Tag: #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. 

Continue reading “Healthcare Decoded – The #Analytics Conundrum by Harish Rijhwani, @Harish_Rijhwani”

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

‘‘Doctor on the Go” Revolution Ready To Change The Reality of Healthcare by @Guneet_B

Digital technology in healthcare is booming at a rate that no one would ever have imagined. From smartphone apps to self-monitoring healthcare devices, the healthcare delivery system has started to change for the better.

Continue reading “‘‘Doctor on the Go” Revolution Ready To Change The Reality of Healthcare by @Guneet_B”

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

Connect with me via any of my Social Media Channels

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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

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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

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    [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