Tag: Inder Davalur

Almighty Data or Hype? By INDERJITH DAVALUR @INDERDAVALUR

DIGITAL TRANSFORMATION AND THE PLACE FOR DATA


Mea Culpa, I am one of those who is guilty of getting on and staying on the Big Data wagon for the wrong reasons. “Data is the new oil” is an oft-repeated phrase. I am about to commit a “virtual” suicide by proclaiming that it is not so. Data has its place and it is not at the top of the digital food chain. I feel that we have crowned the half-naked prince, Emperor in haste.

For the sake of clarity, when I say data, I will be referring to digital data throughout this piece. Data is a by-product of any activity. Therefore, creating data is as natural as breathing. So we have data. A lot of data. So what? Accumulating data, structuring it, storing it, analyzing it are a natural progression from that point onwards. How and what we do with the data is more important. Software. 

The magic that is software, to me, is more transfixing. Consider the prospect of a language written in a semantic that is alien to our natural human language. A cryptic command, logic, condition, trigger – anything at all – that is magically read, understood and acted upon by silicon. Hardware that contains baked-in code that can parse and carry out complex instructions at blazing speeds. Pieces of such chips soldered on a board and communicating through ‘roadways’ of circuits laid out on a board. The miracle of hardware coupled with the magic that is software is what gets my adrenalin pumping. How can such a marvel not be exciting?

Even the awesomeness of hardware pales in comparison to software. Hardware is more or less static. It is confined to physical and functional dimensions. Software, however, is supreme. It can use the same hardware (with some limitations of course) and carry out simple tasks, entertain with games, or perform wildly complex calculations at very very high rates of speed, accurately all the time. And it can do this million million times with alacrity. This is just the beginning of what software can do. But wait, there’s more!

Consider intelligence in software. It suddenly becomes a living, breathing, dynamic being. Almost. Software can learn and teach itself. Crunching data and spitting out patterns and actionable analysis suddenly becomes mundane, banal almost pedestrian. No. I am not against data or big data. By itself, big data is just that. A monstrosity. Sometimes, big data actually gets in the way. Misleads us in making decisions quickly. Software breathes life into data. 

Take any software language or tool. Examine it. Study its flow, the eloquence, the nuance and its brilliance. Brevity in software coding is revered by programming perfectionists. There is elegance in a well-written piece of code that executes beautifully, perfectly, every time. Anyone that can find literary melody in Shakespeare or Milton can certainly begin to enjoy the harmony in a beautifully crafted software application code. So, my appeal goes out to all those who are worshipping big data to take a moment to reflect upon the joy that software brings to our daily lives. After all, the future is software!

Author
Inder Davalur

Inderjith Davalur is a healthcare technology specialist, speaker, writer and utopian dreamer.
Inder works with hospitals committed to transforming the healthcare paradigm with the aid of new innovative technologies. His primary area of interest lies in using data analytics and technologies such as Deep Learning to shift the current physician-driven healthcare model to a patient-driven market dynamic.
Inder focuses on the manifold ways in which data crunching and machine learning can lead to better diagnoses that can not only be made at the time of illness, but predicted way before any symptoms surface. The path ahead in the sector, he believes, lies in the deployment of evolving technologies that immensely influence both diagnostic and therapeutic aspects of healthcare, delivering real patient-driven, data-enabled, informed healthcare.
Inder currently works as the Group CIO at KIMS Hospitals Private Limited, Hyderabad and has previously assumed leadership roles at leading hospitals and companies, in India and the United States of America.

A PhD Researcher’s QnA on #BigDataAnalytics (BDA) with a Healthcare CIO by Inder Davalur, @INDERDAVALUR & Nishita Mehta


Q1. Nishita Mehta: What is data’s role in healthcare & how do you see it influencing future health sector growth in India?

A. Inder Davalur: 

Big Data Analytics (BDA) will have a huge role in healthcare. Healthcare has been a latecomer to using IT as a tool but the future looks good. AI and its children – ML, IoT, and M2M are excellent candidates for advancing technology in healthcare. There is a real potential for technology to advance what I have termed “Connected Continuum of Care” in one of my blogs. This means that with wearables and other Internet of Healthcare Things (IoHT), creating a biome where the patient and doctor/hospital are always connected would become a reality. Always-on Internet is the future and extending that to healthcare is a natural progression. With the price of Internet in India being one of the lowest in the world, we will be in an excellent position to incorporate technology in advancing healthcare delivery.   


Q2. Nishita Mehta: What are the unique challenges of working with clinical data? 

