5 lessons learned while assisting Healthcare #startups by Shailesh Gogate @sgogate


18 months ago Faichi Solutions, http://bit.ly/2slS6n5 an offshore product engineering partner, decided to focus on two verticals: Healthcare and Media/ Publishing.


To scale a company, one should pick one or two verticals to focus on (especially when you have limited budget 🙂 ). These two verticals were identified based on the number of clients we had in those 2 verticals and customer references :).


In the first 4 years of operations, we had worked with a Population health product which was pivoted from a Wellness product, a Patient Management product, and a Health Management platform. In the last 18 months, we have worked/ working on two TeleHealth products, another Population health, a Behavioral Health, and two Health Management products.


While assisting different Healthcare ISVs (product companies a.k.a Independent Software Vendors), Faichi Solutions was initially a product engineering partner. Having that said, we learned a lot (and continue to learn) of business and operational issues (and are now an integral part of the development and release lifecycle). Listing 5 learnings (amongst many) below:

1. Add a product owner even if the Client has one: Core members of a startup end up wearing different hats. It’s hard to manage/ explain (and document – the biggest challenge) user stories, workflows, questions of the developers/ testers (should be accessible). Solution: Have another product owner who mimics client’s product owner. It removes a lot of roadblocks. This is very helpful to finish the number of user stories planned during a sprint.


2. Be ready to educate your Client and be educated: When your key point of contact is a domain expert and not a tech expert (although she thinks she understands technology), you end up educating the Client on technology and its processes. One has to communicate in a way which is politically correct (without hurting the ego of the entrepreneur, requires a different kind of skill). In the same breath, would like to point out, engineering partner needs to understand the nuances of client’s business. Sometimes a simple step in a use-case could be nerve-wracking, keep an open mind to learn.


3. Incorporate business dependencies while estimating a task: While estimating development effort for a user story, e.g. integration with EHR, one may estimate 4 to 5 weeks. However, there are a lot of business dependencies which have to be considered. For e.g. To get a buy-in from the CIO of a hospital / large clinic (particularly if it’s an on-premise EHR) to integrate with a product can take up to six months or more (or none). There are tons of such examples.


4. Have a domain expert on the project: Even if you are engaging with client’s VP/ Dir of Engineering, there are a lot of user stories which need clarification before and during the designing or coding process. For e.g. while moving from ICD 9 to ICD 10 codes, there is an architecture and UI change. The domain expert should point this out early in the process. There are changes being incorporated in US Healthcare, which is going to affect the revenue of a product. One should be able to filter out key implementations from the list of buzz words floating around (e.g. MACRA).


5. Build accelerators to reduce time to market: Anticipate what features are likely to be added to multiple products. For e.g. for telehealth clients, “Patient Intake forms” will be needed in a few months time. For a different set of clients and prospects, Chronic care management workflow will be required. In the initial years, we could not anticipate these needs. However, in the last 18 months, we added a few accelerators which add significant value for our clients. Not only these accelerators are helpful in reducing time to market of our clients, they were also helping in reducing clients’ cost.


There are a lot of best practices which have to be followed while working with offshore teams e.g. Good / Open communication, Tools and Processes, Daily standups, SCRUM masters on both sides, and much more. All of these are implemented and optimized as the relationship with Clients mature. However, the ones which come to mind at the top the head for Healthcare startups are listed above. Am sure engineering/ operation managers will have a lot to share. Feel free to add your learnings in the comments section below. 

Author
Shailesh Gogate

Shailesh Gogate is an entrepreneurial business development leader with deep expertise across Product Engineering services. Shailesh holds more than 20 years of IT industry experience working with companies across the world. He has a strong interest in product management and adds value to healthcare product companies to make them successful.

This post was originally published on the HCITExpert Blog:http://bit.ly/2qAsDGe

on: May 31, 2017 at 06:07PM

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]

How is Blockchain different?

Traditional databases are proprietary to the entity that maintains them and owns them. And the information stored within these databases are accessed only by providing access via an application or shared by the entity in some form of a distributed architecture. 

On the other hand, “blockchain is enabling a database to be directly shared across boundaries of trust, without requiring a central administrator. This is possible because blockchain transactions contain their own proof of validity and their own proof of authorization, instead of requiring some centralized application logic to enforce those constraints. Transactions can therefore be verified and processed independently by multiple “nodes”, with the blockchain acting as a consensus mechanism to ensure those nodes stay in sync.” [2]

A quite often stated example for explaining Blockchain is the Google Doc example. Earlier, collaborating on a document involved a serial approach to making changes to a document. Only once the author has completed the document, can it be forwarded to the next person to edit and provide feedback. 

But consider the Google Doc (or any of the other collaboration tools), once you have created a google doc, you can start creating the document and also share the same document with other collaborators who can also make changes to the document at the same time allowing for reconciliation of changes to be incorporated within the document to finalise it. The author takes the comments from the collaborators and generates the finalised document.

Blockchain: How it Works?

A transaction is requested. The transaction is broadcasted to the peer-to-peer network consisting of computer nodes. The network validates the transaction and the initiating entity’s status using relevant algorithms.  The transaction record is then considered to be verified.

Upon verification, the transaction record is added with other transactions to create a new block of data for the decentralized ledger of all transactions across a peer-to-peer network.

The new Block is added to the existing ledger of all transactions, i.e., the Blockchain. The transaction is now complete.

Types of Blockchains

Permissionless or Unpermissioned Blockchain allows anyone to join the network and participate in the block verification. For instance, a permissionless blockchain example is the Bitcoin.

Permissioned Blockchains restricts the nodes in the network who can contribute to the consensus of the system. Only permissioned nodes have the rights to validate the block transactions.

