#Telehealth In India: Slope of Enlightenment or Plateau of Productivity by Manish Sharma, @msharmas





Clayton Christensen coined the phrase disruptive innovation two decades ago as a way of embracing the deconstruction that is necessary when a new technology displaces an old one.

In healthcare most of the technology disruption has been driven by the adoption in the medtech space as also in the use of innovative techniques in surgery such as minimally invasive surgery and robotic surgery. 

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Artificial Intelligence #AI Could Add $957 Billion to Indian Economy, According to New Research by @AccentureIndia


In a recently published report by Accenture, they have highlighted the need for india to invest in AI, we bring you the excerpts of the report. (The following content is sourced from the Accenture report).


Artificial intelligence (AI) has reached a tipping point. The combination of the technology, data and talent that make intelligent systems possible has reached critical mass, driving extraordinary growth in AI investment. Across the world, G20 countries have been building up their AI capabilities. The power of AI starts with people and intelligent technologies working together within and across company boundaries to create better outcomes for customers and society. But India is not fully prepared to seize the enormous opportunities that AI presents. Even with a tech-savvy talent pool, renowned universities, healthy levels of entrepreneurship and strong corporations, the country lags on key indicators of AI development. Much work remains. 

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A collection of Potential Usecases for #Blockchain in Healthcare


Every once in a while a new technology finds its way in the Gartner Hype Cycle for Technologies (in Healthcare) and its effectiveness and usability is applied to the management and interoperability of Healthcare Records. For instance, access to the Healthcare records by various stakeholders in the care continuum: care providers and patients. 




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Cybersecurity Trends in 2017


Cybersecurity is in the news almost daily and Investment in cybersecurity, by established corporations or venture capital is rising. The stature and business significance of cybersecurity operations within organisations continues its rise to a strategic management issue in every organisation. A dearth of skills shortage continues to impede the progress of a successful cyber defense strategy that can be put in place, this is driving most organizations to increasingly look for outside help be entering into consulting and managed security services contracts.

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The Return of the Wearables, in a New Avatar by @msharmas


IDC: Smartwatches accelerate in the second quarter, Device shipments grew 10.3% year over year to hit 26.3 million units during the second quarter of 2017; smartwatches grew 60.9%.

We are seeing the transformation of the wearables market with the total shipment volumes expected to maintain their forward momentum. According to the International Data Corporation's (IDC) Worldwide Quarterly Wearable Device Tracker, vendors will ship a total of 125.5 million wearable devices this year, marking a 20.4% increase from the 104.3 million units shipped in 2016From there, the wearables market will nearly double before reaching a total of 240.1 million units shipped in 2021, resulting in a five-year CAGR of 18.2%. [1]

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#IoHT is already delivering tangible cost savings, but continuous investment is essential - Accenture

Image Source: https://www.accenture.com/us-en/insight-accenture-2017-internet-health-things-survey
The Internet of Health Things (IoHT) is already delivering tangible cost savings, but continuous investment is essential

In a recently published report by Accenture [2], based on a survey of 77 Healthcare payers and 77 Healthcare providers in the US, the reports findings indicate that healthcare leaders are at risk of missing out on substantial cost savings, if they don't take the full advantage of Internet of Health Things (IoHT).

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What is #ConnectedCare? Is the Healthcare Industry ready to embrace it in India?



During the recently held #PhilipsChat the from Philips Healthcare set the agenda to discuss various aspects of what is Connected Care? 
(http://blog.hcitexpert.com/p/connected-medical-devices.html
Whenever a TweetChat is held, the moderator puts out an agenda for the discussion. Once its time, the participants share their point of view by Tweeting out their responses to the questions, tweeted by the moderator. 

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#DigitalHealth at an Inflection point by Mary Meeker, @kpcb reviewed by Manish Sharma @msharmas





Please note the above slides have been extracted from the Mary Meeker, Internet report 2017 purely for the purposes of this article. The statistics mentioned in this Blog have been taken from the Mary Meeker Internet Report 2017, relevant for DigitalHealth. For more details please view the complete report here  

While reviewing the Mary Meeker, Internet Report 2017 I found came across the statement "DigitalHealth at an Inflection point". So in this article (as also the slide deck above) I have tried to review the Digital Health specific updates and provide a correlation to them by linking it up with the India Internet section that has also been highlighted in the report.

