treatment and even finding out new drugs.

    But not everyone is so optimistic or even welcoming. The idea of machines taking care of our health is creepy to some. Others claim that AI can never replace a doctor, at least not in a foreseeable future. Medicine is too complex for machines to figure out.

    (You must have noted that I am using Healthcare and Medicine interchangeably. The reason being that this is what most people do. Healthcare is the practice of medicine and as such is wider than it. I refer to healthcare as including medicine.)

    The reality, like in the case of GST and most other things, will be somewhere in the middle. The purpose of this article is to find that balanced view. In effect, what I will be saying is:

    “while the replacement of the doctor is a faraway dream, there are a number of things that AI can do in medicine even today. This can turn out to be valuable help for doctors, patients and other stakeholders”.


    Let me first present a short introduction to AI.

    AI, like Philosophy, is a very hard term to define. AI is not really one technology. It is a collection of techniques. Strictly speaking, AI is actually an ambition. The ambition of machines to imitate human capabilities.  
       
    But this definition does not take us very far. Since human capabilities are many, ranging from walking to writing poems, imitating any of these capabilities can be called AI. So for our purposes, we will define AI as the pursuit of those capabilities that are strong points of human beings.

    As an example, consider language. Reading an article and understanding its gist is a simple matter for us humans. For machines to achieve this capability will be quite something. If that happens, machines can go through a number of articles for us and feed us with the just the little bits that we need.

    A whole lot of mathematical and computational techniques have been developed by researchers in the last sixty years to achieve this goal. Deep Learning, Machine Learning and NLP are some names given to a bunch of such techniques. In the last few years, AI has risen to prominence mainly due to three reasons – availability of data, increase in computing power and discovery of new methods. 

    Armed with that introduction, let’s try and put down the areas where AI can make a difference in healthcare. While we do that, we can also try to answer the ‘replace the doctor’ question.

    Diagnosis: Diagnosis is the hardest part of medicine. There is no definite pathway to diagnosing a patient. A lot depends on the experience and intuition of the doctor, in that way, it is more of an art than science. As of now, it is difficult to see AI taking over this role. However, there are many areas where AI is already making a difference:

    • Conditions in which diagnosis is dependent on analysis of a signal over time, such as an ecg or an eeg. Machine Learning combined with signal processing can achieve good results here. Arrhythmia or irregular heartbeat is an example of such a condition that AI can detect well.
    • Diagnosing some disorders involves referring to a lot of data such as past and present reports, images and history. Gatro-intestinal disorders are notoriously difficult to diagnose and require a lot of information to refer. AI can make a big difference here by sifting through the pile of data and presenting important facts to the doctor.
    • In radiology, the volume of cases is huge and the radiologist needs to look at every image to come to a conclusion. Some investigations like MRI produce a large number of images for each patient. This makes the doctor’s time a bottleneck in handling the ever growing number of patients. Deep Learning has shown great promise in being able to classify medical images. For example, it can separate images that indicate normal functioning from those that have some abnormality. This will enable the radiologist to focus on the abnormal cases first. This method will also be a boon for the remote places where a radiologist is not available.
    • AI has provided a new method for laboratory investigations. This may mean that in the future most lab tests including pathology will be done with basic instruments at a very low cost. In a disease like HIV/AIDS, being able to determine the viral load in a quick and inexpensive way can be a very big benefit to the patients. 


    Treatment: The biggest contribution AI can make to treatment of patient is in the area of drug discovery. Currently, discovering a new drug costs more than 2.5 billion dollars and takes more than a decade. The pharmaceutical industry is desperately searching for new ways to reduce the cost and time. AI may be one of the solutions to this problem. Machine Learning and Deep Learning are being used in various stages of drug discovery, such as identifying candidate molecules and studying the expected response of the new drug.

    In our fight with cancer, AI may be an important weapon. Personalized Oncology is rapidly getting attention from the medical community as the way forward in battling with the cancer scourge. To describe in brief, cancer is not one disease – the cancer of every patient is different. If the individuality of cancer is decoded, a personal treatment path can be planned for every patient. AI will become a key part of this process.

    AI is already playing a role in treatment by making robots that perform surgeries. This contribution will grow in the time to come with the robot costs falling and capabilities growing. This will reduce the strain on surgeons and they will be able to perform far more surgeries in the same time. 

    Care: Care during the illness and recovery is as important as the right diagnosis and treatment. Along with IoT, AI will transform patient care. Everything from medicine intake to prescribed activity will be monitored by these systems. Monitoring includes two components – sensing and analysis. While the sensing part is done by the IoT devices, analysis is provided by AI. 

    Prevention: Prevention is definitely preferred to hospitalization and AI is going to play a major role in this. It will involve both personal and public health. Personal health is monitored by the wearables and other simple devices. The AI systems will process this data to look for possible indications of disorders so that they can be fixed inexpensively. 

    Public health will be monitored in the same way but from data that is coming from various healthcare institutes. This enormous data will forewarn us about various health risks such as outbreaks of diseases. It will enable the state to take measures to avoid the calamities.

    In short:
    To summarize, AI will really be a transformational technology for healthcare. It will make healthcare cheaper and faster and enable it to reach more number of people. AI will reduce the strain on doctors and nurses. However, for the future that we can see, AI will serve more as an assistant to the doctors, rather than being their replacement. 

    Author
    Devesh Rajadhyax

    Founder and CEO, Cere Labs, AI, Machine Learning, Deep Learning

    Four ways in which #AI can help humankind @deveshrajadhyax


    Artificial Intelligence is receiving more than its fair share of public attention. On one side there are promises of miracles, while on the other side there are warnings of doomsday. What is probably missing is a simple listing of clear benefits. This is article is an attempt to create such a list.


    Artificial Intelligence is more of an ambition than a technology. The ambition is to imitate human capabilities. Since human capabilities range from walking to solving mathematical problems, AI also encompasses systems of various types – ranging from the humble calculator to Google’s DeepMind.

    In this article, I am majorly referring to the AI systems that try to achieve the cognitive abilities of human beings. Cognitive abilities refer to the processes of our mind such as understanding, reasoning, planning and selecting the right action. Understanding a question and supplying the right answer from our memory is an example of cognitive ability, the one that AI systems called ‘chatbots’ try to imitate.

    Cognitive systems are currently in their initial phase of development. Once they come close to human beings in their competence, they can prove useful to humankind in a number of ways. Here are some:

    1. Better utilization of resources: In our current world, it requires a human being to use resources. For example, a car needs a driver. Platforms like Uber have made it possible to share your car when you don’t need it, but it still requires a skilled human being. Talk to your Ola or Uber driver and you will realize that they are already working at the limit of their capacity. A cognitive system driving vehicle will use them much more efficiently. You will actually need much fewer vehicles than you need today (and probably a lot lesser parking!). This is true of most other resources.

    2. A fairer society: Human beings have many faults in their thinking. In another article I have highlighted this faults, called biases. These biases have their roots in the evolution, so the AI systems will (hopefully) not have them. ( Pl see http://blog.cerelabs.com/2017/06/will-ai-evolve-to-be-as-bad-as-humans.html). This will make decision making at all level fairer for the people. To take an example, typecasting is a very strong bias that we suffer from. This affects decisions taken by, say an interviewer. We can hope to see much fairer selection processes in the future. For an interesting example of how statistics can help to break biased notions, see the movie or read the book ‘Moneyball’.

    3. Repositioning of human efforts: World over, a large number of people are engaged in time consuming tasks that require moderate cognitive ability. Take for instance cooking. A big part of a woman’s day in India is spent in preparing food. Cognitive systems such as robot chefs can easily take over these jobs, freeing up a lot of time that can be invested in more valuable responsibilities like education of the children. In the industries, as the simpler tasks are done by cognitive systems, humans can move up the value chain, pushing the efficiency of the enterprise higher.

    4. Improved care: Currently, care of patients, elderly and disabled is primarily a human responsibility. Many times, this compromises the quality of care as people cannot take out so much time from their daily activities. Cognitive systems can make the life of those in need of care much better. They can talk to the elderly and carry the disabled to places otherwise difficult to reach. The systems can keep an eye on chronic patients, not just reminding but making sure their regimen is adhered to.

    This is of course just a small contribution to an ever growing list of benefits. While we keep our eyes open to the warnings given by the likes of Stephen Hawking and Elon Musk, we should continue in our efforts to harness the power of AI for these benefits.

    Author
    Devesh Rajadhyax

    Founder and CEO, Cere Labs, AI, Machine Learning, Deep Learning

    How Virtual Reality #VR and Augmented Reality #AR is transforming Healthcare by Dr. Vikram @drvikram

    Digital is transforming healthcare. It is creating new channels for improving patient experience, creating better clinical processes and engaging doctors and other para-clinical staff like never before.