For instance, most enterprise Blockchains are permissioned blockchain and allow for privacy, scalability and fine-grained access control. [5]
Interoperability in Healthcare

There are various use cases that come to mind, when we talk about interoperability in Healthcare. (most are N:N interactions)

  1. HIMS to Lab Equipment
  2. HIMS to PACS
  3. HIMS to HIMS
  4. HIMS to Apps
  5. HIMS to Portals (Patient, Physician, etc)
  6. Portal to Portal
  7. Stakeholders to HIE
  8. Hospitals to Insurance

You can consider the number of stakeholders in the Interoperability ecosystem and continue to add them to the above list of use cases. And that allows one to understand the current fragmented nature of the Patient’s Healthcare Information. 

Each of the above stakeholders, generate the patient care record and have the need at one time or another to share this information with others in the ecosystem. We have already seen the benefits and barriers to information exchange. 

For the purpose of this blog, lets consider the Healthcare Information exchange use case. HIEs’ share the patient information in a network that is accessed by participating entities. The Patient information available on the HIE can be accessed as and when required by the patients’ treating doctor. 

The availability of a patient information, at the right place and at the right time was (one of) the intended purpose of a Health Information Exchange. HIE frameworks relied on a centralised or federated or hybrid architectures [3] to make the information available to the participants in the exchange. The exchange is maintained by an entity.

In the nationwide Interoperability roadmap defined by the ONC (US) [1]. They define the critical policy and technical components required as

  1. Ubiquitous, secure network infrastructure
  2. Verifiable identity and authentication of all participants
  3. Consistent representation of authorization to access electronic health information, and several other requirements


Additionally, the ONC challenge stated Potential uses to include:[6]

  1. Digitally sign information
  2. Computable enforcement of policies and contracts (smart contracts)
  3. Management of Internet of Things (IoT) devices
  4. Distributed encrypted storage
  5. Distributed trust

In India, an Integrated Health Information Platform (IHIP) is being setup by the Ministry of Health and Family Welfare (MoHFW). The primary objective of IHIP is to enable the creation of standards compliant Electronic Health Records (EHRs) of the citizens on a pan-India basis along with the integration and interoperability of the EHRs through a comprehensive Health Information Exchange (HIE) as part of this centralized accessible platform. 

IHIP is envisaged to enable
  1. Better continuity of care, 
  2. secure and confidential health data/records management, 
  3. better diagnosis of diseases, 
  4. reduction in patient re-visits and even prevention of medical errors, 
  5. optimal information exchange to support better health outcomes

With the understanding of What is Blockchain, What is Interoperability in Healthcare and What are the use cases for Interoperability in healthcare, do you think Blockchain Technology can be used in Healthcare? Do share your thoughts and use cases.

In the next part of the blog, I will explore some of these use cases in healthcare and for the purpose of defining how Blockchain can help interoperability of Patient Transactions across healthcare facilities.


References

1. Blockchain Opportunities for Healthcare: https://www2.deloitte.com/us/en/pages/public-sector/articles/blockchain-opportunities-for-health-care.html


3. Health Information Exchange – Architecture Types https://corepointhealth.com/health-information-exchange-architecture-types

4. Bitcoin is the Sewer Rat of Currencies, interview of Andreas Antonopoulos by Mark Frauenfelder http://ow.ly/XDMe30bumBy

5. Blockchain – What is Permissioned vs Permissionless? by Deva Annamalai on Core Dump https://bornonjuly4.me/2017/01/10/blockchain-what-is-permissioned-vs-permissionless/

6. ONC Blockchain Challenge: https://www.healthit.gov/newsroom/blockchain-challenge
Author

[tab]
[content title=”About Manish Sharma” icon=”fa-heart”]

Manish Sharma

Founder HCITExpert.com, Digital Health Entrepreneur

Connect with me via any of my Social Media Channels

[/content]
[content title=”Latest Articles”]

[/content] [/tab]

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.


