Clinical Decision Support Systems: Resolving the “Build or Buy” Dilemma - Part 2 by Dr. Ujjwal Rao, @drujjwalrao

The 2 part paper: Discusses the key role of evidence-adaptive clinical decision support systems (CDSS) in the healthcare system of the future. Weighs the pros and cons that hospitals should consider when deciding to buy or build such decision support tools

Healthcare providers today face the challenge of delivering up-to-date, evidence-based care given the ever burgeoning pool of medical evidence, which is not only prone to inconsistencies but also take an average of 17 years to make their way into routine clinical practice. 

Coupled with the hassle of meeting advance electronic health record (EHR) platform integration requirements, Dr. Rao proposes that buying knowledge-based CDSS is increasingly more favorable and the way forward. 

A number of major initial and ongoing hurdles with home-grown solutions – including the significant time and effort needed to constantly update evidence – could overwhelm and overburden healthcare organizations, taking time away from delivering standardized and evidence-based care. 

Dr. Rao offers five ways on how these challenges can be avoided with the purchase of third-party CDSS platforms.

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Clinical Decision Support Systems: Resolving the “Build or Buy” Dilemma - Part 1 by Dr. Ujjwal Rao, @drujjwalrao

The 2 part paper: Discusses the key role of evidence-adaptive clinical decision support systems (CDSS) in the healthcare system of the future. Weighs the pros and cons that hospitals should considered when deciding to buy or build such decision support tools

Healthcare providers today face the challenge of delivering up-to-date, evidence-based care given the ever burgeoning pool of medical evidence, which is not only prone to inconsistencies but also take an average of 17 years to make their way into routine clinical practice. 

Coupled with the hassle of meeting advance electronic health record (EHR) platform integration requirements, Dr. Rao proposes that buying knowledge-based CDSS is increasingly more favorable and the way forward. 

A number of major initial and ongoing hurdles with home-grown solutions – including the significant time and effort needed to constantly update evidence – could overwhelm and overburden healthcare organizations, taking time away from delivering standardized and evidence-based care. 

Dr. Rao offers five ways on how these challenges can be avoided with the purchase of third-party CDSS platforms.

Read more »

How do we value your #startup?  Part 2 by Arpit Agarwal, @arpiit

How do we value your startup? — Part 2

In the previous post we talked about how VCs perceive valuation and how to broadly deal with it. It was aimed to dispel some misconceptions most first-time entrepreneurs may have about this very important aspect of our business. This posts builds on that and another and gives you actual numbers to play with. Before you go on, it maybe a good idea to take a look at the way I define stages of a startup.

Round sizes and dilution benchmarks in India

Now that you know the only two thing that matters to a VC is the stake she’s getting and the amount she’s investing, it is best that you play accordingly. If you’re seen as obsessed too much about valuation, you’re likely to be considered a hard-nosed founder. So be smart and play for ‘lower dilution’ instead. In case you argue that these are one and the same thing, think again :)
The table below presents a broad structure of startup funding in India today. This is what is considered ‘average’ in our industry. Please note that all these numbers are only representative in nature and deals frequently happen on both sides of these extremes. Also, like any well-functioning market, these prices represent only a momentary equilibrium and this changes over time:

© Blume Ventures, 2018 — Please don’t republish without permission. Write to [email protected]
What are the Terms and Conditions?
  1. At any stage of investment, the investor is making a forward judgement on the exit outcome. Hence, it is common for investors to bake the exit scenario in the way you are being valued. For example, if a Series A investor, who’d typically expect a startup to exit at $500M, may value a startup which may exit at only $250M (in their minds) much more harshly than a startup which could easily build a $1B or more as an outcome.
  2. All the rules of the market —namely, demand and supply — still apply. It is not uncommon for serial/exited entrepreneurs to raise money at 5–10x valuation than first-time entrepreneurs.
  3. Valuation remains the last step. Hence, if you don’t pass any of the filters a VC has in their model, your willingness to price yourself very attractively doesn’t count.

How can you use this information?

