Learn to say "No"​ by Sanjay Dandekar, @santhedan

I have found that many people find it difficult to say "No". They end up saying "Yes" when their heart / mind / body is shouting "Noooooo.....!". This could happen due to many reasons:
  • Fear: If I say no, my performance review will be affected.
  • Gratitude: Repaying the debt (however small it may be) - The person asking helped me last time so the least I can do is say "Yes"!
  • Authority: How can I say no to my boss's boss?
  • Affection: How can I say no to my best buddy?
  • Heard mentality: Everyone is saying "Yes". Why be the odd one out?
Some of the after effects of always saying "Yes" are as follows:
  • You will always be overworked and will have no time for anything other than work.
  • You will have some spectacular failures against your name as you will eventually fail at something important while juggling multiple things.
  • You may get exploited - More work for less pay, Your colleagues will have fun while you toil away at your desk.
  • With each "Yes" which should be "No", you will scale the mountain of unrealistic expectations only to fall at some point in future.
  • Your physical and mental health may get affected.
  • Your social and professional relationships may become strained or snap altogether.
  • You will make your team members's life miserable as eventually they also have to support your "yes" one way or another.
"When you say yes to something you don’t want to do, here is the result: you hate what you are doing, you resent the person who asked you, and you hurt yourself." - James Altucher, The Power of No 
One approach to learn to say no is to ask for some time and say "I will think about it" instead of saying yes or no on the spot. Use the time wisely to evaluate what you want to say ("Yes" or "No") and the consequence of the same. Think and try to answer the following:
  • Does it align with your goals and objectives?
  • Does it interest you or not?
  • Do you have the requisite skills / expertise? If no then do you want to acquire the requisite skills / expertise?
  • Given your other responsibilities that you have already said "yes" to, do you have enough time?
  • Are there any other tasks that are currently on your plate that you can offer as a "trade-off" in case you do not have time?
  • Is there a well defined success / failure criteria and expected timelines for completion? Will you be able to meet / exceed the expectations?
  • Will you be dependent on someone / something to complete what is asked of you? Are the dependencies agreed and committed?
  • If you are saying "Yes" on behalf of the team, are all members (or sizable majority) in agreement? The onus is on you to ensure that you do have "false-consensus".
Answering the above will give you clear enough a picture about why you want to say "No". While saying "No", do the following:
  • Explain your "genuine" reasons for saying no - a quantitative approach is preferred
  • Be polite but firm in your response
  • Don't be apologetic
  • Don't feel guilty
Remember you will be successful only if you "want" to do what is asked of you. If you force yourself to be "what you are not" then it will only produce mediocre outcomes at best. Learn to stop saying "Yes" out of fear or obligation or guilt. It is far better to say "No" than to say "Yes" and not deliver on your commitments.
It is only by saying "No" that you can concentrate on the things that are really important - Steve Jobs 
So go ahead and say "No" with confidence and without remorse - There are many differentways to say it!

Learn to accept "No"

When you ask someone to do something, be ready to hear a "No" as that is one of the possible outcome of this exercise! Just because you have the position of authority / own a favor does not mean that the other person is obliged to say "Yes". Give time to the person to make a decision and listen to their reasoning with empathy when they say "No". Do not take the negative response as a negative feedback or rejection of your self. The person has said "No" for the task and not to you as a person. These two are completely different things. If you want to convert the "No" to "Yes", try the following:
  • If the reason for "No" is time constraint, offer to reduce the existing workload i.e. re-prioritize the existing tasks.
  • If skill / knowledge is the constraint, offer coaching, training opportunity and also provide time for ramp-up before the task can start.
  • If the objective / outcome of the task is hazy, then involve the right people to bring about clarity.
  • If there is dependencies then ensure that those are committed and fulfilled at the right time by the right people.
If the person has no interest because the task is not aligned with their goals / objectives or is diagonally opposite of their interest, it is recommended that you accept the "No". You will never get the required outcome in such situations - It might be counterproductive to push for "Yes" using your authority. If you are a "good" leader who is close to your team, you will never be in such a situation as you will know the aspirations of your team members! The best approach in such situation is to find someone else who will say "Yes".
Remember, people who say "No":
  • Have different priority than you
  • Can still be multi-tasking or may not like multi-tasking
  • May want to give their 100% to something else that is also important
  • Are still competent and skillful (Isn't that why you asked them to do the task?)
  • Are team player and are deeply invested in achieving team's goals (Would a badly done task help achieve team's goal?)