Benefits of Implementing an HIE

  1. Benefits of Implementing HIEs:
HIEs that have been implemented in the US have conclusively shown emergency departments gaining efficiency in patient visits with the use of HIE based solutions.
HIEs have shown to reduce the length of patient stay, readmission risk, and number of doctors involved in patient visits [1].
HLNY ER Dept Infographic_HIEGains.png
  1. Discharge Planning
One of the examples of benefits of an HIE, is the ability to generate alerts 24-hour to 48-hour prior to the patient’s’ discharge to Transportation services, Pharmacies at the patient’s location and alerts to help patient identify long term care and home care facilities. [2]
  1. Transfer of Radiology Images:
Currently the process of exchanging patient radiology images either does not exist or at best is time consuming with problems faced by the patients and providers treating the patients.
The ability to access and view radiology images is important for an accurate and timely patient diagnosis and treatment. Historically, the process of image exchange has happened via CDs with an understanding the receiving and reviewing physician will have the ability to view the PACS images leading to high costs and long time to diagnosis.
Enabling a Transfer to PACS capability helped in cutting these lacunae in the image sharing workflow, enabling providers to quickly share images with each other. [3]
  1. Vaccination and Immunisation details:
HIEs are now moving towards incorporating the exchange of patient immunisation details. Thereby enabling patient centered technology implementations.
  1. Disease Surveillance and Immunisation Records
IHIP will provide increased view of disease outbreaks and allow the governments at the state and national levels to deploy resources effectively and efficiently. IHIP based identification and surveillance of disasters and outbreaks is a big benefit of implementing a platform such as IHIP. And additional areas that provide a fillip to the IHIP-initiative needs to be identified and those aspects of the IHIP needs to be implemented in the initial stages.
  1. Medication Information Sharing via HIEs:
The ability for the patient to build and maintain an electronic Drug Profile is important for the continued care for the patient. Presence of a Comprehensive Patient Drug profile has direct correlation to improved patient safety. Improved medication information processing has a direct correlation to the benefits of an HIE like the IHIP since it will be able to provide a more complete clinical picture of the patient. [4]
  1. Telemedicine service enabled by HIEs:
Telemonitors will be able to provide patients a way to measure and record their vital signs daily from home using a touchscreen tablet/ mobile/ PC. The information will be then wirelessly transmitted to nurses monitoring the information for changes, giving patients with, complex disease states such as heart and respiratory conditions, a sense of empowerment around their health. Telehealth has far reaching benefits for specialists providing their services to patients in the rural, underserved and non-tier I cities. With the presence of digital payment gateways and transactions, Telemedicine is fast becoming a viable business model for certain types of visits(e.g., follow-ups, referrals). [5]
  1. New Use Cases for an HIE:
When HIEs have been implemented, new use cases can emerge that extend the usefulness of HIEs. For example, HIEs have been able to send hospitals alerts and reminders when patient transitions occur, device to device data transport, sending and receiving of claims attachments, and exchanges of documents for referrals [6]
  1. Security of Patient Information (PHI):
The greatest benefit of an IHIP-like solution is the Implementations of Security protocols for transport and transfer of patient information between healthcare facilities and between patients and hospitals. This ensures creation of “Trust” centers of patient data.
  1. Improves the Trust in sources of information
One of the reasons a physician would order for a repeat test for a patient in case of a referral, would be “Trust” on the presence of a similar/ same test result available for the patient in an earlier visit. Enabling information sharing via IHIP in a standardised and secure format will enable “Trust” between healthcare facilities as trusted sources of information. [7]
  1. Strategies to avoid Information Blocking:
Information Blocking has been known to be a major cause of hindrance to the benefits brought out by an HIE. Information Blocking is healthcare facilities not sharing patient healthcare record information causing holes in the episodes of care of a patient’s longitudinal record. To avoid this from happening, “Increasing transparency of EHR vendor business practices and product performance, stronger financial incentives for providers to share information, and making information blocking illegal were perceived as the most effective policy remedies,” wrote researchers. [8]
  1. Paradigm Shift in HIE from 1.0 to 2.0:
HIE 1.0 was characterized by a focus on “the noun,” that is trying to address perceived market failures by solving a wide variety of rich use cases through comprehensive interoperability.
By contrast, HIE 2.0 focuses on the verb that is trying to meet market needs most pressing to participating providers; HIE 2.0 has fewer legal challenges because it is trying to tackle less complex use cases and in many instances has the ability to marshal financial, technical and organizational resources. Tripathi also pointed out that HIE 2.0 comes in many shapes and sizes including point-to-patient; point-to-point; vendor-specific; transaction-specific national level; enterprise-level HIE organizations; State-level and regional collaborative HIE organizations and National level collaborative HIE organizations.
Three areas identified to spur innovation and move towards HIE2.0 were: Lab data transmission, Lightweight directed query of patient information, eCPOE and measures.

Problems Implementing HIE: A review of Global HIE Experiences

  1. Unspecified Interoperability Standards:
Barriers to HIE relate to incomplete and unspecific interoperability standards and the cost of interfacing the EHR with the HIE.  The lack of mature, agreed standards around interfaces, patient consent and patient identification are significant barriers to success.
  1. Accurate patient identification is not only a data management and data quality issue, it’s also a patient safety issue
  2. Clinical Information Generator and Vendor relations
In the India context, healthcare facilities like hospitals, laboratories, pharmacies deploy systems that are proprietary in nature and not necessarily standards based. In the event of strained relations between healthcare facilities and respective vendors, there is a need to consider addressing the need to have the patient related information to be relayed to the patient in a HIE readeable format. This information can then be uploaded by the patient thereby ensuring the continuity of care records are maintained in the IHIP, specific to the patient.
In this scenario, there could be a loss of updates to the public health based registries and the hospital based registries and it should be incumbant on the hospital to ensure the data is transmitted before the changeover of systems happens.
  1. Identifying ROI for various Stakeholders
A study needs to be enabled by the government at the national and state levels that will study the benefits of implementing interfaces that will share information between the Healthcare facilities and the IHIP. Potential savings can be quantified based on cost and projected savings in improved efficiencies enabled by the implementation IHIP towards patient safety and care coordination for the stakeholders.
Additionally, its important to quantify the cost of implementing HIE-based interfaces by the various healthcare entities (like Hospitals, Laboratories, Diagnostic centers, pharmacies, etc). It will be important to identify the Revenue Streams to sustain IHIP data sharing, and how can it be sustained by the stakeholders.
  1. Breach of Security of Data contained in IHIP or connected interfaces
We have seen various types of hacks that have breached the security of patient records stored in hospital systems. Enabling security at various levels needs to be ensured before any of the Stakeholders connect with the IHIP. Security guidelines will have to be defined and adhered to and reported on a regular basis as a regulatory requirement.
Security is also necessary at the IHIP level which has been defined as a main requirement for developing the IHIP infrastructure.
In the US Architecturally, RHIOs employ either the CHMIS approach of a centralized database, the CHIN model of federated independent databases, or some combination of the two, hybrid model.
  1. Usability & Access to Information Ok, so the data about a patient has been stored in the Data Repository for all to access and review at the time of emergencies, for enabling a continuity of care record for the patient and for generating population health management analysis. But, what if the data is not easily accessible, the functionality to access the care information of the patient, requires multiple access requests and clicks and permissions. What if, the data has now been stored in the public data repository, who can access it? Who can view it? Can there be an unauthorised data access by persons not connected to the health care of the patient? [25]
  2. Information Blocking:
For-profit EHR vendors have a natural vested interest in increasing revenue by limiting the flow of data.
“The specific forms of and perceived motivations for information blocking were harder to predict a priori,” Adler-Milstein & Pfeifer explain. “What we found in relation to specific forms is that EHR vendors appear to most often engage in information-blocking behaviors that directly maximize short-term revenue. Our respondents reported that EHR vendors deploy products with limited interoperability and charge providers high fees unrelated to the actual cost to deliver those capabilities or refuse to support information exchange with specific EHRs and HIEs.”
Hospitals and health systems likewise utilize information blocking as a means to prevent clients from seeking services elsewhere to keep from losing out to the competition.
“In our results, the most commonly reported forms of information blocking among hospitals and health systems point to their interest in strengthening their competitive position in the market by controlling patient flow, which has been reported in other studies,” they wrote.