A. Inder Davalur: 

Doctors. Well, the challenge lies with the fact that most clinical data is unstructured. Doctors and hospitals are notorious for NOT wanting to follow standards when it comes to coding diagnoses and treatment. Adoption of DSM, Snomed, ICD codes is very spotty. Physicians complain about the inconvenience in the classifications and prefer to use free text in writing their diagnoses and treatment protocols. This creates a credibility gap in how clinical data can be meaningfully classified and analyzed for any useful prediction or AI driven protocols. EMR applications in India struggle with the similar challenges with physicians disagreeing on a set of standards in capturing and documenting clinical data. 

Q3. Nishita Mehta: Healthcare seems to be moving from the use of structured data to unstructured data. What is the difference between them when it comes to clinical utility & improving patient outcomes?

A. Inder Davalur:  

Healthcare has always suffered from a lack of structured data. Unstructured data creates several challenges in a software trying to classify the same diagnosis written with slight variations. The same fate awaits treatment plans. If medical coding (DSM, ICD etc.) is followed, it will enable any analytics software to make sense of the data and provide useful insights. With AI, structured data is still king. Predictability of an outcome for a set of patient symptoms, medications, prior history, genetic propensity, lifestyle habits would have a high accuracy 

Q4. Nishita Mehta:What do you think does a hospital need to implement Big Data solutions, i.e. Big Data Analytics Capabilities in terms of infrastructure and personnel requirement?

A. Inder Davalur:  

One of the major challenges a CIO or an IT head faces in a hospital is the lack of budget allocation for anything beyond the basic networking, computing and storage needs. Hospitals do not see the value in the data they currently possess most likely because they are more empirically driven rather than evidence driven. What this means is that hospitals and by nature the doctors who hold a sway over management decisions are more comfortable with their own decades of experience over some hotshot CIO trying to promote the idea of data mining and predictive value of patient outcomes based on past data. There is also a severe shortage of technology-rich personnel in hospitals due to the dull routine of maintenance of existing hardware and software rather than experimenting with new technology. The pay structure for IT personnel in hospitals is also woefully poor in comparison to the technology companies. All these factors combine to deter anyone who is driven to create in hospitals a digital core

Q5. Nishita Mehta: While Big Data can generate a plethora of interesting patterns or hypotheses, there is still a need of experts to analyze the results to confirm whether they make sense or merit further inquiry. Would you like to comment on this?

A. Inder Davalur:  

Absolutely. Right now, there is a paucity of people with skills to interpret and recommend action plans once an organization implements any sort of analytics software. Unlike other verticals, healthcare is lagging far behind in its focus on data interpretation and application in its business model. It might be a whole decade before hospitals wake up to the reality of meaningful interpretation of data and building an action plan around it


Q6. Nishita Mehta: What are the major drivers of Big Data Analytics in healthcare in India?

A. Inder Davalur:  

Have not seen much evidence of it. Perhaps some hospitals have ventured into some basic AI driven applications in specific areas such as pharmacy sales or patient wait times. Other than that, BDA is yet to catch up.

Q7. Nishita Mehta: What are the key benefits Indian hospitals will draw from implementation of Big Data Analytics? 

A. Inder Davalur:  

First and foremost, hospitals will get to see for themselves how poorly structured their data is. BDA for Indian hospitals can cover a better management of the following: 
  1. Sponsored
  2. Accounts Receivables
  3. Professional Fees
  4. Disposables and Consumables
  5. Pharmacy – Generic vs brand name consumption
  6. Targeted marketing
  7. Continuum of Care post-discharge
  8. Predictability of illness propensity from regular Health Check ups
  9. Results-oriented tasking for better output from employees

Besides these areas, hospitals can contribute tremendously to public health issues by sharing anonymized patient data with the State Health Department which can then study outbreaks and lifestyle disease patters in the general public. 

Q8. Nishita Mehta: How does Big Data Analytics help better decision-making & building disease understanding?

A. Inder Davalur:  

One of the most ignored areas is a deeper dive into results from investigations. Empirically speaking, the values considered “normal range” are never questioned. If a better study is conducted, what is normal for one cohort may not be so for another cohort. As an academic exercise, I had a simple deep analysis done to study the correlation between borderline values of lipid profile and any other element from a blood test. The result was a high (>70%) correlation between borderline lipid profile values and an elevated monocytes count. It turned out that among those who fell in this group, nearly 78% of them were later admitted for some coronary complication. The medical reason is that the monocyte levels are elevated when there is presence of a heart disease. Every one of these patient was merely getting a Health Check. Imagine if hospitals did such studies on a multitude of investigations routinely conducted for patients and conducted regular follow ups as a preventive measure

Q9. Nishita Mehta: One of the biggest concerns in healthcare is the rising costs. What potential solutions does Big Data offer for this problem in Indian context?

