Thursday, 25 February 2016

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


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

The healthcare industry is currently experiencing change at an unprecedented rate. Change is not only occurring in the technology used in diagnostics and care delivery, but this change is so fundamental that it could, and likely will, fundamentally alter the business model of the industry.
Today we have fitness bands, healthcare apps, appointment schedulers, health chats and several such means to access healthcare but one thing that all of this does not necessarily correlate with high quality of care or better outcomes.
We need to understand that “Not even a Ferrari will get us to our destination without a driver.”
Formula of Driver:
Driver = (Need + Incentive) where;
Incentive = (Value + Reward)
Need = (Gap + Demand)
To define the best drivers, we need to first address the need. Need might not make economic or business sense but it is the best opportunity to leave an impact. No one remembers how much business a “Mughal-e-Azam” or “Usual suspects” did but everyone remembers that these were great movies with splendid performances.
In India, we have several such needs today. A survey conducted by HCG on several pressing issues in the field of health and safety highlighted the following:
  1. Women safety
  2. Elderly concierge services
  3. Child safety
  4. Personalized nutrition
  5. Health Insurance for OPD services
  6. Cancer support/ early detection
  7. Infertility
  8. Fitness (scientifically monitored) and performance 

This list is not exhaustive. I don't need to look at statistics to confront the horrid truth. News stories of women from all over India being raped, beaten, killed are flashed across us day after day – and we all are aware of it. The fatal Nirbhaya gang-rape saw an outpouring on the streets of Delhi – protests decrying the fragile status of women in India. Candle light marches, editorials examining the patriarchal and sexist traditions of our country, an awakening on social media – even conversations on streets revolve around the night they cannot forget: the night that took Nirbhaya. We need to do something about women safety. Devices, trackers, processes, helplines- whatever little or more we can do. 
 If you are an innovator in this area, please get in touch with me.
For elderly even small accidents can be deadly. While simple falls, such as slipping while walking off a curb, may seem relatively harmless, they can actually lead to severe injury and death in elderly individuals, according to a new study published in The Journal of Trauma: Injury, Infection, and Critical Care. As the population continues to age, it is important for physicians and caregivers to be aware of and prepared to deal with this issue, which could significantly impact the overall health and wellbeing of older adults. 
In addition to it, low blood pressure, low blood sugar, heart attack and other things can be very worrisome and need constant monitoring. Innovators call to action here is to come out create and raise awareness about such bracelets, devices and jewelry that can be adorned for a purpose.
Without calorie count possible, limited heart rate tracking and availability of other vitals; performance management and fitness efforts are less effective. Measuring your heart rate using a heart rate monitor is a good way to gauge the effectiveness of your workout because as you strengthen your body through exercise, you also strengthen your heart.
Measuring the rate of your heart during exercise can help you determine when you're pushing your body too hard or need to push it harder to achieve the level of fitness you are seeking. I love the work Hexoskin and Kenzen are doing. I am looking for something more affordable and focused for Indian market.
Health tech is blazing hot right now and there's no shortage of companies working on innovative products designed to change the face of healthcare as we know it. That's a good thing, considering Indians are as unfit as ever and bureaucracy continues to muck things up for physicians and patients alike. As technology evolves, it could upend some of these problems. One thing that's certain: Consumer-driven healthcare is coming. And these companies are helping make it happen.
All the best !



Author
Article By: Dr. Ruchi Dass
Digital Health Influencer & Health Innovator (HIT, Big Data, IoT, Analytics and Cloud)| TED speaker | Investor and Mentor

Thursday, 18 February 2016

New Healthcare Aggregators: SMAC and IoT via @pankajguptadr


Author: Dr. Pankaj Gupta
Digital Health Influencer & SMAC / IoT Speaker
15.Feb.2016, India

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

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

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

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

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

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

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

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

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

References

Why Healthcare must Re-imagine itself - and how
https://www.linkedin.com/pulse/why-healthcare-must-re-imagine-itself-how-arun-kumbhat
Why All Indian Hospitals IT is in Bad Shape
http://healthcareitstrategy.blogspot.in/2014/04/why-all-indian-hospitals-it-is-in-bad.html
Global HIS/EMR vendor nightmare outside US
http://healthcareitstrategy.blogspot.in/2012/08/global-hisemr-vendor-nightmare-outside.html
Thick client vs Thin client
http://healthcareitstrategy.blogspot.in/2008/08/thick-client-vs-thin-client.html
There is no Market for EMR in India
http://healthcareitstrategy.blogspot.in/2012/10/there-is-no-market-for-emr-in-india.html
Size of Healthcare-IT Market in India
http://healthcareitstrategy.blogspot.in/2012/06/size-of-healthcare-it-market-in-india.html 

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


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

Thursday, 11 February 2016

Revolution In Healthcare via @SelfCareGuru



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

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

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

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

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

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

 

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


Article By: Joao Bocas
Digital Health Influencer & Wearables / IoT Speaker

Saturday, 6 February 2016

Health ID as Patient IDs unifier in India

Health ID as Patient IDs unifier



06.Feb.2016, Bangalore, India

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

Unique Identifiers, Health ID & Aadhar Number

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

Aadhar Number

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

Patient ID or UHID Number

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

Using Aadhar as a Health ID

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

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

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

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

In Conclusion

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

References:

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

    Suggested Reading

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

     

    Author: 

    Manish Sharma


    Founder HCITExperts.com, Digital Health Entrepreneur.