Interoperability in Healthcare: Some thoughts to share

Having followed the implementations in India for sometime now, I always wonder why interoperability is not a top priority or not implemented in most systems. They are HL7 compliant, but are they really interoperable? And I dont mean the part from HIMS to Lab or Rad equipment, that part is fairly well defined and documented. 

– But from the Patient to Hospital to Patient
– Patient to Insurance to Patient
– Patient to app to hospital to Patient

Take for instance most systems are able to share the discharge summaries as emails to patients, and a print out, even today. But on discharge can the patient “share” her discharge summary from an app or application to another practitioner who takes care of the patient rehab? Are for instance, the systems involved in the above use case, interoperable? 

Another point, how many Healthcare Apps (the production versions) have any data sharing via standards? They can however email PDFs of the recorded data. So what can be done to enable out-of-the-box interoperability in the Healthcare Apps? With the growing number of mHealth Apps, we will soon find ourselves in another new set of “Data-Silos” being created on a daily basis.

Recently we moved from Cash to Cashless to Less Cash scenarios … so is it right to say, in healthcare context, we are working from a Paper to Paperless to Less Paper scenario in Healthcare before going totally paperless? 

And if so: 

1. What will be the business case for interoperability and for sharing the discharge summary/ medications in a format that is easily exchangeable?

2. Can a Healthcare IT think tank, work on defining the standards of “workflow” of the data being generated in healthcare today? Starting from the Patient through the healthcare ecosystem and back to the Patient?


3. Can the Healthcare IT vendors form a group of HIMS, LIMS, Pharma Apps, HomeCare solutions that enable a “Patient Data Workflow” exchange group (a mini-IHIP) that actually enables the “Interoperability” of patient data as a great showcase. It could perhaps be tied to the IHIP effort or NDHA. It adds onto the work that is being planned in the Phase 1 of the IHIP project, by being able to provide feedback on issues, solutions, recommendations, pain points etc.

Its important to note, that a system like IHIP has a potential to solve the accessibility of patient care problem in India. My view is that there is a need to see interoperability from a Patient’s point of view rather than from the point of view of “Systems”. There is a need to map the flow of data from the Patient and back to the Patient, and this can help in enabling a radically different approach to interoperability in Indian Healthcare.

With Aadhar based solutions allowing for the consumer information to be securely transmitted and verified, it only behoves well if we were to adopt an “HIE of Patient” approach to IHIP wherein the Information is exchanged between various stakeholders in the Patient’s Care Continuum and that information finally rests with the Patient’s Electronic Health Record (PEHR). With the EHR standards mandating the Healthcare Information belongs to the patient, it will be extending that mandate to IHIP.

References

  1. NY Health Information Exchange Improves ED Quality, Efficiency
  1. HIE Partnership to improve Health Data Exchange of Imaging
  1. Health information exchange and patient safety
  1. Vermont HIE adds telehealth component
  1. DirectTrust HIE growth shows priority of Interoperability
  1. Health information exchange: persistent challenges and new strategies
  1. Health Information Exchanges report Information Blocking
  1. Maine Rural Veterans Health Access HIT Strategies
  1. The Value Of Health Care Information Exchange And Interoperability (a must read paper on how the costing for HIEs can be done)
  1. Health information exchange: persistent challenges and new strategies
  1. Information Blocking: Is It Occurring and What Policy Strategies Can Address It?:
  1. What is HIE?:
  1. Health Information Exchange?:
  1. HIE Benefits?:
  1. Guide to Evaluating Health Information Exchange Projects
  1. HIMSS Library for Information on HIEs
  1. Health Information Exchange – Overview
  1. 10 things to know about health information exchanges
  1. Selecting & Using a Health Information Exchange | AMA
  1. The Sequoia Project eHealth Exchange
  1. What is Health Information Exchange? | HIMSS
  1. IHIP, India
  1. Are Data repositories set to become data dumps? https://www.digitalhealth.net/2017/04/another-view-neil-paul-21/
  2. Powering the Patient Relationship with Blockchains: https://www.healthit.gov/sites/default/files/7-29-poweringthephysician-patientrelationshipwithblockchainhealthit.pdf
  3. Lessons from the UK | Healthcare IT News


Author

[tab]
[content title=”About Manish Sharma” icon=”fa-heart”]

Manish Sharma

Founder HCITExpert.com, Digital Health Entrepreneur

Connect with me via any of my Social Media Channels

[/content]
[content title=”Latest Articles”]

[/content] [/tab]

Blog Series: #IoT in Healthcare by Manishree Bhattacharya @ManishreeBhatt1


The opportunity for #IoT in Healthcare is estimated to be $2.5 trillion by 2025. How are we embracing this change? The Types of Opportunities that present themselves to the Startups, Healthcare IT organisations are tremendous.