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#DigitalHealth Startup? How to evaluate your #Startup like a VC or Angel by Manish Sharma @msharmas



#Startup, is a favourite word we hear these days from AiM to PM. At times it has connotations of a journey to fulfil, a dream to Startup is to Just go for it, and at times it brings about the memories of your struggles and wins, from that journey. But to startup is to also understand the basics of the entire process of establishing a business and running it.

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What is #BlockChain? Implications for Healthcare by @msharmas

In my previous article I discussed about the benefits and barriers to the use of an Integrated Health Information Platform. In healthcare the need for presenting the Information to the Right Person at the Right Time has been proven to improve outcomes in patient treatment.

Will HIE 2.0 benefit from the use of Blockchain in presenting the information to the Right Person at the Right Time? 


What is Blockchain?
Various definitions of Blockchain have been put across based on the context of the use. Some of these definitions are: 

A digital ledger in which transactions made in bitcoin or another cryptocurrency are recorded chronologically and publicly.

“The blockchain is an incorruptible digital ledger of economic transactions that can be programmed to record not just financial transactions but virtually everything of value.” Don & Alex Tapscott, authors Blockchain Revolution (2016)

The Blockchain is a decentralized ledger of all transactions across a peer-to-peer network. Using this technology, participants can confirm transactions without the need for a central certifying authority. Potential applications include, fund transfers, settling trades, voting etc.

Blockchain is a distributed system for recording and storing transaction records. More specifically, blockchain is a shared, immutable record of peer-to-peer transactions built from linked transaction blocks and stored in a digital ledger. [1]

A Blockchain is a data structure that can be timed-stamped and signed using a private key to prevent tampering. There are generally three types of Blockchain: public, private and consortium. [6] 

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Benefits of an Integrated Health Information Platform #IHIP by @msharmas


We have seen the benefits of Aadhar and how a public data repository can be used for public good. Population Health based clinical data repositories too can play a similar pivotal role in providing potentially great benefits

The use of Healthcare IT in the Indian context is picking up with most of the corporate hospitals going for the #EHRs and HIMS solutions. And these are present mostly in the Tier I cities and urban areas. There is a move now to get these solutions to the Tier 2 and Tier 3 centers as well. I would be looking to review reports that highlight percentage of IT enablement in Healthcare facilities, as part of follow up articles to this one.
The Center for Healthcare Informatics has rolled out an RFI detailing the requirements of an Integrated Healthcare Information Platform (IHIP). You can also visit the dedicated website to review the details of the IHIP RFI:
In this article I would like to highlight the benefits that will accrue from implementing such a solution in India. With no historic data of past implementations of such a system in India, I have reviewed the information available in journals and public domain regarding similar implementations across the world and what are the benefits and barriers in implementing an Healthcare Information Highway of patient healthcare data.

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Understanding the Medical Diagnosis processes, to build an AI based solution by @msharmas



Human Intelligence

is The ability to adapt one's behavior to fit new circumstances.


In Psychology, human intelligence is not regarded as a single ability or cognitive process but rather as an “array” of separate components. Research in building AI systems has focused on the following components of intelligence: [1]
  • learning,
  • reasoning,
  • problem-solving,
  • perception, and
  • Language-understanding
These components of human intelligence are also utilized during diagnosing a patient and defining the treatment plan and protocol for the patient.

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The Current Status of 8 Future Technologies on Healthcare by @msharmas

It's mid-2016, and here is a look at the current status of 8 Future Technologies that might be having a significant impact on Healthcare

Most if not all these technologies will make an impact on Healthcare, and hence it is important to understand the various scenarios and the stories detailing how the experts from across the world are incorporating these technologies in healthcare

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@IFTTT you could in Healthcare by @msharmas



Was reading this article published in a leading newspaper sometime back,



Naturally, I tried thinking of usecases to apply the technology in a Healthcare setting. 