Do not demonize them just because they said "No" when you wanted them to say "Yes"!
Disclaimer :- This disclaimer informs readers that the views, thoughts, and opinions expressed in the text belong solely to the author, and not necessarily to the author's employer, organization, committee or other group or individuals. 
Sanjay Dandekar
A well rounded software architect with almost 20+ years of rich and very diverse technology and domain experience in various verticals including CRM, Retail Banking, Financial Services and Healthcare. Extensive hands-on development, design and architecture experience in various technologies.
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How Healthcare is becoming B2C with the help of Interoperability by Ritika Jain and Vakku Chethalan

I joined the interoperability team at Philips Healthcare in my senior year of college. At that point of time, with a novice approach to software engineering and a look at real world problems with my rose-tinted glasses, interoperability seemed a bit dull. Until, one day I fell off the stairs and had to go through X-rays and six weeks of physiotherapy on my way to recovery. This is when I had a first-hand glance at hospital operations.

Source: Instagram @newyorkercartoons

As I crippled my way to the doctor's office up and down the stairs several times, I realized what I work on everyday is what was needed here.

How could have interoperability helped me?
Interoperability, simply, is SEND -> RECEIVE -> FIND -> USE.

Let's imagine the above situation with interconnected systems - I would register myself at the front desk, and would book an appointment with the doctor. The doctor would recommend an X-ray. I would walk to the X-Ray lab and the technicians would already have all the information that they need to know. I would get an X-ray, walk back to the doctor's room and the doctor would see the scan on the monitor. All I did was register myself at the front desk and the rest was taken care of by the systems that can talk to each other aka, interoperable systems.

This was also an early years agenda by ONC(Office of the National Coordinator for Health Information Technology) for the hospitals to start adapting to the concept. For instance, the Argonaut project was launched to develop a FHIR based application programming interface and define core data specification. Apple Health based on the Argonaut project, is making healthcare information accessible to 200 million people and their doctors, and has a growing client base of 100+ hospitals.

Philips bed site monitors were early adapters of interoperability with the help of Philips' IntelliBridge Enterprise(IBE).

The 21st century definition of interoperability
Healthcare systems are flooded with crucial information, but limitations in utilizing that data turns it useless. Today, efficiency in healthcare interoperability is not just determined by the ability to share data, but by the level to which it enables us to understand the patient. If even one life is saved because of a provider having access to all the crucial data needed to understand the medical history of the patient and take necessary steps, that is when true success in interoperability is achieved. Rest every other metric used to gauge the success of interoperability is a mere paperwork. Thus, the
Use Information to Improve Health Care Quality and Lower Cost six year agenda by ONC.

It also laid down the basis for a secure, timely and reliable exchange of information with interoperability.

80% of hospitals can electronically query other organizations for health information. Hospitals automatically send an electronic notification and care summary to primary care providers when their patients are discharged. This is possible because of continuous work done by healthcare vendors

Philips HealthSuite Digital Platforms is one such example of connected, secure, reliable continuous care. Philips IntelliSpace Precision Medicine leverages HSDP to curate personalize care plans for patients, empowered by IBE.
IntelliSpace Epidemiology, launched in HIMSS this year, is the only decision-support solution in the U.S. that combines clinical informatics and genomic sequencing information from pathogenic bacteria, aiming to efficiently assist infection control prevention teams in identifying infection transmissions, is also empowered by interoperability.

What does the future hold?
Improvement in information sharing at all levels of public health, and research will better generate evidence that is delivered to the point of care. Advanced, more functional technical tools will enable innovation and broader uses of health information to further support health research and public health. The ONC has finally gotten around to proposing a rule that defines activities that do not count as information blocking by Health IT systems - the 21st century Cure's Act. The second draft of ONC's TEFCA(Trusted Exchange Framework and Common Agreement) supports network-network health data exchange on a national level, the goals of TEFCA are well-intentioned. ONC recognizes that the private sector is critical to promoting interoperability with their idea of limiting the burden of operationalizing the common agreement to QHINS or the Qualified Health Information Networks.
And the one thing we are already seeing is more implementation of secure patient-centric APIs.