During the #PhilipsChat, on the 10th April 2017, we asked the experts what they thought about the current trends and focus areas that the IT Industry, Medical Device Manufacturers, Hospitals and Start-ups will need to keep in view, in the near and short-term, while making their organisation ready for the Digital Transformation that can be and will be enabled by #IoT in Healthcare.  
Presenting the insights shared by Manishree Bhattacharya (@ManishreeBhatt1) on #IoT in Healthcare
Q1: In the near term (1-3 years), What are the top 3 innovations in IoT that can benefit healthcare?
Manishree Bhattacharya: 1. Remote monitoring of (cardiac disorders, COPD, Alzheimer’s, Parkinson’s, insomnia, diabetes, elderly, expecting mothers)
2. An integrated/connected surgical room, where devices are interoperable, regularly feeds in data into patient profile in EMR, to streamline post-operative care, both in the hospital and beyond, at patient homes
3. IoT for ensuring drug/treatment adherence, such as sensor-based pills
Q2. Do you see any device, connected via any protocol and with any cloud; as the future, if yes how will that be achieved? Standards?
Manishree Bhattacharya: Right now, developments are quite random and sporadic. To achieve larger goals, moving from connected devices to connected hospitals, some level of standardization and uniformity will be important to ensure an error-free, and secured transmission.
Q3: In India (or your country), what are the Digital Infrastructure requirements for enabling IoT based Innovations in Healthcare?
Manishree Bhattacharya: Seeing Digital Health take off in India in its full bloom is one of my wishes, and the preliminary requisite would be to encourage hospitals go paper-less – have EHR systems implemented, with a timeline set for nation-wide implementation. Just imagine how seamless healthcare delivery will be if primary, secondary and tertiary centres are integrated – data can seamlessly flow from one centre to another. Government has a very strong role to play here, that will help in creating the right infrastructure, timely adoption, establishing standards, lowering costs by promoting local manufacturing, and boosting HealthIT start-ups.
Q4. Please share use cases for Connected Care for: Healthy Living, Prevention, Diagnosis, Treatment, Homecare:
Manishree Bhattacharya:
Healthy Living – Most consumer IoT devices aim to do that – tracking exercise regimes, diet plans
Prevention – Say a heart patient puts on a wearable device that continuously monitors and sends signals to nurses/doctors for any aberration – this can ensure timely treatment and prevent a severe episode.
Homecare – A person who has just had a surgery, and is on homecare – his regular vitals, diet plan, outputs are remotely being tracked by the doctor/nurse – who can selectively revise the diet or post-surgery recovery plan. Same goes with elderly who are on home-care.
Treatment – A sensor-based pill that sends a signal to a care-giver on ingestion of the pill.
The bigger purpose – We know that not all medicines work on every patient. Regularly tracking patients not only help in timely interventions, and more personalized treatments, it also opens routes to more clinical research on personalized medicines.
Q5: What are the Healthcare based Smart City components? How can Local, State and National Government’s make #IoT solutions in healthcare economically viable?
Manishree Bhattacharya: Answering to how can government make IoT solutions viable, my thoughts would be:
  1. By promoting indigenous manufacturing to curb costs
  2. Incentivising IoT adoption in hospitals
  3. Prioritizing HealthIT in the overall start-up agenda
Q6: How can private hospitals justify the RoI’s of Smart Hospital Components?
Manishree Bhattacharya: By improving quality of care; reducing hospital re-admissions, yet prolonging the care process that extends to one’s home; and finally improving patient engagement/adherence. A patient is more likely to visit a doctor who can provide a more personalized treatment than the one who cannot. Important would be define these key metrics/KPIs right at the beginning of implementation.

Q7. Tell us a 5 Year view of IoT in Healthcare and what would a Patient Experience be in a Smart Hospital?
Manishree Bhattacharya: First, we have to understand the purpose of IoT in healthcare – it is not there just for the sake of it, but to truly enable a coordinated and long-term care, that would eventually reduce mortality, morbidity, and hospital re-admissions. Patient experience is bound to improve. A patient will not have to run from one department to another, narrating the whole problem and showing multiple reports. So when a cancer in-patient enters a psychologist’s office, and the doctor already knows the problem, and also has the latest vitals of the patient right in his tablet, he knows that the patient was not able to get any sleep the previous night and has a high BP right now. The doctor would hence probably choose to talk about things that can ease the patient’s current situation. Now, that is truly an enriching experience.

Looking ahead in the future, we may also have AI-enabled voice assistants that will make a patient more comfortable in hospital settings.
Q8. Finally: What areas of IoT based innovations are you looking to partner with Startups for? Can you give us two areas?
Manishree Bhattacharya: Would love to connect with any start-up that can provide meaningful solutions for the Indian healthcare landscape. What I would also like to see is how these start-ups are using the tonnes of data that IoT devices generate, in deriving meaningful analysis – big data, AI, and so on.

References

  1. Here is the original Blog Post announcing the #PhilipsChat Tweetchat : http://blog.hcitexpert.com/2017/04/philipschat-on-iot-in-healthcare.html
  2. 3 ways in which Information Technology can improve healthcare in India by Manishree Bhattacharya (@ManishreeBhatt1) on NASSCOM Community
  1. IoT in India – The Next Big Wave by NASSCOM http://www.nasscom.in/iot-india-next-big-wave
  2. Curated list of Tweets from the #PhilipsChat: https://twitter.com/i/moments/852242427008233473
  3. Review the #PhilipsChat Transcript & analytics via @symplur here >> http://hcsm.io/2loNiv7
Stay tuned to the #IoT in Healthcare Blog series. Bookmark this link to follow on the insights being shared by the experts on the HCITExpert Blog:

http://blog.hcitexpert.com/search/label/IoT%20in%20Healthcare

Author
Manishree Bhattacharya

Manager – Research & Advisory at NASSCOM
Business professional with 7+ years of experience in research and advisory, across IT, healthcare, and medical technologies. At NASSCOM, responsible for identifying digital opportunities, driving thought leadership/innovation and delivering actionable insights for the Indian Technology Industry

Blog Series: #IoT in Healthcare by Dave Brown (@QiiQHealthcare)


The opportunity #IoT in Healthcare is estimated to be $2.5 trillion by 2025. How are we embracing this change? The Types of Opportunities that present themselves to the Startups, Healthcare IT organisations are tremendous.

We asked experts what they thought about the current trends and focus areas that the IT Industry, Medical Device Manufacturers, Hospitals and Startups will need to keep in view in the near and short-term while making their organisation ready for the Digital Transformation that can be and will be enabled by #IoT in Healthcare.  

Presenting the insights shared by Dave Brown (@QiiQHealthcare) on #IoT in Healthcare.

Q1: In the near term (1-3 years), What are the top 3 innovations in IoT that can benefit healthcare?:

Dave Brown: Great user-centered design; cheaper sensors; integration-friendly cloud services (including ML and AI).

Q2: Is an IoT based system going to be a utility or a service?:
Dave Brown: The UI -where the rubber meets the road- is a service. The software behind it is also a service. I can see some of the hardware elements and networking tech’y being a utility.