    It is also creating new models for areas like medical education, rehabilitation and managing supply chain. In these there key areas Augmented Reality (AR) and Virtual Reality (VR) are playing a key role. But first let’s start with the definition and differences between AR and VR.


    Augmented Reality or AR is a live direct or indirect view of a physical, real-world environment whose elements are “augmented” by computer-generated sensory input such as sound, video, graphics or GPS data. So the game Pokemon Go is a good example of AR. (Source: Wikipedia)

    While VR on the other hand VR- Virtual reality (VR) is a technology that uses Virtual reality headsets, sometimes in combination with physical spaces or multi-projected environments, to generate realistic images, sounds and other sensations that simulate a user’s physical presence in a virtual or imaginary environment. (Source: Wikipedia) So VR requires a headset specialized for the same. 

    The Industry seems to be taking notice of this emerging area. These are some numbers from the industry

    1. More than 150 of Global Fortune 500 investing in AR/VR
    2. VC and corporate investment upto $2.3 Billion in AR/VR Startups 
    3. IDC projects revenues from AR/VR to grow from $5.2 billion today to $162 billion by 2020

    But why are the key reasons why AR/VR has reached this level

    1. We have more computing power than ever before. Today we have GPU’s and TPU’s that put immense computing power at our disposal
    2. There is a explosion in digital data. By 2020 it is believed that we would have created 40,000 Exabyte of data
    3. Finally programmers today are writing better algorithms. That is why machine learning is mainstream today

    So what are the implications of the same in healthcare?

    There are clearly implications in Medical Education. Pilots conducted in Miami Children’s hospital have shown an 80% increase in retention while using AR/VR. There are other pilots involving treating war veterans using VR for Post Traumatic Stress Disorder.

    I will be speaking on this topic on, 23 Aug 2017, at the IT Healthcare Summit 2017 in Bangalore. It will be interesting to discuss and other topics on digital health and how it is transforming healthcare in India. Looking forward to hearing your views on the same. 

    Author

    [tab]
    [content title=”About Dr. Vikram Venkateswaran”]

    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.
    Connect with me

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    Continuous Glucose Monitoring Made Affordable and Accessible by Piyush Gupta @Ambrosia_Sys

    Living with diabetes comes with many challenges. At the top of the list is monitoring glucose levels to avoid a health crisis. Monitoring can be inconvenient and expensive, but thanks to advances in technology, these issues are being addressed like never before.


    Dealing With Diabetes
    Diabetes relates to the body’s ability to produce and process the hormone insulin. Without it, cells cannot absorb sugar, or glucose, which we need for energy.


    Diabetics are typically diagnosed with one of two types of the disease: Type 1 or Type 2. Type 1 is when the body produces no insulin. The immune system destroys the cells that release it. Type 2 diabetes occurs when the body is not producing enough insulin, or the levels produced are not sufficient to help the body generate energy.

    In either case, the person diagnosed must make lifestyle changes to ensure glucose levels are kept in check. According to the American Diabetes Association, individuals with type 1 and type 2 diabetes should work out at least 2 hours/wk spread over 3 days/wk with no more than 2 consecutive days without exercise. The ADA also recommends nutritional counselling to address eating patterns, including lowering carbohydrates, fat intake and adding fruits, vegetables and low-fat dairy to your diet. Of course, there is no one-size-fits-all program, and it’s important to consult your doctor to determine the dietary, exercise and behavioural changes that are best for you.

    By The Numbers

    According to the Centers for Disease Control, 29.1 million people or 9.3% of the US population has diabetes. Type 2 diabetes accounts for the largest group of people who have diabetes.

    Another 86 million have been diagnosed as being pre-diabetic.

    Globally, according to a 2016 report by the World Health Association, an estimated 422 million adults were living with diabetes in 2014, compared to 108 million in 1980. In fact, the global prevalence of diabetes has nearly doubled since 1980, rising from 4.7% to 8.5% in the adult population. Diabetes is on the rise not only in the United States but also around the world, and the complications from diabetes are impacting individuals and their families.

    Behind these numbers are people coming to terms with the emotional and physical realities of managing their disease. We mentioned the importance of activity and exercise as well as healthy eating habits. Stress is also an important considering when managing diabetes. Learning to live with diabetes can weigh down the strongest amongst us and that stress can raise your blood sugar. Learning ways to lower stress, from yoga and deep breathing to gardening and listening to your favourite music, can keep your mind in a healthy state. 

    The National Institute of Diabetes and Digestive and Kidney Diseases recommends acquainting yourself with the ABCs: your A1C, Blood Pressure, and Cholesterol. Considering your ABCs can help lower your chances of having a heart attack, stroke, or other diabetes problems. When it comes to your blood pressure, monitoring it is a necessary addition to your daily routine. The key to the lifestyle changes diabetics undergo is having options to monitor glucose levels that are both effective, and affordable.

    Technology Makes Monitoring Easier

    Active management and monitoring of glucose is neither convenient nor cost effective for many. Some medical professionals recommend up to 10 tests per day. Assuming you have the schedule and discipline to stick with it, most diabetics have had to resort to testing their glucose levels through frequent, invasive needle pricks on their fingers.

    There are saliva-testing devices under review by the US Food and Drug Administration, and Google was rumoured to be testing smart contact lenses that could monitor glucose levels as well. But a finger sticks remains the most common test despite the pain of a prick, the need to record readings and do so multiple times per day.

    More convenient and accurate methods of testing glucose levels are becoming more readily available. For example, Abbott Laboratories invented the FreeStyle Libre system.

    The device has been hailed for its convenience. Placed just under the skin, the sensor continuously measures glucose levels in the interstitial fluid that bathes the cells. Those wearing the device can use their smartphones to get immediate readings. According to Bloomberg, FreeStyle Libre users scanned their sensors an average 16 times a day; some exceeded 45.

    While the repeated checks help diabetics lower their glucose levels, Continuous Glucose Monitoring (CGM) systems are costly. Prices can range between $3,000 and $4,000/year, limiting the accessibility of life-saving monitoring. However, companies like Ambrosia Systems are reinventing the wheel, bringing cost savings and convenience to glucose monitoring.

    Introducing BluCon
    We invented BluCon to build an affordable next generation continuous glucose monitoring like system for diabetic and pre-diabetic patients. Our iOS and Android apps work with Abbot’s FreeStyle Libre sensor, sending glucose readings to any Bluetooth enabled connected device.

    Today, two factors prohibit active monitoring and management of diabetes: cost and inconvenience. BluCon quickly reads data from Abbott’s FreeStyle Libre sensor and sends that data to the LinkBluCon mobile app on your phone for less than half the annual cost of available solutions. Our battery life is also twice as long, adding to the convenience and cost savings brought by BluCon.

    Living with diabetes entails constant glucose monitoring, which, as we noted, can mean significant lifestyle changes. Checking glucose levels, and keeping an accurate record, can be complicated. BluCon is meant to simplify glucose monitoring and ongoing management of your type 1 or type 2 diabetes.

    Author
    Piyush Gupta

    Several years experience in product management worked at Abbott Diabetes Care, Kaiser Permanente, Capital One Bank and a couple of healthcare startups as senior product management executive. Helped companies in building next generation platform, iOS and android mobile products

    India aims to be a Global Leader in #DigitalHealth by Rajendra Pratap Gupta @rajendragupta

    The Article was first published in Mr. Rajendra Pratap Gupta’s LinkedIn Pulse, the Article is republished here with the authors permission


    In May this year, India had tabled a resolution at WHO for mHealth, which was supported by over 30 nations. This clearly signals India intent to be a global leader in Digital Health.

    Digital Health has the potential to revolutionize how populations interact with national health services and also strengthen health systems and will play an important role in preventive , promotive and curative health. India is now embarking on a futuristic journey to bridge the healthcare divide between have’s and have-nots using digital health tools. We have a number of projects that will extensively deploy technology .


    The Ministry of Health & Family Welfare has been taking several impactful initiatives in the field of Digital Health. Our Hon’ble Prime Minister has envisioned for Digital Platform & Electronic Health to be optimally leveraged, so as to meet the key challenges posed to us in health sector e.g. shortage of health human resource, accessibility of healthcare infrastructure, affordability of healthcare services etc. Electronic Health Records (EHRs) of citizens are envisaged to be created for ensuring continuity of care and other associated benefits. Delivery of services to citizens through “online mode” is at core of the overall electronic health ecosystem being talked about.

    Major I.T. initiatives by Ministry include various mHealth initiatives for improving efficiency and efficacy of public healthcare across the country under the Digital  India Programme. Some of the initiatives are:

    Mobile applications

    Various mobile apps have been launched

    Vaccine Tracker mobile application support parents in tracking immunization status of their children and helps them in ensuring complete and timely vaccination.

