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

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Manish Sharma

Founder HCITExpert.com, Digital Health Entrepreneur

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TRIVENI: A remote patient monitoring solution via @msharmas – Part 2

Introduction to Part 2

In the part 2 of this series, I will endeavour to define the Business Case and the Timelines for the Research and Development of the TRIVENI framework.

In putting across the Business Model Canvas, the effort is to present a case study for Medical Device development in India.

In this blog post I provide the details of the 9 building blocks of the TRIVENI: Business Canvas Model

In the concluding part of the blog, I will provide the Project Plan and effort estimates for developing the TRIVENI platform to cover the Research & Product Development Phase.

Suggested Reading

  1. Unlocking the potential of the Internet of Things | McKinsey on Healthcare
  2. 10 most in-demand Internet of Things Skills – CIO – Slideshow
  3. Analyzing Cost Structure for Medical Device Companies – Market Realist 
  4. Lantronix on “Why Every Healthcare Device Should be Connected to the Internet of Things” | Symmetry Electronics

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: manish.sharma@hcitexpert.com

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

New Healthcare Aggregators: SMAC and IoT via @pankajguptadr

Author: Dr. Pankaj Gupta

Digital Health Influencer & SMAC / IoT Speaker
15.Feb.2016, India


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

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

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

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

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

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

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

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

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

References

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

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

Article By: Dr. Pankaj Gupta

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