Q3. Do you see any device, connected via any protocol and with any cloud; as the future, if yes how will that be achieved? Standards?:
Dave Brown: More public exposure of performance metrics will incentivize QI and therefore innovation. Free-market competition (between innovators) will drive down costs. With this accelerated change, risk will rise – this can’t be avoided. However, reliability and data security standards will stabilise risk.

Q4: In India (or your country), what are the Digital Infrastructure requirements for enabling IoT based Innovations in Healthcare?:
Dave Brown: Not sure.  But to my previous answer – system reliability and security standards will help confidence levels for healthcare providers who are frightened of change.

Q5. How can hospitals leverage #IoT based solutions for service delivery and patient care? :
Dave Brown: Start with the big picture in mind; begin with small, measured implementations, and look for IMPACT.  Advance quickly as success metrics show up.

Q6: What are the aspects of Connected Care for the Patient Care Continuum
Dave Brown: Healthy Living, Prevention, Diagnosis, Treatment & Home Care. THIS DOES NOT HAPPEN WITHOUT PROGRESSIVE APPROACHES TO INTEGRATION. The future = API’s.

Q7. Please share usecases for Connected Care for: Healthy Living, Prevention, Diagnosis, Treatment, Homecare:
Dave Brown: One simple picture: a FitBit user shares their data with their provider network; always-on data analysis (that also taps the user’s genomic data) triggers alerts when bad signs arise; then an automatic clinical response launches to address the issue before it becomes a serious problem. This process is AI-driven.

Q8: What are the Healthcare based Smart City components? How can Local, State and National Government’s make #IoT solutions in healthcare economically viable?:
Dave Brown: BIG question – hard to predict – creative and informed entrepreneurs will come up with many. I think these IoT solutions emerge from a vibrant startup community. Governments assist merely by creating incentives for the birth&growth of well-run startups, including spurring investment. They can also help round up healthcare executives and tech entrepreneurs to thoughtfully examine REAL problems and viable solutions (to save entrepreneurs from building solutions that no-one will buy and deploy).

Q9: How can private hospitals justify the RoI’s of Smart Hospital Components? :
Dave Brown: Similar answer as Q2a: start small and measure measure measure.

Q10: Give us a Buzzword we are going to be hearing regarding IoT based innovations in Healthcare.:
Dave Brown: Not sure.  How ’bout: “Smart API’s”

Q11. Tell us a 5 Year view of IoT in Healthcare and what would a Patient Experience in a Smart Hospital?:
Dave Brown: It’ll take more than 5 years for a real transformation to occur. But as I’ve already written, more good data (genomic + real-time consumer sensors) with strong AI will increase proactive community interventions, thus reducing the demand on urgent care.

Q12. Finally: What areas of IoT based innovations are you looking to partner with Startups for? Can you give us two areas?:
Dave Brown: We ARE a startup, committed to helping redesign workflow in urgent care.  We need to partner with companies contributing to acute care IT. We eventually need to integrate with community-care solutions to further improve the patient experience in moving from community care to acute care.

You can contact QiiQ Healthcare via their website: http://QiiQHealthcare.com
You can reach Dave via Twitter: @DaveBrutusBrown

References

  1. Here is the original Blog Post announcing the #PhilipsChat Tweetchat : http://blog.hcitexpert.com/2017/04/philipschat-on-iot-in-healthcare.html
  2. Curated list of Tweets from the #PhilipsChat: https://twitter.com/i/moments/852242427008233473
  3. Review the #PhilipsChat Transcript & analytics via @symplur here >> http://hcsm.io/2loNiv7

Stay tuned to the #IoT in Healthcare Blog series Bookmark this link to follow on the insights being shared by the experts on the HCITExpert Blog:

http://blog.hcitexpert.com/search/label/IoT%20in%20Healthcare

Author
Dave Brown

Co-Founder at QiiQ Healthcare, designer/engineer – perceptive, meticulous, smart and sensible
leader/entrepreneur – social, tenacious, visionary and realistic

With age, I’ve become a “big picture” guy, but I can and will roll up the sleeves….

I’ve led small and medium-sized user-facing technology projects: starting with strategy, and flowing right down to the detailed tactical level. I get the P&L picture, and am very comfortable driving execution.

Blog Series: #IoT in Healthcare by Srinivas Prasad M.R. @prsdsrnvs


The opportunity in #healthcare IoT is estimated to be $2.5 trillion by 2025. How are we embracing this change?

During the #PhilipsChat, on the 10th April 2017, we asked questions related to the current trends and focus areas that the Healthcare IT Industry, Medical Device Manufacturers, Hospitals and Startups will need to keep in view in the near and short-term while making their organisation ready for the Digital Transformation that can be and will be enabled by #IoT in Healthcare.
A great discussion ensued that has spawned this blog series. Presenting the insights shared by M. R. Srinivas Prasad (@prsdsrnvs) on #IoT in Healthcare #PhilipsChat. (http://en.wikipedia.org/wiki/M._R._Srinivasaprasad)


Q1: In the near term (1-3 years), What are the top 3 innovations in IoT that can benefit healthcare?:
M. R. Srinivas Prasad: In the emerging markets the IOT devices that would play an important role in extending care to the homes and community, would be those that can enable remote monitoring of cardiac patients, COPD patients and pregnancy monitoring in the rural community. These devices could be devices like Connect diagnostic ECG, Low cost but reliable wearables to monitor basic vital signs and breathing patterns and connected intelligent fetal dopplers to help monitor the child during birth helped by midwives

Q2: Is an IoT based system going to be a utility or a service?:
M. R. Srinivas Prasad: This will be a mix of both. It can (also) be an Outcome-based pricing model which is a variant implementation of the Service Model.

Q3. Do you see any device, connected via any protocol and with any cloud; as the future, if yes how will that be achieved? Standards?:
M. R. Srinivas Prasad: Need to adhere to Continua standard for these devices for open connectivity but in the near term I see that cost will prevail over the interoperability standard if regulatory bodies don’t ensure conformance from the start.