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Social Media Technographics - A way to engage your audience by @msharmas


"Taken together, the Social Technographic groups make up the ecosystem that forms the groundswell. By examing how they are represented in any subgroup, strategists can determine which sorts of strategies make sense to reach their customers." - Forrester

As part of a successful social media campaign, its important to know the audience with whom we are sharing the content and creating the content for. 

I came across this insightful categorization from Forrester, that provides a categorisation of your Social Media users, using the Social Technographics ladder on the basis of their level of activity on your Social Media Channels

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#Interoperability the Missing Link for #DigitalHealth Apps by @msharmas


In India we have 204.1 million smartphone users in 2016 [ http://www.statista.com/statistics/467163/forecast-of-smartphone-users-in-india/ ], it's only natural to find startups using the mobile as the way to acquire customers by providing mobile Health based products and services.

While it is a great way to provide accessibility and affordability of healthcare services via mobile health solutions, it is also important to understand the need to ensure interoperability of the healthcare data being captured in these apps.

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Benefits of an AI-Based Patient Appointments service for Hospitals by @msharmas


One of the areas where AI can be implemented in the Hospital with high volume of transactions, is the Appointments Scheduling of Patients. On any given day, there are a finite number of slots available for a doctor, e.g. 10 min or 30 min slots, depending on whether its a first visit or a follow up visit. In most hospitals, Routine patients are scheduled in advance and some patients are scheduled based on an urgency, to the physician schedule.  [Denton et al - 8]
A typical workflow for booking an appointment can go like this:

1. Patient calls (or visits) the hospital, and speaks to the person at the reception, at a specific department
2. The person looks up the available time slots, that a doctor is free and available in the clinic
3. Consults with the Patient on the best time possible for her appointment and then schedules the appointment



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TRIVENI: A remote patient monitoring solution via @msharmas - Part 1



TRIVENI, a remote patient monitoring solution that is a confluence of three aspects of patient information: 

Data | Medical Devices | Connectivity

Introduction

Just the other day we heard the SpaceX rocket zoom off to the space to deliver a satellite to the geospatial orbit, Rosberg won the 2016 russian grand prix & Mars rover continuously transmitted the images and vital parameters from millions of miles away in the space

The above three scenarios present the ability to stream data in realtime to a base station providing the ability to remotely monitor the performance of a space-craft, a formula 1 car and a remote autonomous vehicle.

Similarly consider the following use cases in relation to a patient in a Healthcare setting:

  • patient information in a Hospital
  • patient in an ambulance or
  • patient under homecare
presents use cases that require remote monitoring of patient information. 

The existing technological paradigms such as IoT, data streaming analytics, connectivity & interoperability allow for a framework to allow for remote patient monitoring in each of the three Healthcare use cases

TRIVENI

I would like to propose TRIVENI, a remote patient monitoring solution that is a confluence of three aspects of patient information
  • DATA
  • MEDICAL DEVICES
  • CONNECTIVITY
Triveni proposes to implement a plug-n-play framework that will allow for easy connectivity between healthcare information sources.

The etymology of the word TRIVENI in Sanskrit means “where three rivers meet”. Similarly, the three aspects of Patient Information need to be integrated to meet the requirements of a remote patient monitoring solution

Focus areas of TRIVENI

Initially to showcase the Proof-Of-Concept for the solution, the above three focus areas will be considered to present as the use cases. Each of the three focus areas present the ability to test the confluence of three aspects of Patient Information defined above
  • Cardiology
    • MI
    • Chest pain
  • Neurology
    • Stroke
    • Head Injury
    • Epilepsy
  • Emergency Services
    • Trauma

Need for TRIVENI

The Tower of Babel (Pieter Bruegel the Elder, c. 1563), a metaphor for the challenges existing in medical device semantic interoperability today