"To make a seamless experience in healthcare happen, a lot of different technologies need to come together, "There's no one technology that's going to do everything", making standardization key- Karen Appelbaum, executive director of enterprise access operations and technology at Providence St. Joseph Health .

These are the building blocks of a learning health system and ONC's long term agenda.

According to a Pew Research Center survey, the amount of time Americans spend tracking their health habits is second only to the time they spend surfing the web. Patient's will be the catalyst that solve the interoperability challenge. There are over 325,000 healthcare apps, wearable sensors, fitness bands, sleep tracking tools, habit tracking apps and patients are becoming active participants in managing their own health.

Interoperability at the patient's fingertips, along with the relevant decision support tools and layers of AI that can extract actionable health insights, will reduce the probability of treatment conflicts between various providers

Philips wearable biosensor for vital-signs monitoring is one such example where care is managed by the patient at the ease of his or her home, reducing hospitalization costs, bed cost for the hospitals and as it is interoperable the care-provider gets regular information on patient's condition and gets notification when intervention is needed.

The future looks bright, and hopeful with public and private sector coming together and relaxation in the laws, lucrative monetary incentives, roll out of frameworks that are easier to adapt and ensure trust. Over the years, as a recurring participant in IHE Connectathon and having had to build showcased solutions for HIMSS, I have observed that the clinical workflows have more or less remain the same, it is the interconnectedness that has evolved, with technology, for the good.

On a side note, as we take a look back at HIMSS 2019, the talk about interoperability has reduced in ten years, but we are still not there

Disclaimer :- This disclaimer informs readers that the views, thoughts, and opinions expressed in the text belong solely to the author, and not necessarily to the author's employer, organization, committee or other group or individual. 


Ritika Jain
A regular at IHE Connectathon and HIMSS, with 5 years of differentiated experience as integration consultant and engineer with Philips Healthcare. Drives innovation and technical competence across the team, and solution discussions with cross-functional team across Philips globally. Skilled in HealthTech, Healthcare Interoperability, and Software Design.

Vakku Chethalan
Experienced Product Manager with a demonstrated history of working in the hospital & health care industry. Drives & maintains Product roadmap activities, strategy, product releases and liaison with every cross-functional teams. Skilled in Healthcare, Interoperability for Healthcare OnPremise and Cloud, Software Architecture, and Embedded Software.
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What does the Health Stack mean for you? Part 3 by Anukriti Chaudhari, @anukritichaudh2

The National Health Stack is a set of foundational building blocks which will be built as shared digital infrastructure, usable by both public sector and private sector players. In our third post on the Health Stack (the first two can be found here and here), we explain how it can be leveraged to build solutions that benefit different stakeholders in the ecosystem.
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Re-Imagining #EMR for India by Kumar Satyam, @kr_satyam

I was out of doctor’s room in couple of minutes with a scribbled prescription in hand, not very sure if the physician had actually understood my problem. Clinic’s pharmacist words gave me confidence “Doctor is very experienced, he can diagnose problems within a minute. You will get better in couple of days”.  

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How #telemedicine technology can reduce healthcare costs by Dr. Arjun Kalyanpur, @arjunkalyanpur

Studies have highlighted the multiple benefits that telemedicine lends to screening, including TB detection, PAP smear for cervical cancer and mammogram analysis for breast cancer.

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The case of #AI medical software regulation in developing countries by Dr. Sandeep Reddy, @docsunny50

Has the cart been placed in front of the horse? The case of AI medical software regulation in developing countries.

Medical software is defined as the use of software for medical purposes. The uptake of medical software in healthcare has increased in line with increased application computation in healthcare delivery. Examples of medical software include software used in bedside monitors, MRIs, PACs, radiation therapy software, infusion pump rate devices, smartphone-based health applications. Etc. 