First, it is always a great idea to know what’s the playbook on the other side. At the same time, smart people would know that such discrete classifications can’t be taken for granted. Second, whenever you have term-sheet on offer, you should know that valuation is largely formulaic for a VC, hence pay immense attention to the terms that come along with it. That’s the detail most first-time entrepreneurs struggle with!
Finally, as most experienced entrepreneurs will tell you,
forget valuation and focus on creating things of value.
If there’s value, valuation cannot be far behind. And creating anything of value is incredibly hard in any economy, doubly so in India. Once you are past your curiosity about valuation, you’d notice that life after raising VC money becomes much harder. In fact, the more you raise (by corollary, the higher your valuation) the more complicated it will get!

What’s more?

Hope these two posts satisfy a lot of your curiosities. As you can imagine, the art of valuing a startup is much deeper than what we covered here. Do post your responses and ask me if I skipped a step in my explanation.

The article was first published in the Arpit's Medium Blog here,  and has been republished here with the Author's permission.
Arpit Agarwal
Arpit has been involved with promotion of startups and ecosystem since 2006 when he co-founded Headstart Network, today India's largest early stage entrepreneurs' network with over 20 city chapters.

Arpit has been with Blume for last four years as a Principal, responsible for scouting science-led and hardware businesses, apart from managing a portfolio of about 15 companies, which include companies in a variety of sectors ranging from used goods market to IOT to Healthcare to Enterprise services.

He's based in Delhi, in an MBA from IIT Bombay and holds a BTech from NIT Trichy
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How do we value your #startup?  Part 1 by Arpit Agarwal, @arpiit

This is the favorite topic of every single startup entrepreneur in early stages of their evolution. It also incites an academic curiosity in a large number of people who, like the 3 adorable dads in this video, have a highly misplaced notion about it. A big reason why this happens is because we don’t write about it so often in India and, perhaps, everyone understands this quite well in US or China.
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5 product management hacks to build great products by Subhadeep Mondal, @smondal1008

In the past 5 years, I had the opportunity to build and ship great consumer products which touches the lives of millions of people around the world. Recently, Branchmetrics invited me to share some of my learnings at Innov8 CoWorking Space along with speakers from UrbanLadder, HeadSpin, and Glispa Global.
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Vision 2025: What Health Care Could Look Like a Decade from Now by Dr. Vicky Parikh, @ParikhVicky

Value-based care, coordinated care, information technology integration . . . healthcare is undergoing transformation.