Current Landscape

  • Piecemeal integration creating information silos; leading to difficulty in sharing patient information
  • Silos unable to deliver real-time patient data reliably; leading to lack of data synchronization to ensure latest  time-aligned data
  • Vendor Dependent solutions; leading to internal battlegrounds
  • Lack of semantic interoperability between systems; leading to a tower of babel situation in medical device semantic interoperability
  • Captive investments by healthcare facilities in existing medical devices leading to a long time before the medical devices can be replaced with newer systems with easier connectivity features

The Remote Patient Monitoring Process Flow

 
Typical Remote Patient Monitoring process (adapted from Center for Technology and Aging)


The Center for Technology and Aging indicates a 5 - Step process for Remote Patient Monitoring. The 5 steps are essential to deliver a continuous flow of patient related information to the remote base station monitoring a patient(s) in any of the use cases or the focus areas presented earlier

The Remote Patient Monitoring Process Flow Mapped with TRIVENI Framework Components


It becomes imperative for the solution to incorporate these founding principles of a remote monitoring process into any framework/ product of such a nature. The process steps get implemented in the TRIVENI framework, allowing for the continuous monitoring of patient information from the various connected systems.

The processes allow for a modular approach to the Product Definition of the TRIVENI framework, with the ability for each component of the platform to evolve as dictated by its internal technology and thus enables each component to incorporate newer technology paradigms as and when they present themselves

The TRIVENI Components are

  1. TRIVENI Connect ®
    1. A programmable Connector that allows the transmission of data from the connected medical device
    2. Supports BLE, Wireless technologies
  2. TRIVENI  Hub ®
    1. A Medical Device Data Aggregator that has the ability to receive data from the TRIVENI Connect and transmit the patient vital data streams to the TRIVENI Exchange
    2. Supports 2G, 3G, Wifi, 4G networks
  3. TRIVENI  Exchange ®
    1. TRIVENI Exchange is a secure, reliable patient vital data store that can seamlessly transmit data received from TRIVENI Hub to TRIVENI Apps
    2. SSL Security, supports interoperability, Data Delivery to TRIVENI Apps or Connected EHR Systems (via HL7)
  4. TRIVENI Apps ®
    1. TRIVENI Apps have the ability to securely receive identified patient’s Medical Data from the TRIVENI Exchange
    2. TRIVENI Apps are delivered on Android, iOS, Web-based platforms






TRIVENI Connect


The TRIVENI Connect is a device that acts as a converter that allows any medical device to connect to the TRIVENI system. The Connect device for instance will be connected to a Patient Monitor via the RJ45, RS232-to-USB converter.
Once connected, the TRIVENI Connect will automatically download the relevant driver from the TRIVENI HUB, that allows for the Patient Data Stream from the Monitor to be streamed. Additional features of the TRIVENI Connect are: 

  • Has the ability to Fetch Data from the connected Device
    • No. of Manufacturers
    • No. of Devices
    • One TRIVENI Connect per Device
  • Convert Data from Device by encoding Device Data with Following information
    • Device ID, Manufacturer ID
    • Device Type
    • Patient ID
    • Ambulance ID/ Hospital ID
  • The TRIVENI Device Should be configurable with the above data. Additional capabilities of the TRIVENI Connect are:
    • Allow for Access Point Configuration
    • Via PC/ Via mobile device
    • Configure the TRIVENI Exchange IP
    • Send Data to TRIVENI Exchange
  • Software Upgrade:
    • Via PC
    • Over the Air
  • Linux Based, WiFi USB Dongle with a RS232 – USB Converter

TRIVENI HUB

The TRIVENI HUB is a device that acts as a data aggregator device at the remote location. All the Patient Data streams from various connect devices are routed to the HUB.

The HUB can be configured via a mobile app. Using the mobile app the users will be able to configure various aspects of the TRIVENI HUB like the internet connectivity, TRIVENI Connect linked to the HUB, Username and password configuration of the HUB & Connect devices, Store and forward configuration to name a few.
 