A. Inder Davalur:  

India’s population is now facing more mortalities from lifestyle diseases – Non Communicable Diseases (NCD) as opposed to communicable diseases. There is a great potential to flip the business model of the healthcare industry to go from disease management to health management. I have written blogs on this topic. The premise is very simple. Make it more profitable for hospitals to keep the public healthy than to treat them. If the payment structure is modified to increase the prices for health checkups and promoting healthy prophylactic therapy methods as opposed to coronary by-pass surgeries, it could completely change the paradigm. These prices can be graded based on age. All old age related treatments can receive higher prices; while treatments like a heart surgery for a 40-year old can be less. At the same time, therapeutic treatments for younger population geared for promoting good health can receive higher prices. A larger healthy population means a larger market for the hospitals. This ensures that the hospitals have a higher incentive to make the healthy population larger

Q10. Nishita Mehta: What would you highlight as being the major challenges today in developing & actually implementing Big Data Analytics capabilities to truly extract meaningful insights?

A. Inder Davalur:  

An urgent awareness creation among promoters and owners of hospitals of the benefits of investing in the technical hardware and personnel resources to build and maintain a BDA infrastructure. Without that awareness, IT costs are always seen as a sunken wasteful expenditure as opposed to an investment. There is nothing else lacking in this respect.

Q11. Nishita Mehta: Do most doctors now have a checklist for what they should be doing with patients with certain conditions? How does Big Data solution change what they are doing currently?

A. Inder Davalur:  

Hard to predict. Most clinical pathways and treatment protocols are traditionally empirically driven. It is hard to imagine a medical community to take notice of what BDA might reveal and radically change their protocols. That said, things have changed – take robotic surgery – and there is hope and a high degree of probability that medicine might be “data-powered” (my phrase over the more commonly used data-driven) offering the physician to choose to use such data-powered results wherever she finds it viable or desirables

Q12. Nishita Mehta: How do hospitals need to adapt to embrace the full potential of data-driven innovation?

A. Inder Davalur:  

Promoters and owners having a greater understanding of the power of data

Q13. Nishita Mehta: How important do you think Big Data Management & Analytics is right now to enhance healthcare in India?

A. Inder Davalur:  

Tremendously. With the technical resources at its disposal, India would be imprudent not to take full advantage of the benefits of BDA. Population health data is one of the most ignored among developing nations. India would do extremely well to develop and use BDA for advancing population health

Q14. Nishita Mehta: What do you see as the main emerging opportunities for hospitals from greater adoption of Big Data Analytics?

A. Inder Davalur:  

Connected Continuum of Care (a phrase I first used in a blog) is a concept of keeping the patient engaged post treatment and post discharge through the use of wearables and IoHTs (Internet of Healthcare Things). This ensures that hospitals are not merely agents in episodic encounters and instead become agents of well-being. BDA will help provide the big picture in the overall health and well-being of the population it serves

Q15. Nishita Mehta: What are some of the biggest challenges facing the healthcare industry in terms of its ability to use Big Data to improve healthcare outcomes?

A. Inder Davalur:  

A better understanding and incentive to invest in the infrastructure is all it takes. Once that happens, India is best equipped to leverage from its large technology-aware population. At the hospital level, BDA could help establish a new approach to purely outcomes-driven pricing structure and treatment protocols that would be data-powered. 

Q16. Nishita Mehta: Would you like to share additional insights on the topic, which I might have missed?

A. Inder Davalur:  

Public-Private-Partnerships with educational institutions and hospitals would also be beneficial. There is going to be a severe shortage of technical resources who are trained in AI and BDA by 2020. If the government partnered with colleges to promote courses and training in AI and BDA India could be the largest supplier of technical talent to the world. If hospitals also partnered with the government to share health data, the state of overall population health will rise and costs will come down.

The article was first published on Mr. Inder Davalur’s LinkedIn Pulse page. The blog was Mr. Inder’s answers to Ms. Nishita Mehta’s Survey published on the HCITExpert Blog earlier, here. I would like to thank both the Author’s for sharing their insights via the HCITExperts Blog. 
Team @HCITExperts [Updated: 03 rd Sep 2018]
Authors
Nishita Mehta

Ph.D. Scholar at SYMBIOSIS INTERNATIONAL UNIVERSITY

Inder Davalur

Inderjith Davalur is a healthcare technology specialist, speaker, writer and utopian dreamer.
Inder works with hospitals committed to transforming the healthcare paradigm with the aid of new innovative technologies. His primary area of interest lies in using data analytics and technologies such as Deep Learning to shift the current physician-driven healthcare model to a patient-driven market dynamic.
Inder focuses on the manifold ways in which data crunching and machine learning can lead to better diagnoses that can not only be made at the time of illness, but predicted way before any symptoms surface. The path ahead in the sector, he believes, lies in the deployment of evolving technologies that immensely influence both diagnostic and therapeutic aspects of healthcare, delivering real patient-driven, data-enabled, informed healthcare.
Inder currently works as the Group CIO at KIMS Hospitals Private Limited, Hyderabad and has previously assumed leadership roles at leading hospitals and companies, in India and the United States of America.