Sweeping changes are putting pressure on the entire system, particularly from an administrative standpoint. With all the paperwork and logistics to worry about, it's easy to grow frustrated and lose sight of what we are working to achieve: economically viable solutions for providing the highest level of care to all our patients.
Sometimes it helps to take a step back, to forget the red tape and day-to-day grunt work of overhauling a 2.8 trillion dollar industry. For a moment, let's allow ourselves to focus only on the possibilities. Looking ahead, we'll explore one patient's journey through health care in the not-so-distant future. This is a story about health care in the year 2025.
Introducing Mr. Average Patient
Our patient - we’ll name him Philip - is a 35-year-old man in average health. Like many Americans, Phil tries to eat right and exercise, but enjoys rich foods, fails to sleep adequately, and relies on calorie-laden designer coffees, energy drinks to keep him energized. For months, he's been ignoring symptoms of frequent urination, fatigue, and dry mouth. But when Phil’s smartwatch repeatedly alerts him of high blood pressure readings, he decides to speak with a doctor.
This is 2025, so Phil won’t be taking any time off work for an office visit. Instead, he logs into his personal health management system - a cloud-based program accessible via web browser or specialized app - for a video chat with a member of his care team (let's call her Dr. McCoy).
While Phil describes his symptoms, the user interface provides Dr. McCoy an overview of his medical history. Phil’s vitals have been uploaded from his smartwatch and 20 pounds of weight gain have been registered by his smartscale over the past year. Dr. McCoy notes a family history with genetic predisposition of heart disease and diabetes, and that Phil's most recent blood work, drawn over a year ago, showed an elevated blood glucose level.
Suspecting diabetes as the source of Phil’s woes, Dr. McCoy uploads an order for a CBC and A1C while sending Phil instructions for scheduling his outpatient appointment.
Exploring the untapped potential of mobile health
In this scenario, two trends diverge with promising results. First, we are taking advantage of the increased popularity and decreased cost of the Internet as a way to passively monitor patient health. Familiar devices already track heart rate, sleep quality, activity levels, weight and BMI for non-clinical purposes. Before long, these technologies will advance, allowing us to discreetly record temperature, blood pressure, pulse oximetry, and maybe even blood chemistry. Like crash avoidance systems on a car, these devices can act as early warning systems, alerting patients of brewing health problems and encouraging them to contact a health professional.
Secondly, we are combining this with the growing availability of “doctor on demand” services. Telemedicine companies such as Teladoc have seen exponential growth in recent years, largely fueled by changing reimbursement schedules. Currently, this low-cost alternative to traditional office and urgent care visits is limited to addressing the most common of health concerns (runny noses, etc). But, we envision telemedicine as an integral part of coordinated patient care. An on-call doctor with access to telemetry from wearables and a complete medical record could remotely diagnose and manage a wide variety of medical issues. In this futuristic system, patients benefit from convenience, doctors from increased efficiency and reduced overhead, and payers from lower costs.
Mr. Average Patient skips the waiting room
After Dr. McCoy signs off, Phil follows the link she sent him to make his outpatient appointment. Scrolling through the list of available providers, he sorts by location, price, patient ratings, and earliest availability. He chooses a location near his home and schedules a same-day appointment. Before logging off, he pays his copay and downloads directions to his phone's GPS.
At the outpatient clinic, Phil checks in by tapping his smartphone to the reception kiosk. It provides him on-screen directions to the lab. There, he is greeted by his nurse who performs a quick physical examination before drawing Phil's blood. All told, the appointment takes no more than 30 minutes out of our patient's day.
How patient self-service benefits everyone
Consumers today are accustomed to booking airline flights, hotels, rental cars, even haircuts online. There is no reason health care providers shouldn't benefit from this same technology. Early adopters have discovered that online appointment scheduling simultaneously reduces administrative burdens (and associated costs) while increasing patient satisfaction. The Oregon-based Zoom+ health system, for example, has established a positive reputation for itself by providing on-demand health care services with transparent pricing and online appointment scheduling. As more patients and providers join in, we foresee sites like ZocDoc evolving into Expedia-like clearinghouses complete with payment and review functions.
Further automation will take place on-site at medical centers. Already, some hospitals have discovered that both patients and staff enjoy the shorter lines and reduced wait times that check in kiosks accommodate. In our scenario, these kiosks have evolved to incorporate technology borrowed from modern mobile payment systems. With a tap, encrypted information is exchanged between the patient's smartphone and the provider's practice management system: uploading doctor's orders, insurance authorizations, patient records, and payment information. The result is a near instantaneous check-in, freeing up staff, virtually eliminating paperwork, and dramatically speeding up appointment turnover. Once again, patients benefit from convenience while providers increase the number of patients they can see in a day, which lowers per-patient costs for payers.
Mr. Average Patient learns about self-care
The day after his appointment, Phil receives an email notification that his test results have come back. The email contains a link for another video chat with Dr. McCoy. She informs Phil that his labs indicate diabetes; she'd like to have a nurse practitioner come visit with him, or, if he'd prefer, she can schedule an appointment with his PCP. Phil opts for the nurse practitioner.
When Beverly, our local nurse practitioner, receives Dr. McCoy’s order, she calls Phil to schedule their face-to-face meeting. She brings with her his new medications and supplies (including a bluetooth-enabled glucose meter which will automatically record readings in Phil’s health management system). Together, she and Phil develop a care plan that includes follow up labs and visits with his GP. They set up reminder texts that help Phil remember to take and refill his medications on time. Phil also agrees to use his smartwatch to better manage his activity level and a nutrition diary to help him (and his care team) watch his caloric intake. Before leaving, Beverly leaves behind her contact information and informs Phil she’ll be checking in with him by phone once a week for the next several weeks.
Furthermore, Phil's diagnosis automatically adds him to an email list for patients with diabetes. Unless he opts out, Phil will receive daily educational emails with informational articles, videos, healthy recipes, as well as lifestyle tips and challenges. He’s invited to attend local diabetes classes and to join an online forum for diabetics and their families.
Personal attention keeps patients out of hospitals
Patient non-compliance is currently costing the American health care system an estimated $290 billion every year. That number will only grow unless we improve patient engagement in self-care. Many factors have been identified as contributing to patient non-compliance. In this scenario, we tackle several of these issues.
Poor communication between patient and provider has been identified as one component in patient non-compliance. This is why we have given our patient a choice between visiting his GP or meeting a nurse practitioner in an environment where he feels more comfortable. The nurse practitioner serves the dual role of educating the patient and providing one-to-one support for someone who has just received a life-changing diagnosis. By staying in touch over time, she fosters a positive patient/provider relationship that can lead to greater trust and hence greater compliance.
Next, we are making sure to involve our patient in his own care planning. He is provided tools such as electronic reminders and an app-based nutrition diary to help him stay on track. By monitoring medication usage, diet, and exercise via the health management system, Phil's care team is able to intervene if he is not following his care plan.
Finally, we are taking full advantage of modern multi-media resources for educational purposes. Being well-educated about one’s condition, medications, and long-term prognosis can help patients stick to their care plan. Since not all patients absorb information in the same way, our scenario uses a mix of articles, videos, game-like challenges, live classes, and online interactions with peers to keep him motivated.
The future of health care
Health care is looking to technology to boost efficiency and thereby lower administrative costs. Some in our industry worry this will detract from doctor/patient relationships, forcing doctors to spend more time staring at computer screens and less time interacting with patients. However, our scenario demonstrates how technology can actually increase personalization, contributing to higher patient satisfaction and better clinical outcomes. Nothing presented in our story is far-fetched; in fact, most of these technologies are already in use or under development in pockets across the nation. Our challenge is to identify and proliferate those innovations that most benefit the health care system as a whole: patients, providers, and payers alike.