The HUB device has the following features: 
  • Is a WiFi Router + Cellular Modem
  • Has the functionality to work as a patient data stream aggregator with a store and forward feature
  • Has multiple SIM slots or Multiple USB ports for Broadband Connectivity
  • In Ambulance:
    • Will Work as a WiFi Router Access Point for the TRIVENI Connect
    • Will work as a Cellular Modem for Transmitting the data to the TRIVENI Exchange
  • In Hospital:
    • Will work as a WiFi Router Access Point for the TRIVENI Connect
    • Will connect with the Hospital LAN to connect to the Internet
  • Has the ability to store and forward patient data
  • Data streams will be prioritized based on the QoS of network connection
  • Ability to send data packets over multiple networks to reduce packet loss
  • Data aggregation from multiple types of sources other than TRIVENI Connects
  • Maintains the security of the data-on-move over wire and when data-stationary when within the TRIVENI Hub by enabling security protocols (SSL) and encryption of data

TRIVENI EXCHANGE

The TRIVENI EXCHANGE is a Medical Data+Media Server that can be configured as a Virtual / Physical Server. The EXCHANGE has RTP/ RTSP/ RTCP Capabilities for Live Streaming of the Patient Data Streams from each of the HUBs connected to the EXCHANGE. 
The features of the TRIVENI Exchange are 
  • Site Configuration: Allows the Creation of an Identity for a Client (Ambulance Services/ Hospital Provider)
  • Identification/ Allocation of IP Address (Destination IP for Medical Data Streams) for the TRIVENI Exchange
  • Allows the configuration of the TRIVENI Connect’s to stream data to the Identified IP Address
  • Has the ability to update the TRIVENI Connect / TRIVENI Exchange Firmware OTA
  • Has the ability to receive Voice and Data Streams
  • Has the ability to enable Live Streaming of Data, Video and Voice to TRIVENI Apps
  • Linux Based system
  • Virtual/ Physical Server
  • 128-bit Encryption, https, 2-factor authentication enabled
  • Can be Configured for each client in a multi-tenant server configuration.
  • Has a Medical Data Controller module to identify the source and destination of the medical data streams
  • Ability to allow store and forward data on demand
  • Allows data push or pull configurations for the TRIVENI Components
  • Maintains the “device” drivers for various types of patient sources

TRIVENI APPs

The TRIVENI APP is an android or iOS based app. There are two APPs that come with the TRIVENI framework. One APP is for configuring the remote configuration for the connect and the hub devices at the location for the client
Another APP is for configuring the Exchange and for viewing the data being streamed from the various devices connected to the patients in the remote locations
  • Enables Care Anywhere
  • Web-based, Android or iOS based apps
  • Allows for a two way communication between devices
  • Free to download app on the App Store
  • Allows the user to authenticate her credentials
  • Allows two way communication between the Apps between two users
  • Ensures the reliability of the data
  • Security enabled to ensure patient data authenticity
  • TRIVENI Apps will be developed as web-based and subsequently as native apps
  • TRIVENI apps will incorporate the usability guidelines for the healthcare based apps
  • TRIVENI apps can be configured for data push or pull options
  • TRIVENI apps enabled with security and data encryption profiles
  • There are two types of TRIVENI Apps: TRIVENI HUB & TRIVENI EXCHANGE apps to configure remote and base components

Interoperability Considerations for Medical Peripherals

If one was to trace the progression of delivery of printer drivers, it presents an interesting case study regarding how hardware-software interoperability has progressed over the years in the IT industry. And studying these aspects help us to, hopefully in the future define the way Interoperability in the Healthcare Industry should be handled.

Printers have been essential hardware devices that are connected to the software platform (OS) via various types of connectivity platforms, and service the productivity needs of the organisation.

Lets consider the various Printer installation processes we have seen in the past

  1. CD with OS compatible drivers: Printers started out as peripherals that required a specific driver to be installed on the system (PC/ Laptop/ Server) that was going to be connected to the printer, via a printer cable
  2. OS with Pre-installed Printer Drivers: Then we progressed to the OS itself having a list of compatible drivers that enabled the OS to auto-detect the type of printer or peripheral that was connected to the system. This also allowed for network printers to be installed in the network and allowed for the print server to have all the relevant drivers installed just on that server. PCs in the network wanting to use the printer resource, just needed to send the document to the print server.
  3. Cloud Printers: Now a days, it is possible to connect the printer to the cloud via HP-ePrint or google printer services and access the printer from anywhere in the world.