    The India Fights Dengue mobile application provides interactive information on identification of symptoms of Dengue and links users to nearest hospitals and blood banks

    The swasth Bharat ( Health India ) mobile application provides detailed information on healthy lifestyle, disease conditions and their symptoms, treatment options, first aid and public health alerts.

    Ministry recently launched the Stress management app – ‘NO MORE TENSION’ on google / IOS.

    Mobile Academy

    Mobile Academy is a free audio training course designed to expand and refresh the knowledge base of ASHAs and improve their communication skills. Approximately 170,000 ASHAs of Jharkhand, Madhya Pradesh, Rajasthan and Uttarakhand are expected to benefit from Mobile Academy. As of 31 Aug 2016 more than 45,000 ASHAs have started the course and out of which more than 40,000 have completed it successfully.

    Kilkari

    Kilkari delivers free, weekly, time-appropriate 72 audio messages about pregnancy, child birth and child care delivery to families’ mobile phones. Approximately 1.9 Million pregnant women and children in Jharkhand, Odisha, Uttar Pradesh, Uttarakhand and High Priority Districts (HPDs) of Madhya Pradesh and Rajasthan have been reached by the service in Phase 1 as of 31 Aug, 2016.

    Tobacco Cessation Programme

    Programme launched on 15th January 2016. Ministry of Health & Family Welfare, in partnership with World Health Organisation and the International Telecommunications Union, started an initiative for utilising mobile technology for tobacco cessation. Currently, more than 1900,000 users registered for mCessation on Tobacco.

    mDiabetes Program

    An initiative for prevention and care of diabetes, launched on 22nd , June 2016 on ‘World Diabetes Day’. It is based on proven algorithms for diabetes prevention and care, and builds on previous international experiences in using mobile technologies to deliver these interventions. Using constant text messaging on mobile phones. Currently more than 100,000 users registered for mDiabetes

    Nikshay for Tuberculosis Control Programme

    To monitor and track services and status relating to screening, diagnosis, treatment and follow-up of Tuberculosis cases. NIKSHAY was launched in 2012 and has been implemented across all States, and has 6 million registered users

    Online registration System (ORS)

    Launched in July 2015, ORS is a system to link various hospitals across the country for online registration, appointment and for providing patient centric services like viewing Lab reports, blood availability status etc. As on date, 48 hospitals covering over around 500 departments across 18 States/UTs are offering services through ORS and over 4,00,000 appointments have been transacted online till date.

    These initiatives are ensuing remarkable improvement in healthcare delivery and management.

    MyGov

    A discussion group viz. ‘Healthy India’ has been created by MoHFW under the “MyGov” portal and seven discussion areas covering various issues have already been hosted so far. https://www.mygov.in/

    National Health Portal (NHP)

    Launched on 14.11.2014, serves as a single point access for authenticated health information for citizens. (http://www.nhp.gov.in).

    NHP Voice Portal

    Toll free national number 1800-180-1104 for providing information related to health, diseases, lifestyle, first aid, directory services, health programs etc.

    National Healthcare Innovations Portal

    (www.nhinp.org)- An online portal for documenting innovations taken up by states, NGOs and other private sector organizations.

    National Identification Number (NIN) Portal

    put in place for allocation of NIN to all health Facilities in India. As of 10th October 2016, 2,14,340 facilities were allocated NIN. Out of these 1,88,841 public health facilities (88%) facilities were verified by the states.

    HMIS-MCTS Facility master mapping has been completed for all states and states are currently verifying the mapping to match health facilities in both systems. Incorporation of other hospitals of MoHFW and other ministries in NIN Portal is in progress

    National Health Resource Repository (NHRR)

    NHRR envisages creating a single gateway of authentic, standardized, updated public and private healthcare resource intelligence and develop user friendly system with utility to serve as a decision making tool for varied categories of health system stakeholders. The pilot of the survey was completed and the soon the pan-India survey will be initiated to collect health resources data. This data will be placed online for easy access to all stakeholders.

    eHospital@NIC

    6 modules available on eHospital Cloud version; other modules to be made available by Dec’16 by NIC. Over 30 large hospitals are using eHospital and 7 hospitals are using cloud version of eHospital

    EHR Standards

    were first notified in 2013. The EHR standards are meant to facilitate semantic interoperability between different EMR /EHR systems. EHR Standards include SNOMED CT standards for providing consistent terminology across all health care domains. India became member of International Health Terminology Standards Development Organization (IHTSDO), effective from 1st April, 2014.

    Notification of revised EHR Standards (2016) is under process and will be released shortly. CDAC, Pune has been nominated as interim National Release Center (NRC) for SNOMED CT. As of now 140 SNOMED CT affiliate licenses are issued by iNRC.

    Mother and Child Tracking System/ RCH System

    Implemented across all the States & UTs, approximately 3.00 crore pregnant women and 2.72 crore children are expected to be covered annually under MCTS and RCH application combined. 1,16 million pregnant women and 994,000 children were registered in MCTS and RCH portal combined as on 20th September, 2016.

    Missed Call Centre for reaching unreached TB patients

    A dedicated toll free number with a call centre that is currently available in the States of Punjab, Haryana, Chandigarh and Delhi. Around 30,899 calls have been made till date.

    National AIDS Control Organization (NACO)- Strategic Information Management Information System (SIMS)

    has over 20,000 reporting units across the country. Centralized Project Financial Management System (CPFMS)- details of allocation, expenditure of budget disbursed at Central and state level are monitored.

    Inventory Management System (IMS)

    for tracking inventory at every point of supply chain to establish a robust supply chain Management,

    India HIV/AIDS Resource Centre (IHRC)

    A Digital Resource Centre (www.indiahivinfo.naco.gov.in ) which is one stop shop for resources available on HIV and related issues, and get an average of 2000 calls per month and covers 60 districts in 10 States (Bihar, Haryana, Punjab, Rajasthan, Karnataka, Maharashtra, Uttarakhand, Uttar Pradesh, Chhattisgarh, Jharkhand)

    Rashtriya Swasthya Bima Yojana

    RSBY uses IT platform for enrolment of beneficiaries, smart card for beneficiary authentication, cashless transactions, grievance management, has over 41 million (41,331,073 ) smart Cards : and has handled over 11 million (11,841,283 ) hospitalisation Cases : as on date: 31/03/16 .This scheme is likely to be the template for the National Health Protection Scheme

    ‘Mera Aspataal’ (Patient Feedback System)

    To empower the patient to give his / her views on quality of services rendered by a healthcare facility, MoHFW has designed an ICT-based Patient Satisfaction System (PSS) for implementation in public and empanelled private hospitals. During the pilot phase 117 State / Central government hospitals are being considered where feedback will be collected from more than 1,00,000 patients per day. 37 hospitals were sharing data with My Hospital as on 19th September, 2016.

    eRakt Kosh

    Launched on 7th April 2016, eRakt Kosh application is a centralized blood bank management system. eRakt Kosh is being rolled out for all the licensed blood banks in public and private health facilities in States / UTs. Presently eRakt Kosh is running in 4 blood banks of Madhya Pradesh, 5 blood banks of West Bengal and blood bank of national HQ of Indian Red Cross Society in Delhi. The application is going to be initiated in some blood banks of Gujarat, Jharkhand, Telangana and Uttar Pradesh shortly.

    National Organ & Tissue Transplant Orgnaization (NOTTO)

    (http://notto.nic.in)- (Launched in 2015). There are two registries in place under this program-

    1. Online Registration for Organ/Tissue Transplantation or Retrieval– Total registration- 1721

    2. Online pledge registry by citizen for organ donation: Total registration-23695

    National Cancer Registry Program

    (http://www.ncrpindia.org/)- National Cancer Registry Program being run by ICMR collects data on cancer patients across country. The registry data is used to compile cancer atlas which provide details about cancer incidences, types underlying causative agents and risk factor details

    Central Drugs Standard Control Organization (CDSCO)

    “SUGAM” for processing of applications for import and registration of drugs and permits for import of small quantities of drugs for personal use. System Launched in November 2015.  Total Firms registered for import of drug (2089), medical devices (1076) and cosmetics (116). 

    FSSAI

    The system facilitates online License to the Food Business Operators falling under central license-; online clearance mechanism for imported food items; online system for product approval of food items which are not standardised under the Food Safety and Standards Act & Regulations made there under.

    Total Bill Of Entries filed: 26997 for 34235 food items.

    32597 food Items granted No Objection (NOC) whereas 292 items were rejected

    NOC generation for 1346 items is under process

    Food Licensing and Registration system:

    Total application received online till date for central license : 28461

    License issued till date : 28027

    Total renewal application received : 13705

    Total renewal done : 13649

    ERMED (Electronic Resource in Medicine) Consortium

    National Medical Library’s ERMED Consortium is an initiative taken by the MOHFW to develop nationwide electronic information resources in the field of medicine . The consortium is coordinated through its headquarter set up at the NML since 2008.