Q4: In India (or your country), what are the Digital Infrastructure requirements for enabling IoT based Innovations in Healthcare?:
M. R. Srinivas Prasad: A change in the mindset of going from paper to paperless is needed. Then there is a need to educate hospitals “Software is not free”. In addition, enabling IoT will need reliable telecom networks, work with the ecosystem to set up datacenters. Maturity & innovation around commercial business models will be a need Supporting infrastructure like connected ambulances, trained paramedics & and efficient transportation system will help.

Q5. How can hospitals leverage #IoT based solutions for service delivery and patient care? :
M. R. Srinivas Prasad: Postoperative care can be shifted to the patient’s home. This can help free up beds in the hospital which can help in increase revenue to the hospital from a new patient. Hospital-acquired infections can be reduced and finally, in bringing down the cost of care, the benefit that can be extended to the patient.

Q6: What are the aspects of Connected Care for the Patient Care Continuum?
M. R. Srinivas Prasad: From Philips Healthcare point of view Connected care for the Patient Care Continuum comprises of Healthy Living, Prevention, Diagnosis, Treatment and Homecare. Here’s a video that explains these aspects https://www.youtube.com/watch?v=Xe-KxiiIyNI

Q7. Please share usecases for Connected Care for: Healthy Living, Prevention, Diagnosis, Treatment, Homecare:
M. R. Srinivas Prasad: (elaborated on each of the aspects of Connected Care for the Patient Care Continuum)
#HealthyLiving There are many in the market but it is important to choose the right one like the ones which are accurate e.g. Philips watch. Eating healthy food but tasty from an Indian cuisine context means fried food. Philips air fryer helps air fry tasty healthy food.

#Prevention Breathing Fresh & clean air is important for us to avoid pulmonary complications in countries like ours where pollution levels are high. #Philips Air Purifier helps address this issue

#Diagnosis Early diagnosis is critical to increase survival rate and reduce the cost of treatment. Use of AI in helping clinicians early diagnosis and also managing a larger population base can help solve the India challenges. Either for aiding in detection of infectious diseases like TB or identifying lesions from brain and breast scans.

#Treatment Minimally invasive devices are the key here . Low dose interventional X-ray systems or mobile surgery systems . Radiation planning systems which aid accurate and the right dose planning.

#HomeCare Monitoring of post cardiac patients and COPD patients at home. Philips Home Co business in india extends care into the home. This reduces cost of care and also helps the hospital to manage more new patients. Monitoring compliance to medication is another key aspect when extending care to home.

Q8: What are the Healthcare based Smart City components? How can Local, State and National Government’s make #IoT solutions in healthcare economically viable?:
M. R. Srinivas Prasad: Government should step in with policies that support in “giving the last mile connectivity” to decentralize healthcare (and) help in the convergence of Mobile technology, Consumer engagement and Payment reforms.
Additionally, Population management to understand disease profiling, to understand the spread of infectious diseases like malaria, typhoid etc. Smart ambulances. Garbage clearing monitoring. Air quality monitoring device across the city. Adequate availability of AED ‘s and accessible and connected. These are all related to health care.

Q9. How can private hospitals justify the RoI’s of Smart Hospital Components?
M. R. Srinivas Prasad: Demanding solutions from healthcare companies. Looking at OPEx models where the capex requirement is low. Productivity improvement from workflow efficiencies. Productivity gains or clinicians from using AI and smart tools. Better clinical decisions and patient re-admissions which will be enhance patient stickiness and also enhance the brand which will drive more patients to the hospital.

Q10. Tell us a 5 Year view of IoT in Healthcare and what would a Patient Experience in a Smart Hospital?M. R. Srinivas Prasad: A seamless experience which helps the hospital in its business, helps the clinicians make better decisions, helps patients by reducing their healthcare costs and the insurance providers become more efficient and manage their premiums better. A win win for all. Example from the onset of chest pain to early diagnosis, to emergency care, seamless patient data flow into the hospital EMR’s. Flow or patient context and information right through the various departments in the hospital including radiology, cardiology, critical care and also seamless extension of this care into home or the community post discharge and post operative care on remote care settings. A seamless experience in a distributed care environment

Q11. What areas of IoT based innovations are you looking to partner with Startups for? Can you give us two areas? M. R. Srinivas Prasad: Advanced AI models to aid early diagnosis of chronic diseases – Cardiac, COPD, Oncology and Mother and Child space. Smart IOT devices to support Monitoring of patients under various clinical conditions post discharge. Pregnancy monitoring and post natal care. Solutions in the healthcare informatics space and connect care solutions to help extend care into the community and homes

To one other question from Mr. NS Ramnath (@rmnth): On a scale of 1 to 10, where do you think the sensors in wearables in the market today stand?
M. R. Srinivas Prasad: It’s in a very nascent stage but with a huge potential and key to help solve our healthcare challenges.

Mr. M.R. Srinivas Prasad, signed-off from the chat by urging the participants, “let’s define the future of healthcare for a better India and a better world. Technology is key! Cheers

References

  1. Here is the original Blog Post announcing the #PhilipsChat Tweetchat : http://blog.hcitexpert.com/2017/04/philipschat-on-iot-in-healthcare.html
  2. #IoT and #AI: Potent combo redefining healthcare by M. R Srinivas Prasad @prsdsrnvs on Livemint http://www.livemint.com/Opinion/iuOHAO5UCn1qzH2q5JwJvL/IoT-and-artificial-intelligence-Potent-combO-redefining-hea.html
  3. Curated list of Tweets from the #PhilipsChat: https://twitter.com/i/moments/852242427008233473
  4. Review the #PhilipsChat Transcript & analytics via @symplur here >> http://hcsm.io/2loNiv7
Author
M. R. Srinivas Prasad

CEO, Philips Innovation Campus, India

Blog Series: #IoT in Healthcare by Dr. Vikram @drvikram

The opportunity in #healthcare IoT is estimated to be $2.5 trillion by 2025. How are we embracing this change? The Types of Opportunities that present themselves to the Startups, Healthcare IT and Healthcare organisations are tremendous


During the #PhilipsChat, on the 10th April 2017, we asked the experts what they thought about the current trends and focus areas that the IT Industry, Medical Device Manufacturers, Hospitals and Startups will need to keep in view in the near and short-term while making their organisation ready for the Digital Transformation that can be and will be enabled by #IoT in Healthcare.