Device & Software Interoperability

Taking learning from the way peripherals interoperability has been handled in the IT industry, Healthcare Interoperability should be a de-facto feature that should be present in most systems
Interoperability needs to be made as a plug-n-play feature in the Healthcare Services and Solutions. What are the various “Peripherals” that need to be connected in the Healthcare Industry?

  •     Healthcare Information Management Systems
  •     Medical Devices
  •     Laboratory Devices
  •     Radiology Devices
  •     Medical Apps

Additional Thoughts on Interoperability

Now the idea for defining the progression of a hardware connectivity w.r.t. The Printer device, is to try and define how medical device connectivity & interoperability should be enabled in the future
Currently, Interoperability is a “Service” that is offered as part of the implementation process by the system integrator or the vendor of the healthcare software. The point is, why should the customer bear the cost of “connecting” the hardware and software OR two software's within an organisation
In Healthcare we are working towards providing such seamless and plug-n-play connectivity between EMRs, medical devices and now a days, additionally the  mobile health applications.

Suggested Reading

  1. Unlocking the potential of the Internet of Things | McKinsey on Healthcare - http://ow.ly/ykoy300oNJp
  2. 10 most in-demand Internet of Things Skills - CIO - Slideshow - http://www.cio.com/article/3072132/it-skills-training/10-most-in-demand-internet-of-things-skills.html#slide1
  3. 12 Quantified Self Public Health symposium 2014 report: http://quantifiedself.com/symposium/Symposium-2014/QSPublicHealth2014_Report.pdf  (PDF)
  4. Remote Patient Monitoring Lets Doctors Spot Trouble Early - WSJ http://ow.ly/3rHJ10099JP 
  5. What's New In Indian Hospitals: A Hi-Tech ICU And How It's Saving http://ow.ly/oPoV300zlpo 
  6. Study: Remote Patient Monitoring Saves $8K Per Patient Annually http://ow.ly/gqy3301Agwh 
  7. Lantronix on “Why Every Healthcare Device Should be Connected to the Internet of Things” | Symmetry Electronics - http://bit.ly/1XC2V0b
  8. #IoT software development requires an integrated DevOps platform - http://ow.ly/eg6p1006N
  9. Remote patient monitoring technology becoming imperative for providers http://ow.ly/xMK4100cAXH #IoT #HITsmIND
  10. Remote patient monitoring: What CIOs can do to make it happen - Health IT Pulse http://ow.ly/w7W3100cAY0 #IoT #HITsmIND
  11. Remote #Patient Monitoring: 8 Trending #Healthcare Infographics https://t.co/drZJmP0fVk
  12. Five innovative examples of #mHealth and #telehealth technologies http://ow.ly/WMFn100cAYk
  13. Big data fuels #telemedicine, remote patient monitoring http://ow.ly/rg3n100cAZ4 
  14. OpenICE - Open-Source Integrated Clinical Environment https://www.openice.info/
  15. Fundamentals of Data Exchange | Continua http://www.continuaalliance.org/node/456
  16. Global Patient Monitoring Devices Market Analysis & Trends - Industry Forecast to 2025 - http://www.researchandmarkets.com/publication/mf3oj2t/3757021

I am looking for partnerships, sponsors to develop this solution. If interested kindly get in touch via email: [email protected]
Author
Manish Sharma


Founder HCITExpert.com, Digital Health Entrepreneur.

Additional Articles by the Author
  1. Health ID as Patient IDs unifier in India  by Manish Sharma  
  2. 5 Steps towards an Integrated Digital Health Experience in Indian Healthcare in 2016 
  3. Top Healthcare & Digital Health Predictions for 2016
  4. Zen Clinicals: An Activity & Workflow based solution (1 of 3)
  5. RFID in Healthcare: Usecases from Hospitals
  6. 10 Solutions for the Healthcare IT Fringes
Read more »



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