    At present, 70 state and centrally funded Government Institutions (including all AIIMS) from 24 states are selected as its members

    One of the advantages of ERMED consortium is that it not only provides current issue of Journals from leading publishers , but also facilitates its users with the archival issues (print as well as electronic) for example, British Medical Journal, an International peer reviewed Medical journal is fully searchable, with an archival backup since 1840. National Medical Library have a distinction of having BMJ since 1840 in print format. Print archive available since Oct 1840 to Dec 1993, and online archive available Jan 1994 to till date, and The BJU International is available since 1929 with full-text archive. One of the biggest strength of NML is its vast collection of 7.5 lakh volumes of books, reports, bound volume of journals and other literature, and adds latest books and journals every year. It also subscribes to 1500 current periodicals. The library has good collection of 19th century medical literature.

    National Medical College network

    Under National Medical College Network (NMCN), scheme , 50 Govt. Medical Colleges  are being inter-linked with the purpose of Tele-education, e-Learning and Online Medical Consultation by utilising the connectivity provided by National Knowledge Network (NKN). Under this imitative, a virtual layer of Specialty/ Super Specialty doctors from these Medical colleges would also be created  for providing “Online Medical Consultation” facility to citizens which will be similar to OPD facility but in a virtual way through a web-portal. This will help patients from rural, remote and urban areas to access doctors and specialists easily even from their home location through their Smart Phones, through Government healthcare institutions (PHC/CHC) and through Common Service Centers (CSCs). 

    National Telemedicine Network (NTN)

    In the first phase of National Telemedicine Network project, it is proposed to connect 500 PHC/CHC/SDH at remote/rural locations with 50 District Hospitals. These District hospitals will be networked with 50 Medical Colleges.

    Telemedicine by using Space Technology

    Establishment of SATCOM based telemedicine centres at Chardhams and other important places of pilgrimage in collaboration with DoS (ISRO).

    Integrated Health Information Platform (IHIP)

    In order to augment the overall Electronic Health ecosystem further, the Ministry has envisaged setting up IHIP. This is a major step in the direction of addressing the existing situation of ‘electronic silos’ in health system. Interoperability and data exchange amongst Health IT Systems is almost lacking.

    IHIP is expected to address various key issues and challenges such as fragmented information systems, accessibility & quality of data, duplicate information systems and most important lack of common EHR System. Today, most of the patient records get trapped in multiple silos. IHIP would work in the direction to enable the EHRs of citizens to be made available nationwide with the help of Health Information Exchange.

    IHIP would in due course facilitate better health services to citizens and improve efficiency of healthcare services and programmes through optimal utilization of resources, availability of information for better decision and reduction in medical errors etc. With help of EHRs, cost reduction in medical cost is expected as requirement of redundant medical tests would be checked.

    Citizens would be empowered through online access to IHIP to view their health records and also to upload other medical records in order to create and maintain personal health record.

    In line with Startup India initiative, IHIP would also provide an opportunity to Health IT start-ups to host their innovative solutions for use by different stakeholders. 

    States and Union Territories (UTs) are being supported for implementation of hospital information system at hospitals and health centres for facilitating creation of EHRs.

    Ministry has already started the process for setting up IHIP and it is expected to be ready for pilot in select States/UTs early next financial year. The platform will by then be ready for progressive roll-out all over the country. 

    National Digital Health Authority

    Setting up of the National Digital Health Authority (NDHA) is another milestone for Indian Healthcare IT. The various regulatory aspects of digital health deployent like privacy, security, access, disclosure, exchange. would be taken care of by National Digital Health Authority (NDHA) proposed to be set up by MoHFW. The work on the same is already on , and this will institutionalize the support for digital health.

    National Health Helpline

    The Ministry is working on setting up of the health helplines . We want to ensure that people have the information they need, and on time 24 x7 in the remotest and inaccessible areas . This project should roll out by early next year . National Health Helpline  is envisioned to be offering its services in 16 regional language including reliable medical information with a doctor/an expert by harnessing the high number of mobile connections in India (in almost every household). This health helpline facility will help rural population save money and time on visits to doctor in a large number of cases

    India Health Information Network (IHIN)

    The Ministry of Health & Family Welfare , Government of India has initiated IHIN – A think tank of private and public sector to advice the Government on Digital Health.

    Ministry is committed to financially support all the digital initiatives, and looks forward to multi-stakeholder engagement, and private public partnerships to scale up these initiatives

    Update: 
    CHANGING THE PARADIGM OF #DIGITALHEALTH IN INDIA REPORT 5TH GOVERNMENT INDUSTRY DIALOGUE by @rajendragupta 
    http://governmentindustrydialogue.org/documents/pdf/5th-gid-report.pdf 




    Rajendra Pratap Gupta is the Advisor to the Union Minister of Health & Family Welfare , Government of India . Views are personal. 

    Author
    Rajendra Pratap Gupta

    Rajendra Pratap Gupta (Rajendra) is an original thinker and an innovator and one of the most influential and sought after public policy expert in the country. He has worked with some of the largest organizations across the world and was nominated to the Global Agenda Council of the World Economic Forum for 2012-2014 in recognition of his work.

    He was conferred; ‘Global Healthcare Leader of the Year’ award in 2012 by the sheriff of Los Angeles; named the ‘Thought Leader of the Year’ three years in a row by ICT Post; Featured amongst the ’25 living Legends of Healthcare in India’ and is listed amongst the “100 Most Impactful Healthcare Leaders”.

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


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

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


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

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

    The India Internet Story

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

    The India Healthcare Story

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

    The Digital Health at an Inflection Point

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

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

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

    Author

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

    Manish Sharma

    Founder HCITExpert.com, Digital Health Entrepreneur

    Connect with me via any of my Social Media Channels

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    Blog Series: #IoT in Healthcare by Swetha Jegannathan @csweths


    The opportunity in #healthcare IoT is estimated to be $2.5 trillion by 2025. How are we embracing this change? The Types of Opportunities (http://blog.hcitexpert.com/2016/05/infographic-iot-in-healthcare-opportunities.html) that present themselves to the Startups, Healthcare IT organisations are tremendous.
    Presenting the insights shared by Swetha Jegannathan (@csweths) on #IoT in Healthcare #PhilipsChat.
    Q1: In the near term (1-3 years), What are the top 3 innovations in IoT that can benefit healthcare?:
    Swetha Jegannathan:
    1. Geriatric Care – IoT is and will continue to be of great value in elderly care, allowing the doctors and care givers to monitor, track and alert when away from their loved ones – especially in cases of neurological disorders like Dementia and Alzheimer.
    2. Maternal and Infant Monitoring – IoT, through monitoring devices worn by the individual, can provide timely intervention in the area of maternal and infant health – one of the primary goals of the UN sustainable development agenda.
    3. Remote consulting – The low doctor patient ratio in India can be effectively overcome through remote consulting – making patients responsible for their well-being – leading to the doctors and hospitals prioritise focus on emergency and chronic patients.

    Note: Since radio frequency is central to most of the IoT innovations, innovator must adhere to protection standards on effects of radio frequency (RF) fields as tabulated by the International Commission on Non-Ionizing Radiation Protection (ICNIRP, 1998) and the Institute of Electrical and Electronic Engineers (IEEE, 2005)

    Further the paper “IEEE Standard for Safety Levels with Respect to Human Exposure to Radio Frequency Electromagnetic Fields, 3 kHz to 300 GHz” also gives few pointers on safe use of the IOT technology. http://emfguide.itu.int/pdfs/C95.1-2005.pdf
    Q2: Is an IoT based system going to be a utility or a service?:
    Swetha Jegannathan: The system will be successful if offered as a service. Hospitals would be the drivers providing this service to their patients with companies engaged in the manufacture and distribution of medical devices being the enablers of the technology.
    Q3. Do you see any device, connected via any protocol and with any cloud; as the future, if yes how will that be achieved? Standards?:
    Swetha Jegannathan: RFID based devices connected through the anti-collision protocols and the Apple watch will be the future.

    The RFID chips are inserted into the human beings for unique identification and capture of information relating to their general health and well being like blood pressure, weight, blood sugar levels.  The RFID tags can also be used for improving the efficiency of the medicine distribution networks as tracking of the medicines becomes easier.

    Prevention of inappropriate usage of the collected information in terms of charging higher insurance premiums or classification of the individuals tracked by the device is one of the biggest challenges to its widespread implementation. However, if used judiciously, healthcare can certainly move from curative to preventive care.