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Data as an identity, diagnosis, health coach, drug and treatment by Prof. Rajendra Pratap Gupta, @rajendragupta

Electronic Health Records make data the identity for the patient. It can be in form of UHID or ADHAAR (in India). The data reveals the identity of the patient

Recently, I was in Bangladesh on the call of the Prime Minister’s office to speak on Big Data, Artificial Intelligence (AI) and to help draft the AI strategy for Bangladesh. I shared, that Big data is going to change the way we deliver healthcare, and how “big data combined with AI is not just data, but an identity, diagnosis, health coach, a drug and treatment when it comes to healthcare delivery”. It was based on the enormous possibility of what data & AI can do to healthcare delivery. 

Data as Identity: Electronic Health Records make data the identity for the patient. It can be in form of UHID or ADHAAR (in India). The data reveals the identity of the patient 

Data as diagnosis: According to Intel, AI in a single heartbeat can look at 10,000 attributes with 90 % accuracy and traditional methods look at 7 attributes with 56 % accuracy. Google’s AI algorithms help in diagnosing diabetic retinopathy. AI has been proven to be accurate in radiology for reading images and diagnosis. During the recent floods in Kerala, AI backed system, UptoDate was used by about 320 doctors in diagnosis and treatment. This solution has millions of cases in its repository and is used by clinicians worldwide, and the list goes on, on how Big Data and AI are helping in diagnosis. Big data and AI are increasingly being used as a diagnostic tool and its accuracy is of ‘clinical grade’ in specialties it has been used. 

Data as a health coach, a drug & Treatment: More than four years ago, I wrote an article on Software as a drug (SaaD) https://bit.ly/2TfWWDG 

Blue Star by Welldoc is a great example of how insulin dose can be calibrated by AI and does not need doctors. This mobile app for diabetes management is cleared by the US FDA, and it guides the patient to adjust the dosage of insulin with options of activity and diet (healthy choices with restaurant helpers), and provides with over 20,000 coaching messages and has been proven to reduce HBA1C by an average of 2 points between 3-6 months. This is considered a great achievement in the field of endocrinology. 

Need for an AI strategy: It is time that countries shape up their AI roadmap / strategy for every sector. Imagine if public hospitals in India like AIIMS, PGI Chandigarh, JIPMER, SGPGI & Tata Memorial feed in the daily OPD / IPD data and create an AI tool? How much the tool can help the ‘young medical graduates’ in accurate diagnostics and treatment? Today, timely diagnosis and treatment remains the biggest challenge in healthcare and it leads to over diagnosis and wrong treatment! With Ayushman Bharat covering over 500 million population, the data from this scheme can be used to create an AI tool in healthcare which can be shared with LMIC countries, and can serve as an important tool in form of healthcare diplomacy. Moreover, young medical graduate with such an AI tool with millions of cases in its repository will have the experience of a senior doctor with decades of experience when he or she uses an AI tool to diagnose and treat patients. Also, such a tool can prove to be a boon in rural areas as well, where people suffer the most.

In 2015, when I was writing a book on healthcare reforms (Healthcare Reforms in India – Making up for the lost decades), I did a survey with patients of RML & AIIMS and it was revealed that, patients visit an average of 6 doctors before visiting AIIMS, and add to this, the fact, that the reason for their AIIMS visit is, ‘treatment failure or not diagnosed’ from the earlier facilities or doctors visited! Moreover, it is not possible for everyone in India to reach AIIMS, Delhi or Tata Memorial in Mumbai. In such a serious situation, it makes sense for India to invest in developing an AI tool based on patient’s data in public healthcare facilities, and the patients covered under Ayushman Bharat. Also, this data can be used for fraud detection. 

AI is likely to create jobs and add to the economy. If India builds a proper AI strategy, it needs to look at the following components; Data storage, data security, data transfer, certifications and compliance, and each has the potential to add billion dollars to the economy 

Components of AI strategy: India needs a detailed roadmap for data storage, networking infrastructure, data governance, Sensors & IOT, training and human resources & research and development 

Big Data & AI hold a lot of promise for outcome driven healthcare which is accountable and affordable and India must aim to be a global leader in Big Data & AI.

(Prof. Rajendra Pratap Gupta is a leading public policy expert and is a former advisor to the Union Health Minister, Government of India ) 

The article was first published here, its republished on the HCITExperts Blog, with the author's permission

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

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