A great discussion ensued and that has spawned this blog series. Presenting the insights shared by Dr Vikram Venkateswaran (@drvikram) on #IoT in Healthcare #PhilipsChat.

Q1: In the near term (1-3 years), What are the top 3 innovations in IoT that can benefit healthcare?:
Dr Vikram Venkateswaran:
In my opinion, the immediate benefits are in areas where other industries have made progress: cheaper rates for Sensors, Increased security at device and sensor level. Additionally, an Increased integration of sensors and devices with EMR allowing for proactive interventions and remote monitoring for Chronic diseases.
Another aspect is Managing inventory and tagging assets are key for more hospitals, and i think that is an immediate benefit that will accrue.
To the question of, Do you think India will benefit from cheaper portable diagnostic devices or remote treatment a better stead ? asked by Divye Marwah; I would say, both patients and the hospitals will benefit.
Sukesh Kumar: Do you think #AI will help in taking healthcare to the next level?
Dr Vikram Venkateswaran: Its already happening in certain specialties like Oncology
Q2: Is an IoT based system going to be a utility or a service?
Dr Vikram Venkateswaran: Tricky one but I would say a service, with elements of a utility.

Ms. Manishree Bhattachar (@ManishreeBhatt1), Analyst with NASSCOM, “Do you think EHR implementation is a requisite, to go for a full bloom service+utility models for IoT devices?”

Dr Vikram Venkateswaran: I think so personally, without the full view of patient history, proactive intervention; depends on the care priorities for the Hospital.

Q3. Do you see any device, connected via any protocol and with any cloud; as the future, if yes how will that be achieved? Standards?:

Dr Vikram Venkateswaran: That is one of the biggest challenges today, EMR integration with IoT devices for example Wearables, remote pacemakers, Bionic Limbs, lenses with ability to monitor sugar levels and Blood Pressure.

Q4: In India (or your country), what are the Digital Infrastructure requirements for enabling IoT based Innovations in Healthcare?:

Dr Vikram Venkateswaran: Network connectivity and availability of LE sensors is the key, Most healthcare systems are still on paper records, Patient education is the key as well, massive change in perception is required.

Q5. How can hospitals leverage #IoT based solutions for service delivery and patient care? :
Dr Vikram Venkateswaran: Health Checks, remote health monitoring as a service, pro active intervention as a service

Q6: What are the aspects of Connected Care for the Patient Care Continuum?
Dr Vikram Venkateswaran: Interoperability and adherence of standards, increased communication, Change in perception of patients and hospitals

Q7. Please share usecases for Connected Care for: Healthy Living, Prevention, Diagnosis, Treatment, Homecare:
Dr Vikram Venkateswaran: Remote monitoring of cardiac pacemakers,  monitoring of blood glucose, Sweat analysis for athletes, Sleep monitoring for patients and athletes

Q8: What are the Healthcare based Smart City components? How can Local, State and National Government’s make #IoT solutions in healthcare economically viable?:
Dr Vikram Venkateswaran: Disease Surveillance, Leveraging weather data to predict disease patterns, Population health management

Q9: How can private hospitals justify the RoI’s of Smart Hospital Components? :
Dr Vikram Venkateswaran: Hospitals can prioritise understanding disease patterns

Q10: Give us a Buzzword we are going to be hearing regarding IoT based innovations in Healthcare.:
Dr Vikram Venkateswaran: Smart Care, Home Healthcare, Remote Health Monitoring, Home Health, Connected care, Connected Health

Q11. Tell us a 5 Year view of IoT in Healthcare and what would a Patient Experience in a Smart Hospital?:
Dr Vikram Venkateswaran: Hospitals to focus on critical care, emergencies and palliative care. Regular check ups and follow ups to be conducted leveraging IoT

Q12. Finally: What areas of IoT based innovations are you looking to partner with Startups for? Can you give us two areas?:
Dr Vikram Venkateswaran: Disease Surveillance, Home Healthcare

References

  1. Here is the original Blog Post announcing the #PhilipsChat Tweetchat : http://blog.hcitexpert.com/2017/04/philipschat-on-iot-in-healthcare.html
  2. #IoT and #AI: Potent combo redefining healthcare by M. R Srinivas Prasad @prsdsrnvs on Livemint http://www.livemint.com/Opinion/iuOHAO5UCn1qzH2q5JwJvL/IoT-and-artificial-intelligence-Potent-combO-redefining-hea.html
  3. Join the #Philipschat on Twitter #IoT in #Healthcare on Monday 10th April 2017, 3 PM – Health Care in India http://healthcare-in-india.net/healthcare-technology/join-the-philipschat-on-twitter-iot-in-healthcare-on-monday-10th-april-2017-3-pm/
  4. Curated list of Tweets from the #PhilipsChat: https://twitter.com/i/moments/852242427008233473
  5. Review the #PhilipsChat Transcript & analytics via @symplur here >> http://hcsm.io/2loNiv7
  6. #IoT & #AI – A potent combination redefining healthcare event by @PhilipsBlore moderated by @drvikram https://youtu.be/6cpeICKV9Fw

Stay tuned to the #IoT in Healthcare Blog Series Bookmark this link to follow on the insights being shared by the experts on the HCITExpert Blog:


Team @HCITExperts [Updated: 29th May 2016]
Author

[tab]
[content title=”About Dr. Vikram Venkateswaran”]

Dr. Vikram Venkateswaran

Dr Vikram Venkateswaran is a healthcare thought leader who writes and speaks about the emerging healthcare models in India and the role technology plays in them.
Connect with me

[/content]
[content title=”Latest Articles”]

[/content] [/tab]