    RFID standards need to focus on the following:
    – How the RFID systems work
    – What frequencies do they operate on and how to use a common frequency across the globe
    – Method of data transfer
    – Communication between reader and the tags
    – Complementary products development compatible to the RFID
     
    Q4: In India (or your country), what are the Digital Infrastructure requirements for enabling IoT based Innovations in Healthcare?:
    Swetha Jegannathan: In India, most of the patient data is available in physical form and this needs to be converted to electronic form.  Only if 100% of the required data is in electronic form, further analysis can be simplified.
    For all the required data to be available electronically and their analysis, high end scanners, significant investment in hardware – to cater to large databases – and software (machine learning – image recognition; AI) to effectively manage data and make decisions. Further, a standard medical data code for data transmission and retrieval is a prerequisite.
    Once the data is collected, stored and retrieved efficiently, analysis is accurate and easier leading to appropriate decision making.
    Q5. How can hospitals leverage #IoT based solutions for service delivery and patient care? :
    Swetha Jegannathan: Some usage of IOT in the indian and international hospitals are given below:
    GE used sensors in a New York hospital to track the usage of hospital beds resulting in  optimised occupancy levels and reduced the emergency room wait times by four hours.
    e-Alert, a HW/SW solution by Philips Healthcare, virtually monitors the health of its machines to prevent outages. Timely alerts on the wear and tear of the machines leads to savings on replacements and repair.
    In India, Manipal Hospitals has been using a wearable device for the expecting mothers to enable doctors to remotely monitor real time information of the growing foetus.
    Apollo hospitals has been an early adaptor of IoT in the country in healthcare for accessing patient records at one go with its Unique Hospital Identification initiative across the country.
    In addition to the above, the hospitals can leverage IOT in the following areas:
    – Clinical decision enablers
    – Effective control on hospital borne infections
    – Targeted and painless surgery using AI/ VR.
    – Connected care pre and post discharge
    Q6: What are the aspects of Connected Care for the Patient Care Continuum (https://twitter.com/HCITExpert/status/692309239570628608):
    Swetha Jegannathan: Connected care for patient care continuum would include:
    1. Preventive health – with regular check-ups, timely alerts and early interventions
    2. In-Patient Care – Personalised treatment enabled by technology
    3. Post operative care – Remote tracking, consulting and treatment follow-ups using telemedicine and diagnostic tools.
    Q7. Please share usecases for Connected Care for: Healthy Living, Prevention, Diagnosis, Treatment, Homecare:
    Swetha Jegannathan: The use case suggested is based on the premise that it is executed at state level involving the hospitals and care givers.
    – The state monitors the citizen’s health using IoT technology – Wearable/ regular check-ups to name a few
    – State collects data and, post analysis, alerts the hospitals if there is a deviation from normal
    – Concerned citizen and the hospital are in touch and the identified individual is put on preventive treatment with periodic observation of the readings
    – If the preventive treatment is successful, then sustenance is monitored through home care including life style changes
    – If the preventive treatment is not working for the individual, further investigation is encouraged.  Post investigation, if the individual is diagnosed with the suspected condition, the relevant treatment procedure is given to the individual.
    – Monitoring of the progress of the individual’s condition during the treatment is an important step
    – On conclusion that the treatment is successful, the hospital, through IOT, will monitor the relevant data periodically.
    – The hospital and the individual may decide to have remote follow up consultations till the individual is deemed to be healthy again and there are no signs of relapse.
    Q8: What are the Healthcare based Smart City components? How can Local, State and National Government’s make #IoT solutions in healthcare economically viable?:
    Swetha Jegannathan:
    The following are the healthcare based Smart City components:
    – Digital e-health and m-health systems
    – Remote patient monitoring leading to customised treatments and medication
    – Devices and wearables linking patients with remotely present doctors and nurses
    – Data anonymisation
    – New innovations on sharing medical learnings that are digitally collected
    – Common medical data standards for collection, distribution, analysis and retrieval

    The implementation of the Smart City concept in healthcare can be achieved by having a model district containing the above components.  This model needs to be continuously monitored and course corrected (wherever relevant) for it to be successfully expanded to the state, other states and finally the country.

    Healthcare based Smart City components, if implemented efficiently, will lead to optimisation of the healthcare costs incurred by the governments.
    Q9: How can private hospitals justify the RoI’s of Smart Hospital Components? :
    Swetha Jegannathan: Thought, the initial investment and efforts required may be enormous, the patient convenience and hospital resource optimisation through the process streamlining will be worth the efforts and the investment. With the entire patient record being seamlessly available to all the relevant stakeholders, significant savings will be achieved in collecting, sharing and transcribing data – in terms of cost and time. This would also minimise medical errors and, in turn, enhance the reputation of the hospitals in the long run.
    Q10: Give us a Buzzword we are going to be hearing regarding IoT based innovations in Healthcare.:
    Swetha Jegannathan: Human barcoding
    Q11. Tell us a 5 Year view of IoT in Healthcare and what would a Patient Experience in a Smart Hospital?:
    Swetha Jegannathan: In 5 years the patients should be able to experience hospitals as wellness clinics with patient centric design in both service and delivery being the priority. This would be achieved if the following plan in implemented in a systematic manner:
    – The patient will be assigned to the nearest healthcare facility by the smart city based healthcare network algorithm
    – When the patient walks into the hospital (without any physical file), the face recognition technology will retrieve his records and direct him to appropriate department for treatment and physician without any wait time
    – Incase of further investigation, the medical record will be sent to the nearest laboratory that then collects the samples from the patient and send the results to the hospitals online for further deciding treatment protocol, including surgeries and therapies. Alternatively for some tests FDA approved diagnostic mobile applications can replace the laborious laboratory tests and share the results instantly with the hospital over the data cloud
    – Painless surgeries with targeted robotic precision will be the norm
    – During the treatment course (either as in-patient/ out-patient), medical prescription is shared electronically with the pharmacy that delivers the medicine to the patient
    – Home care will be an extension of the hospital care with the wearables monitoring the patient’s health and alerting medicine/ therapy schedule
    – Physicians will do remote consulting for acute cases, thus freeing them and hospital facilities to attend to only chronic patient in person
    – After the recovery stage, the IoT based diagnostic kits will be used to monitor the health of the patient remotely and alert any relapse or detect a new condition

    Thus, seamless integration of health system and data without human intervention (or edits) will greatly reduce medical errors and enhance the patient experience.
    Q12. Finally: What areas of IoT based innovations are you looking to partner with Startups for? Can you give us two areas?:
    Swetha Jegannathan: – Technologies looking at reducing or eliminating the radiation effects of radio frequency that is so central to IoT use cases.
    – Smart human centric designs to make healthcare more patient centric without compromising on the human touch.


    Stay tuned to the #IoT in Healthcare Blog series Bookmark this link to follow on the insights being shared by the experts on the HCITExpert Blog:

    Author
    Swetha Jegannathan

    Swetha is a lifescience/ healthcare IT consultant with focus on business flow, pre and postsale lifecycle of a software. She has been fortunate to be part of different sub-sectors within the health and life science vertical, be it e-health and m-health at Eli-Lilly Co-Innovation lab for HCL, Singapore or Clinical Data Management & Computation and Laboratory Information Management Software (LIMS) suite at Phase Forward – Waban Software group (now acquired by Oracle) and Ocimum Bioslutions. She has catered to clients across major pharmaceutical majors in US, Europe and South East Asia.

    She was instrumental is setting up the DNA sequencing wet lab for MWG Biotech (Now Eurofins), a German company, when they were establishing their base in India in 2004.

    Swetha is also passionate about promoting green businesses and innovations that are socially relevant, economically viable and environmentally sustainable. An advocate and practitioner of natural living, she has also done social work assignments with focus on sustainable agriculture, food security and environment. (nominated for the UN Online Volunteering Award in 2010 and her volunteering work was published in UN Online Volunteering newsletter March 2011) and covered in The Strait Times, Singapore national daily.

    Specialties: Digital health, Green business, Start-up facilitator, Business Analysis, Consulting, Entrepreneur, Marketing, Social Media, Project Management, Presentation Skills, Networking.

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


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


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

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

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

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

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

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

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

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

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

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

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

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

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

    What is the Bell – Mason Diagnostic Evaluation Model?

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

    1 The Founding Premise

    The the BMD Model’s founding premise is

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

    2 The Four Diagnostics

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

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

    1. Space

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

    The 12 Dimensions of the Bell Mason Diagnostic are: 

    12 Dimensions of the Bell – Mason Diagnostic (BMD)

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

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

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

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

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


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

    BELL MASON DIAGNOSTIC – STAGES


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

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

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

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

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

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

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

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

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

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

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

    How to, Build to Last

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

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

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

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

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

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

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

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

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

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

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


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

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

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

    Author

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

    Manish Sharma

    Founder HCITExpert.com, Digital Health Entrepreneur

    Connect with me via any of my Social Media Channels

    [/content]
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    Blog Series: #IoT in Healthcare by Manishree Bhattacharya @ManishreeBhatt1


    The opportunity for #IoT in Healthcare is estimated to be $2.5 trillion by 2025. How are we embracing this change? The Types of Opportunities that present themselves to the Startups, Healthcare IT organisations are tremendous.