The article is republished here with the authors' permission. The article was first published here
Dr. Vicky Parikh
Healthcare Executive who combines clinical, public heath, and data management knowledge and success, transforming healthcare systems and improving delivery and quality. Leads continuous improvement processes, creating fundamental change in healthcare industry with new value-based care delivery systems, innovative collaborations, and partnerships for a sustainable healthcare model. Strives to improve quality of healthcare while lowering costs. Specializes in advancing efforts in population health and care delivery models, addressing increased healthcare costs and improving quality of patient care.
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#HIMSS18: Where the brightest mind in healthcare meet !! by @ tejasvdeshmukh

It’s been over 3 weeks post HIMSS18 in Las Vegas; I am almost done with all my follow-ups and before getting caught up with ATA18 preparation, allow me to share my experience!
Known as the Mecca of Healthcare, HIMSS is a platform to explore innovation, meet thought leaders, network and partner. That said it is easy to get lost, loose orientation and miss out on meetings, when you are dealing with 40k+ attendees and 1000+ exhibitors. It is overwhelming the moment you enter Sand Expo and see HIMSS banners all over the place.
The Pinksocks meet-up that took place on the March 5th at Money Play Restro was filled with the most exuberant people. Nick Adkins has taken an initiative to consolidate all Healthcare professionals, who are determined to disrupt the industry with innovation. The HIMSS Social Media Ambassadors are part of this group and real meaningful exchange of information happened at the meet-up.

Pinksocks HIMSS

With more than 100+ meetings, exploring innovation, healthcare use cases and technologies defines a whole new equation of healthcare:

Disrupting technologies + Digital transformation = Better Patient Care

Let’s take a look at the trending topics at HIMSS18 that promise Better Patient Care:
  • Disrupting technologies  
    • Artificial Intelligence, Machine Learning, Big Data
    • Blockchain
  • Digital transformation
    • Mobility and Cloud
    • Wearable and IoT
    • Consumerism
  • Telehealth (From Synchronous to Asynchronous model)
Healthcare companies have finally realized the potential of Artificial Intelligence, Machine Learning in addition to Big Data. The ability to perform complex predictions in a blink of a second will result in advanced decision support, chat bots resulting in real time efficient care delivery system. From Ayasdi to Google Deep Minds, everyone is set to disrupt the traditional healthcare with super-efficient ecosystem.        