My thoughts on DISHA – The Digital Information Security in Healthcare Act, India by Mr. Inder Davalur @inderdavalur

Here’s my tuppence on DISHA (Draft Digital Information Security in Health Care Act)


I have listed the areas that the CIO would do well to examine the capabilities in the HIS/EMR used at her/his hospital. The dependency for the CIO on the vendor goes up multiple fold because, the ability of the hospital to respond to the Government/Courts with reports and evidence and also provide flexibility to the patient to request and effect changes to their consent are key. I have attempted here to respond with my thoughts on some salient points in the draft legislation.
These sections would require that hospitals are capable of obtaining reports from the HIS/EMR to comply with the authorities who may want to conduct audits.
(a) Ensure that the clinical establishments and other entities in the state collect, store, transmit and use digital health data as per the provisions of this Act and the standards, protocols and operational guidelines issued by the National Electronic Health Authority, from time to time;
(b) Conduct investigations to ensure compliance with the provisions of this Act;
(2) Without prejudice to sub-section (1) above, for the purpose of enabling the State Electronic Health Authority to generally discharge its functions under this Act, it shall direct a clinical establishment or a class of clinical establishments, or all clinical establishments as the case may be, or entities, to submit such records or file such returns within such time and in such manner as specified from time to time.
These points relate to the ability to record and produce evidence that the patient consent was taken and also that the same patient was given the choice to retract prior consent in HIMS. The patient will also have the right to punitive damages for mishandling or otherwise misusing or abusing his/her private data
(2) An owner shall have the right to give or refuse consent for the generation and collection of digital health data by clinical establishments and entities, subject to the exceptions provided in Section 29 of this Act.
(3) An owner shall have the right to give, refuse or withdraw consent for the storage and transmission of digital health data.
(4) An owner shall have the right to refuse consent to the access or disclosure of his or her digital health data, and if refused it shall not be disclosed, subject to the exceptions provided in Section 33 of the Act.
(a) The right to rectify without delay, from the respective clinical establishment or health information exchange or entity, any inaccurate or incomplete digital health data, in the prescribed form as may be notified by the National Electronic Health Authority;
(b) The right to require their explicit prior permission for each instance of transmission or use of their digital health data in an identifiable form, through such means as may be prescribed by the Central Government;
(c) The right to be notified every time their digital health data is accessed by any clinical establishment within the meaning of Section 34 of the Act;
(d) The right to ensure that in case of health emergency, the digital health data of the owner may be shared with their family members;
(e) The right to prevent any transmission or disclosure of any sensitive health related data that is likely to cause damage or distress to the owner;
(f) The right not to be refused health service, if they refuse to consent to generation, collection, storage, transmission and disclosure of their health data;
(g) The right to seek compensation for damages caused by a breach of digital health data.
This section deals with encrypted form of transmission of data. Which means that any investigation results obtained via mobile or website must be encrypted Transmission of data
All these conditions can be met only when and if hospitals have full access to patient data and are capable of producing reports as mandated (5) The owner of the digital health data shall have a right to access his or her data in such form and manner, as may be specified by the National Electronic Health Authority of India.
(6) In case of an emergency, certain digital health data shall be immediately made accessible to a clinical establishment, upon a request, including information related to allergies, drug interactions and such other information as may be specified;
This clause requires hospitals to be able to make corrections within specified times or face penalties
(2) On receipt of such application under sub section (1), the clinical establishment or health information exchange shall rectify such digital health data immediately or within three working days from the date of receipt of such application and the same shall be intimated to the owner in writing.
Penalty
(2) Any person who commits a serious breach of health care data shall be punished with imprisonment, which shall extend from three years and up to five years; or fine, which shall not be less than five lakh of rupees.

The article was first published on Inder Davalur’s LinkedIn Pulse page here, its been republished here with the Authors’ permission. 

Author
Inder Davalur

Inderjith Davalur is a healthcare technology specialist, speaker, writer and utopian dreamer.
Inder works with hospitals committed to transforming the healthcare paradigm with the aid of new innovative technologies. His primary area of interest lies in using data analytics and technologies such as Deep Learning to shift the current physician-driven healthcare model to a patient-driven market dynamic.
Inder focuses on the manifold ways in which data crunching and machine learning can lead to better diagnoses that can not only be made at the time of illness, but predicted way before any symptoms surface. The path ahead in the sector, he believes, lies in the deployment of evolving technologies that immensely influence both diagnostic and therapeutic aspects of healthcare, delivering real patient-driven, data-enabled, informed healthcare.
Inder currently works as the Group CIO at KIMS Hospitals Private Limited, Hyderabad and has previously assumed leadership roles at leading hospitals and companies, in India and the United States of America.