    During the #PhilipsChat, on the 10th April 2017, we asked the experts what they thought about the current trends and focus areas that the IT Industry, Medical Device Manufacturers, Hospitals and Start-ups will need to keep in view, in the near and short-term, while making their organisation ready for the Digital Transformation that can be and will be enabled by #IoT in Healthcare.  
    Presenting the insights shared by Manishree Bhattacharya (@ManishreeBhatt1) on #IoT in Healthcare

    Q1: In the near term (1-3 years), What are the top 3 innovations in IoT that can benefit healthcare?
    Manishree Bhattacharya: 1. Remote monitoring of (cardiac disorders, COPD, Alzheimer’s, Parkinson’s, insomnia, diabetes, elderly, expecting mothers)
    2. An integrated/connected surgical room, where devices are interoperable, regularly feeds in data into patient profile in EMR, to streamline post-operative care, both in the hospital and beyond, at patient homes
    3. IoT for ensuring drug/treatment adherence, such as sensor-based pills
    Q2. Do you see any device, connected via any protocol and with any cloud; as the future, if yes how will that be achieved? Standards?
    Manishree Bhattacharya: Right now, developments are quite random and sporadic. To achieve larger goals, moving from connected devices to connected hospitals, some level of standardization and uniformity will be important to ensure an error-free, and secured transmission.
    Q3: In India (or your country), what are the Digital Infrastructure requirements for enabling IoT based Innovations in Healthcare?
    Manishree Bhattacharya: Seeing Digital Health take off in India in its full bloom is one of my wishes, and the preliminary requisite would be to encourage hospitals go paper-less – have EHR systems implemented, with a timeline set for nation-wide implementation. Just imagine how seamless healthcare delivery will be if primary, secondary and tertiary centres are integrated – data can seamlessly flow from one centre to another. Government has a very strong role to play here, that will help in creating the right infrastructure, timely adoption, establishing standards, lowering costs by promoting local manufacturing, and boosting HealthIT start-ups.
    Q4. Please share use cases for Connected Care for: Healthy Living, Prevention, Diagnosis, Treatment, Homecare:
    Manishree Bhattacharya:
    Healthy Living – Most consumer IoT devices aim to do that – tracking exercise regimes, diet plans
    Prevention – Say a heart patient puts on a wearable device that continuously monitors and sends signals to nurses/doctors for any aberration – this can ensure timely treatment and prevent a severe episode.
    Homecare – A person who has just had a surgery, and is on homecare – his regular vitals, diet plan, outputs are remotely being tracked by the doctor/nurse – who can selectively revise the diet or post-surgery recovery plan. Same goes with elderly who are on home-care.
    Treatment – A sensor-based pill that sends a signal to a care-giver on ingestion of the pill.
    The bigger purpose – We know that not all medicines work on every patient. Regularly tracking patients not only help in timely interventions, and more personalized treatments, it also opens routes to more clinical research on personalized medicines.
    Q5: What are the Healthcare based Smart City components? How can Local, State and National Government’s make #IoT solutions in healthcare economically viable?
    Manishree Bhattacharya: Answering to how can government make IoT solutions viable, my thoughts would be:
    1. By promoting indigenous manufacturing to curb costs
    2. Incentivising IoT adoption in hospitals
    3. Prioritizing HealthIT in the overall start-up agenda
    Q6: How can private hospitals justify the RoI’s of Smart Hospital Components?
    Manishree Bhattacharya: By improving quality of care; reducing hospital re-admissions, yet prolonging the care process that extends to one’s home; and finally improving patient engagement/adherence. A patient is more likely to visit a doctor who can provide a more personalized treatment than the one who cannot. Important would be define these key metrics/KPIs right at the beginning of implementation.

    Q7. Tell us a 5 Year view of IoT in Healthcare and what would a Patient Experience be in a Smart Hospital?
    Manishree Bhattacharya: First, we have to understand the purpose of IoT in healthcare – it is not there just for the sake of it, but to truly enable a coordinated and long-term care, that would eventually reduce mortality, morbidity, and hospital re-admissions. Patient experience is bound to improve. A patient will not have to run from one department to another, narrating the whole problem and showing multiple reports. So when a cancer in-patient enters a psychologist’s office, and the doctor already knows the problem, and also has the latest vitals of the patient right in his tablet, he knows that the patient was not able to get any sleep the previous night and has a high BP right now. The doctor would hence probably choose to talk about things that can ease the patient’s current situation. Now, that is truly an enriching experience.

    Looking ahead in the future, we may also have AI-enabled voice assistants that will make a patient more comfortable in hospital settings.
    Q8. Finally: What areas of IoT based innovations are you looking to partner with Startups for? Can you give us two areas?
    Manishree Bhattacharya: Would love to connect with any start-up that can provide meaningful solutions for the Indian healthcare landscape. What I would also like to see is how these start-ups are using the tonnes of data that IoT devices generate, in deriving meaningful analysis – big data, AI, and so on.

    References

    1. Here is the original Blog Post announcing the #PhilipsChat Tweetchat : http://blog.hcitexpert.com/2017/04/philipschat-on-iot-in-healthcare.html
    2. 3 ways in which Information Technology can improve healthcare in India by Manishree Bhattacharya (@ManishreeBhatt1) on NASSCOM Community
    1. IoT in India – The Next Big Wave by NASSCOM http://www.nasscom.in/iot-india-next-big-wave
    2. Curated list of Tweets from the #PhilipsChat: https://twitter.com/i/moments/852242427008233473
    3. Review the #PhilipsChat Transcript & analytics via @symplur here >> http://hcsm.io/2loNiv7
    Stay tuned to the #IoT in Healthcare Blog series. Bookmark this link to follow on the insights being shared by the experts on the HCITExpert Blog:

    http://blog.hcitexpert.com/search/label/IoT%20in%20Healthcare

    Author
    Manishree Bhattacharya

    Manager – Research & Advisory at NASSCOM
    Business professional with 7+ years of experience in research and advisory, across IT, healthcare, and medical technologies. At NASSCOM, responsible for identifying digital opportunities, driving thought leadership/innovation and delivering actionable insights for the Indian Technology Industry

    Blog Series: #IoT in Healthcare by Dave Brown (@QiiQHealthcare)


    The opportunity #IoT in Healthcare is estimated to be $2.5 trillion by 2025. How are we embracing this change? The Types of Opportunities that present themselves to the Startups, Healthcare IT organisations are tremendous.

    We asked experts what they thought about the current trends and focus areas that the IT Industry, Medical Device Manufacturers, Hospitals and Startups will need to keep in view in the near and short-term while making their organisation ready for the Digital Transformation that can be and will be enabled by #IoT in Healthcare.  

    Presenting the insights shared by Dave Brown (@QiiQHealthcare) on #IoT in Healthcare.

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

    Dave Brown: Great user-centered design; cheaper sensors; integration-friendly cloud services (including ML and AI).

    Q2: Is an IoT based system going to be a utility or a service?:
    Dave Brown: The UI -where the rubber meets the road- is a service. The software behind it is also a service. I can see some of the hardware elements and networking tech’y being a utility.

    Q3. Do you see any device, connected via any protocol and with any cloud; as the future, if yes how will that be achieved? Standards?:
    Dave Brown: More public exposure of performance metrics will incentivize QI and therefore innovation. Free-market competition (between innovators) will drive down costs. With this accelerated change, risk will rise – this can’t be avoided. However, reliability and data security standards will stabilise risk.


    Q4: In India (or your country), what are the Digital Infrastructure requirements for enabling IoT based Innovations in Healthcare?:

    Dave Brown: Not sure.  But to my previous answer – system reliability and security standards will help confidence levels for healthcare providers who are frightened of change.

    Q5. How can hospitals leverage #IoT based solutions for service delivery and patient care? :
    Dave Brown: Start with the big picture in mind; begin with small, measured implementations, and look for IMPACT.  Advance quickly as success metrics show up.

    Q6: What are the aspects of Connected Care for the Patient Care Continuum
    Dave Brown: Healthy Living, Prevention, Diagnosis, Treatment & Home Care. THIS DOES NOT HAPPEN WITHOUT PROGRESSIVE APPROACHES TO INTEGRATION. The future = API’s.

    Q7. Please share usecases for Connected Care for: Healthy Living, Prevention, Diagnosis, Treatment, Homecare:
    Dave Brown: One simple picture: a FitBit user shares their data with their provider network; always-on data analysis (that also taps the user’s genomic data) triggers alerts when bad signs arise; then an automatic clinical response launches to address the issue before it becomes a serious problem. This process is AI-driven.