  • Blockchain
It is another technology having tremendous potential to transform health care, shifting the patient at the core of ecosystem, coupled by enhanced data security, privacy, and interoperability.Blockchain will provide a new benchmark for interoperability by enhancing secure and efficient health data exchange. While it is not going to address all the healthcare challenges, it does provide a sense of confidence to explore, invest and test its actual potentials in Healthcare. PokitDok, Health Wizz and Hyperledger are amongst few to watch.

  • Mobility and Cloud
It is estimated that by end of 2018, 65% of healthcare interaction between patient and providers will occur using smart phone devices. 80% of doctors are already using one or other medical app to engage with patients.
Cloud is further transforming the way providers deliver quality and cost effective healthcare services. Adoption on cloud strategy significantly reduces infrastructure and administrative cost, thus providing relief from the ever growing pressure of cost reduction.
On one hand patient are demanding instant quality healthcare services and on the other hand government is pushing on use of common standards further monitoring the quality stringently. This complicates the matter further with existing infrastructure and legacy systems. Providers are gearing up to address the increased demand and support 24/7, access to top-quality healthcare, and adopting cloud strategy. Cloud and mobile access is technological reason for the actual consumerism.
Few of the innovators to watch in this space are CloudMine and AlphaSoftware

  • Wearable and IoT
Wearable and IoT has taken the healthcare out of hospitals, and into our homes. Healthcare at home is a win-win for all patients, providers and insurance. Remote monitoring coupled with video collaboration platforms have innovated the space with low cost high quality patient care. Innovative startups like Care Innovation backed by large giants like Intel, Google are making lot of noise in this space.

  • Consumerism in healthcare
Transformation of digital landscape, has led to serious disruption, patients of 21st century are experiencing empowerment. As we unlock the barriers of EHR for better access and quality, consumer satisfaction increases.
Patients can now have similar experiences to retail and shop for best value products based upon their needs. For example, someone with chronic illness, injuries, wrong procedure, and misguided surgeries can get expert advice from companies like Best DoctorsSecond Opinion ExpertsAmino for as low as $300. Ability for patients to make best choices in terms of treatment, procedures with right information, is going to be a blessing. And imagine how much cost health insurance companies are going to save!

  • Diving into telehealth

While Telehealth has been around for decades, yet the real potential has been unlocked just few years back. Federal backup, technological advancement and infrastructure maturity has helped it gain the momentum. Today’s telehealth products are a combination of video and specific use case catering to diverse areas, from Behavioral health to Physiotherapy and so on.
While big players like AmericanWell, Teladoc and other continue to dominate the space. Small players like CloudbreakZipnosis, and Avera with specific requirements are making lot of noise.

Telehealth has demonstrated over and over the improved outcomes with minimal cost. The new age products are equipped with advanced analytics, addressed reimbursement and legislative concerns. The use of advanced technologies like AI and ML on top of telehealth component will be soon gaining momentum to further enhance patient experience and optimize healthcare cost.

It was my 3rd consecutive time to attend HIMSS and every time one has so much to learn. You can digest as per your appetite; I am a Healthcare Professional turned into technologist, and was really amazed to see innovation all around me. All this experience gathered is shared with the clients for whom we build products, it gives them an insight on where the industry is heading.

Faichi Solutions is technology service provider, under the umbrella of Saksoft Inc, New Jersey. We are 1000+ employees, across 3 continents, with Healthcare service as a focused vertical.

We are trusted partners in Innovation for Healthcare ISV’s and Technology companies. Focused on:
-Digital Transformation                     
-Product Development                       
-Mobility and Cloud
-Analytics and BI                    
-Data Warehouse                   
-Managed Services
The article has been re-published here with the Authors permission. The article first appeared here
Tejas Deshmukh
Highly skilled and motivated professional with rich experience of 13+ years in software product development for Healthcare and Life Sciences vertical, proven track record of building innovative solutions, providing strategic consulting, pre-sales and operational management.
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