    Q8: What are the Healthcare based Smart City components? How can Local, State and National Government’s make #IoT solutions in healthcare economically viable?:
    Dave Brown: BIG question – hard to predict – creative and informed entrepreneurs will come up with many. I think these IoT solutions emerge from a vibrant startup community. Governments assist merely by creating incentives for the birth&growth of well-run startups, including spurring investment. They can also help round up healthcare executives and tech entrepreneurs to thoughtfully examine REAL problems and viable solutions (to save entrepreneurs from building solutions that no-one will buy and deploy).

    Q9: How can private hospitals justify the RoI’s of Smart Hospital Components? :
    Dave Brown: Similar answer as Q2a: start small and measure measure measure.

    Q10: Give us a Buzzword we are going to be hearing regarding IoT based innovations in Healthcare.:
    Dave Brown: Not sure.  How ’bout: “Smart API’s”

    Q11. Tell us a 5 Year view of IoT in Healthcare and what would a Patient Experience in a Smart Hospital?:
    Dave Brown: It’ll take more than 5 years for a real transformation to occur. But as I’ve already written, more good data (genomic + real-time consumer sensors) with strong AI will increase proactive community interventions, thus reducing the demand on urgent care.

    Q12. Finally: What areas of IoT based innovations are you looking to partner with Startups for? Can you give us two areas?:
    Dave Brown: We ARE a startup, committed to helping redesign workflow in urgent care.  We need to partner with companies contributing to acute care IT. We eventually need to integrate with community-care solutions to further improve the patient experience in moving from community care to acute care.

    You can contact QiiQ Healthcare via their website: http://QiiQHealthcare.com
    You can reach Dave via Twitter: @DaveBrutusBrown

    References

    1. Here is the original Blog Post announcing the #PhilipsChat Tweetchat : http://blog.hcitexpert.com/2017/04/philipschat-on-iot-in-healthcare.html
    2. Curated list of Tweets from the #PhilipsChat: https://twitter.com/i/moments/852242427008233473
    3. Review the #PhilipsChat Transcript & analytics via @symplur here >> http://hcsm.io/2loNiv7

    Stay tuned to the #IoT in Healthcare Blog series Bookmark this link to follow on the insights being shared by the experts on the HCITExpert Blog:

    http://blog.hcitexpert.com/search/label/IoT%20in%20Healthcare

    Author
    Dave Brown

    Co-Founder at QiiQ Healthcare, designer/engineer – perceptive, meticulous, smart and sensible
    leader/entrepreneur – social, tenacious, visionary and realistic

    With age, I’ve become a “big picture” guy, but I can and will roll up the sleeves….

    I’ve led small and medium-sized user-facing technology projects: starting with strategy, and flowing right down to the detailed tactical level. I get the P&L picture, and am very comfortable driving execution.

    Blog Series: #IoT in Healthcare by Srinivas Prasad M.R. @prsdsrnvs


    The opportunity in #healthcare IoT is estimated to be $2.5 trillion by 2025. How are we embracing this change?

    During the #PhilipsChat, on the 10th April 2017, we asked questions related to the current trends and focus areas that the Healthcare IT Industry, Medical Device Manufacturers, Hospitals and Startups will need to keep in view in the near and short-term while making their organisation ready for the Digital Transformation that can be and will be enabled by #IoT in Healthcare.
    A great discussion ensued that has spawned this blog series. Presenting the insights shared by M. R. Srinivas Prasad (@prsdsrnvs) on #IoT in Healthcare #PhilipsChat. (http://en.wikipedia.org/wiki/M._R._Srinivasaprasad)



    Q1: In the near term (1-3 years), What are the top 3 innovations in IoT that can benefit healthcare?:
    M. R. Srinivas Prasad: In the emerging markets the IOT devices that would play an important role in extending care to the homes and community, would be those that can enable remote monitoring of cardiac patients, COPD patients and pregnancy monitoring in the rural community. These devices could be devices like Connect diagnostic ECG, Low cost but reliable wearables to monitor basic vital signs and breathing patterns and connected intelligent fetal dopplers to help monitor the child during birth helped by midwives

    Q2: Is an IoT based system going to be a utility or a service?:
    M. R. Srinivas Prasad: This will be a mix of both. It can (also) be an Outcome-based pricing model which is a variant implementation of the Service Model.

    Q3. Do you see any device, connected via any protocol and with any cloud; as the future, if yes how will that be achieved? Standards?:
    M. R. Srinivas Prasad: Need to adhere to Continua standard for these devices for open connectivity but in the near term I see that cost will prevail over the interoperability standard if regulatory bodies don’t ensure conformance from the start.

    Q4: In India (or your country), what are the Digital Infrastructure requirements for enabling IoT based Innovations in Healthcare?:
    M. R. Srinivas Prasad: A change in the mindset of going from paper to paperless is needed. Then there is a need to educate hospitals “Software is not free”. In addition, enabling IoT will need reliable telecom networks, work with the ecosystem to set up datacenters. Maturity & innovation around commercial business models will be a need Supporting infrastructure like connected ambulances, trained paramedics & and efficient transportation system will help.

    Q5. How can hospitals leverage #IoT based solutions for service delivery and patient care? :
    M. R. Srinivas Prasad: Postoperative care can be shifted to the patient’s home. This can help free up beds in the hospital which can help in increase revenue to the hospital from a new patient. Hospital-acquired infections can be reduced and finally, in bringing down the cost of care, the benefit that can be extended to the patient.

    Q6: What are the aspects of Connected Care for the Patient Care Continuum?
    M. R. Srinivas Prasad: From Philips Healthcare point of view Connected care for the Patient Care Continuum comprises of Healthy Living, Prevention, Diagnosis, Treatment and Homecare. Here’s a video that explains these aspects https://www.youtube.com/watch?v=Xe-KxiiIyNI

    Q7. Please share usecases for Connected Care for: Healthy Living, Prevention, Diagnosis, Treatment, Homecare:
    M. R. Srinivas Prasad: (elaborated on each of the aspects of Connected Care for the Patient Care Continuum)
    #HealthyLiving There are many in the market but it is important to choose the right one like the ones which are accurate e.g. Philips watch. Eating healthy food but tasty from an Indian cuisine context means fried food. Philips air fryer helps air fry tasty healthy food.

    #Prevention Breathing Fresh & clean air is important for us to avoid pulmonary complications in countries like ours where pollution levels are high. #Philips Air Purifier helps address this issue

    #Diagnosis Early diagnosis is critical to increase survival rate and reduce the cost of treatment. Use of AI in helping clinicians early diagnosis and also managing a larger population base can help solve the India challenges. Either for aiding in detection of infectious diseases like TB or identifying lesions from brain and breast scans.

    #Treatment Minimally invasive devices are the key here . Low dose interventional X-ray systems or mobile surgery systems . Radiation planning systems which aid accurate and the right dose planning.

    #HomeCare Monitoring of post cardiac patients and COPD patients at home. Philips Home Co business in india extends care into the home. This reduces cost of care and also helps the hospital to manage more new patients. Monitoring compliance to medication is another key aspect when extending care to home.

    Q8: What are the Healthcare based Smart City components? How can Local, State and National Government’s make #IoT solutions in healthcare economically viable?:
    M. R. Srinivas Prasad: Government should step in with policies that support in “giving the last mile connectivity” to decentralize healthcare (and) help in the convergence of Mobile technology, Consumer engagement and Payment reforms.
    Additionally, Population management to understand disease profiling, to understand the spread of infectious diseases like malaria, typhoid etc. Smart ambulances. Garbage clearing monitoring. Air quality monitoring device across the city. Adequate availability of AED ‘s and accessible and connected. These are all related to health care.

    Q9. How can private hospitals justify the RoI’s of Smart Hospital Components?
    M. R. Srinivas Prasad: Demanding solutions from healthcare companies. Looking at OPEx models where the capex requirement is low. Productivity improvement from workflow efficiencies. Productivity gains or clinicians from using AI and smart tools. Better clinical decisions and patient re-admissions which will be enhance patient stickiness and also enhance the brand which will drive more patients to the hospital.

    Q10. Tell us a 5 Year view of IoT in Healthcare and what would a Patient Experience in a Smart Hospital?M. R. Srinivas Prasad: A seamless experience which helps the hospital in its business, helps the clinicians make better decisions, helps patients by reducing their healthcare costs and the insurance providers become more efficient and manage their premiums better. A win win for all. Example from the onset of chest pain to early diagnosis, to emergency care, seamless patient data flow into the hospital EMR’s. Flow or patient context and information right through the various departments in the hospital including radiology, cardiology, critical care and also seamless extension of this care into home or the community post discharge and post operative care on remote care settings. A seamless experience in a distributed care environment

    Q11. What areas of IoT based innovations are you looking to partner with Startups for? Can you give us two areas? M. R. Srinivas Prasad: Advanced AI models to aid early diagnosis of chronic diseases – Cardiac, COPD, Oncology and Mother and Child space. Smart IOT devices to support Monitoring of patients under various clinical conditions post discharge. Pregnancy monitoring and post natal care. Solutions in the healthcare informatics space and connect care solutions to help extend care into the community and homes

    To one other question from Mr. NS Ramnath (@rmnth): On a scale of 1 to 10, where do you think the sensors in wearables in the market today stand?
    M. R. Srinivas Prasad: It’s in a very nascent stage but with a huge potential and key to help solve our healthcare challenges.

    Mr. M.R. Srinivas Prasad, signed-off from the chat by urging the participants, “let’s define the future of healthcare for a better India and a better world. Technology is key! Cheers

    References

    1. Here is the original Blog Post announcing the #PhilipsChat Tweetchat : http://blog.hcitexpert.com/2017/04/philipschat-on-iot-in-healthcare.html
    2. #IoT and #AI: Potent combo redefining healthcare by M. R Srinivas Prasad @prsdsrnvs on Livemint http://www.livemint.com/Opinion/iuOHAO5UCn1qzH2q5JwJvL/IoT-and-artificial-intelligence-Potent-combO-redefining-hea.html
    3. Curated list of Tweets from the #PhilipsChat: https://twitter.com/i/moments/852242427008233473
    4. Review the #PhilipsChat Transcript & analytics via @symplur here >> http://hcsm.io/2loNiv7
    Author
    M. R. Srinivas Prasad

    CEO, Philips Innovation Campus, India

    Blog Series: #IoT in Healthcare by Dr. Vikram @drvikram

    The opportunity in #healthcare IoT is estimated to be $2.5 trillion by 2025. How are we embracing this change? The Types of Opportunities that present themselves to the Startups, Healthcare IT and Healthcare organisations are tremendous


    During the #PhilipsChat, on the 10th April 2017, we asked the experts what they thought about the current trends and focus areas that the IT Industry, Medical Device Manufacturers, Hospitals and Startups will need to keep in view in the near and short-term while making their organisation ready for the Digital Transformation that can be and will be enabled by #IoT in Healthcare.

    A great discussion ensued and that has spawned this blog series. Presenting the insights shared by Dr Vikram Venkateswaran (@drvikram) on #IoT in Healthcare #PhilipsChat.


    Q1: In the near term (1-3 years), What are the top 3 innovations in IoT that can benefit healthcare?:
    Dr Vikram Venkateswaran:
    In my opinion, the immediate benefits are in areas where other industries have made progress: cheaper rates for Sensors, Increased security at device and sensor level. Additionally, an Increased integration of sensors and devices with EMR allowing for proactive interventions and remote monitoring for Chronic diseases.
    Another aspect is Managing inventory and tagging assets are key for more hospitals, and i think that is an immediate benefit that will accrue.
    To the question of, Do you think India will benefit from cheaper portable diagnostic devices or remote treatment a better stead ? asked by Divye Marwah; I would say, both patients and the hospitals will benefit.
    Sukesh Kumar: Do you think #AI will help in taking healthcare to the next level?
    Dr Vikram Venkateswaran: Its already happening in certain specialties like Oncology
    Q2: Is an IoT based system going to be a utility or a service?
    Dr Vikram Venkateswaran: Tricky one but I would say a service, with elements of a utility.

    Ms. Manishree Bhattachar (@ManishreeBhatt1), Analyst with NASSCOM, “Do you think EHR implementation is a requisite, to go for a full bloom service+utility models for IoT devices?”

    Dr Vikram Venkateswaran: I think so personally, without the full view of patient history, proactive intervention; depends on the care priorities for the Hospital.

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

    Dr Vikram Venkateswaran: That is one of the biggest challenges today, EMR integration with IoT devices for example Wearables, remote pacemakers, Bionic Limbs, lenses with ability to monitor sugar levels and Blood Pressure.

    Q4: In India (or your country), what are the Digital Infrastructure requirements for enabling IoT based Innovations in Healthcare?:

    Dr Vikram Venkateswaran: Network connectivity and availability of LE sensors is the key, Most healthcare systems are still on paper records, Patient education is the key as well, massive change in perception is required.

    Q5. How can hospitals leverage #IoT based solutions for service delivery and patient care? :
    Dr Vikram Venkateswaran: Health Checks, remote health monitoring as a service, pro active intervention as a service

    Q6: What are the aspects of Connected Care for the Patient Care Continuum?
    Dr Vikram Venkateswaran: Interoperability and adherence of standards, increased communication, Change in perception of patients and hospitals

    Q7. Please share usecases for Connected Care for: Healthy Living, Prevention, Diagnosis, Treatment, Homecare:
    Dr Vikram Venkateswaran: Remote monitoring of cardiac pacemakers,  monitoring of blood glucose, Sweat analysis for athletes, Sleep monitoring for patients and athletes

    Q8: What are the Healthcare based Smart City components? How can Local, State and National Government’s make #IoT solutions in healthcare economically viable?:
    Dr Vikram Venkateswaran: Disease Surveillance, Leveraging weather data to predict disease patterns, Population health management

    Q9: How can private hospitals justify the RoI’s of Smart Hospital Components? :
    Dr Vikram Venkateswaran: Hospitals can prioritise understanding disease patterns

    Q10: Give us a Buzzword we are going to be hearing regarding IoT based innovations in Healthcare.:
    Dr Vikram Venkateswaran: Smart Care, Home Healthcare, Remote Health Monitoring, Home Health, Connected care, Connected Health

    Q11. Tell us a 5 Year view of IoT in Healthcare and what would a Patient Experience in a Smart Hospital?:
    Dr Vikram Venkateswaran: Hospitals to focus on critical care, emergencies and palliative care. Regular check ups and follow ups to be conducted leveraging IoT

    Q12. Finally: What areas of IoT based innovations are you looking to partner with Startups for? Can you give us two areas?:
    Dr Vikram Venkateswaran: Disease Surveillance, Home Healthcare

    References

    1. Here is the original Blog Post announcing the #PhilipsChat Tweetchat : http://blog.hcitexpert.com/2017/04/philipschat-on-iot-in-healthcare.html
    2. #IoT and #AI: Potent combo redefining healthcare by M. R Srinivas Prasad @prsdsrnvs on Livemint http://www.livemint.com/Opinion/iuOHAO5UCn1qzH2q5JwJvL/IoT-and-artificial-intelligence-Potent-combO-redefining-hea.html
    3. Join the #Philipschat on Twitter #IoT in #Healthcare on Monday 10th April 2017, 3 PM – Health Care in India http://healthcare-in-india.net/healthcare-technology/join-the-philipschat-on-twitter-iot-in-healthcare-on-monday-10th-april-2017-3-pm/
    4. Curated list of Tweets from the #PhilipsChat: https://twitter.com/i/moments/852242427008233473
    5. Review the #PhilipsChat Transcript & analytics via @symplur here >> http://hcsm.io/2loNiv7
    6. #IoT & #AI – A potent combination redefining healthcare event by @PhilipsBlore moderated by @drvikram https://youtu.be/6cpeICKV9Fw

    Stay tuned to the #IoT in Healthcare Blog Series Bookmark this link to follow on the insights being shared by the experts on the HCITExpert Blog:


    Team @HCITExperts [Updated: 29th May 2016]
    Author

    [tab]
    [content title=”About Dr. Vikram Venkateswaran”]

    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.
    Connect with me

    [/content]
    [content title=”Latest Articles”]

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

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


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

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

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

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

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

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

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

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

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


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

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


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

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



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

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

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

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

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


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

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

    Agenda for #PhilipsChat : #IoT for Healthcare

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

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

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

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

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

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

    > Healthy Living
    > Prevention
    > Diagnosis
    > Treatment
    > Homecare


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

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

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

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

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

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

    Transcript of the #PhilipsChat

    References

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


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

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


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


    1 Internet of Things

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

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

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

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

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

    2 Augmented Reality

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

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

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

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

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

    3 Virtual Reality

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

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

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

    VR tech is currently being used to 

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

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

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

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

    Blockchain technology is supposed to benefit healthcare 

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

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

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

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

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

    Artificial Intelligence ecosystem consists of:

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

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

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

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

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

    Source: CBINSIGHTS


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

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

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

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

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

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

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

    7 Drones

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

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

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

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

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

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

    8 Robotics

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

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

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

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

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

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

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

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

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

    We appreciate you considering sharing your knowledge via The HCITExpert Blog

    Suggested Reading

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

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