#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. 

One technology however has started to see more adoption from the Industry and the mainstream population, is Telemedicine or as I would like to use the term … Connected Health. 

Alliance for Connected Care (http://www.connectwithcare.org/what-is-connected-care/) defines Connected Care as: 

Connected Care is the real-time, electronic communication between a patient and a provider, including telehealth, remote patient monitoring, and secure email communication between clinicians and their patients. Connected Care improves access to care, helps providers and patients avoid costly health care services, and increases convenience for patients.   

Despite the rapidly developing technology and increasing interest among patients and physicians in the use of Connected Care, legal and regulatory barriers continue to limit mainstream acceptance of this technology. To achieve the promise of Connected Care in health care system, there must be a renewed urgency among policymakers to develop a regulatory structure that enables safe and accessible use of this technology.


In one of the previous articles, I had discussed about what Connected Health means, and how today’s advances in accessibility and affordability of connectivity and mobile Technology has allowed for disruptive power to be placed in the hands of more and more people in India (Mary Meeker in her 2017 report mentions about #DigitalHealth being at an Inflection Point)

Connected Health, Telemedicine or Telehealth technologies are all poised to be seen as an effective tool to enable the delivery of healthcare. And move from Sick-care to true Health-care. 

WHO defines Telemedicine as, “The delivery of health care services, where distance is a critical factor, by all health care professionals using information and communication technologies for the exchange of valid information for diagnosis, treatment and prevention of disease and injuries, research and evaluation, and for the continuing education of health care providers, all in the interests of advancing the health of individuals and their communities” (WHO definition). 

What is the Gartner’s Hype Cycle?

Each Gartner Hype Cycle drills down into the five key phases of technology’s life cycle. 
No. Phase Description
1 Technology Trigger A potential technology breakthrough kicks things off. Early proof-of-concept stories and media interest trigger significant publicity. Often no usable products exist and commercial viability is unproven.
2 Peak of Inflated Expectations Early publicity produces a number of success stories—often accompanied by scores of failures. Some companies take action; most don’t.
3 Trough of Disillusionment Interest wanes as experiments and implementations fail to deliver. Producers of the technology shake out or fail. Investment continues only if the surviving providers improve their products to the satisfaction of early adopters.
4 Slope of Enlightenment More instances of how the technology can benefit the enterprise start to crystallize and become more widely understood. Second- and third-generation products appear from technology providers. More enterprises fund pilots; conservative companies remain cautious.
5 Plateau of Productivity Mainstream adoption starts to take off. Criteria for assessing provider viability are more clearly defined. The technology’s broad market applicability and relevance are clearly paying off.
The term “hype cycle” and each of the associated phases are now used more broadly in the marketing of new technologies. [1]



Gartner Hype Cycle – Telehealth Technologies


In healthcare the need to allocate resources (Doctors, Nurses, Hospital Beds) to treat the patient at a particular time and specific place plays an important role in delivery of care to the persons visiting the hospitals/ clinics. 


Connected Care, Telehealth, Telemedicine technologies can help in fundamentally altering the care delivery process outside of the brick-and-mortar structures that have been traditionally used to deliver care.

A 2017 study by American Well found that 50 million Americans would be willing to switch primary care providers if it meant getting access to video visits, up from 17 million in 2015. It will be an interesting to study similar trends in India, specially given the access to internet connectivity in India, with the context of the Mary Meeker report referenced earlier.

Today the patient has an option to pick up her phone and call her doctor and seek advice on the phone or via a message, to seek an advice on quick care (headaches and minor ailments), or get an advice on medication schedule and therefore, it’s safe to predict that consumer habits will continue to look for convenience and cost. 

In some Healthcare Facilities, you would find a medical assistant recording the symptoms and the complaints once the patient visits the clinic. The information is recorded based on a questionnaire put together by the medical team for the specialty. When the doctor starts the consultation, the she reviews this information recorded by the medical assistant and proceeds to record her assessment and plan for the patient. 

After the consultation with the doctor, the medical assistant stays on, and continues to advice the patient regarding the next course of action and the medications that needed to be taken by the patient. The medical assistant ensures that the patient understands the instructions conveyed by the doctor. However, the move to creating new workflows that help in streamlining the patient engagement process also means asking, “what do patients think about non-physicians?” 

https://www.politico.com/agenda/story/2017/10/25/role-of-physician-in-healthcare-000554


In India, we have the ASHA – Accredited Social Health Activists, who have been doing a yeoman service to help reach healthcare services to the last mile. As part of the National Rural Health Mission, there was a plan for 250,000 ASHAs in every village in 10 states as of 2012. As of 2013, the number of ASHAs in India was reported in July 2013 to be 870,089 [5]. The Indian MoHFW describes them as:

“…health activist(s) in the community who will create awareness on health and its social determinants and mobilize the community towards local health planning and increased utilization and accountability of the existing health services.”[5]


With the availability of improved network connectivity in the rural areas [1], improved digital tools with the ASHAs, can perhaps further improve the accessibility to primary healthcare.

The Key benefits of Telemedicine or Connected Care? [2]

  • Improved access to primary care, specialists, 
  • Cost Savings,
  • Reduction in emergency room utilisation, 
  • Improved clinical outcomes, 
  • Increased patient satisfaction with care
  • Reduces appointments, freeing up capacity
  • Clinicians have access to patient readings at any time.
  • Patients are not bound to Healthcare Organisation hours
  • Travel costs are reduced for both healthcare professionals and patients
  • Regular monitoring means changes in treatment can happen much sooner
  • It enables patients to understand their condition


Barriers to Adoption: 
A. India Internet Connectivity [3]:
The internet connectivity has been stated as one of the barriers to adoption of connected health and telehealth/ connected health services, “According to a joint study by ASSOCHAM India, Internet penetration in India is likely to double by 2020 (India’s Internet population likely to touch 600 million by 2020: study, 2016). As of now, 27 out of 100 Indians log on to the internet, because of 3G and 4G connectivity. In absolute numbers, this represents 343 million users of the internet. 

By 2020, the number is expected to increase to 600 million. According to a recent report on rural consumers (98% of connected rural users men; 79% from the city: report, 2016) “more than half of new Internet users in India is from rural communities, and rural users constitute almost half (48%) of connected users in India by 2020.” 

As per the report, “The number of Indian rural Internet users will increase from about 120 million in 2015 to about 315 million in 2020, registering close to a 30% y-o-y growth.” [3]

B. Healthcare Telemedicine Framework – Current Trends: [2]
India is facing shortfall of 32% & 23% in no. of community & primary health centres

India’s telemedicine market which has been growing at a compounded annual growth rate (CAGR) of over 20 per cent. It is expected to grow from USD 15mn to over 35mn by 2020, noted a recent study by apex industry body ASSOCHAM.

In the study conducted by ASSOCHAM, “Promoting Rural Healthcare: Role of Telemedicine” it was noted that Efforts need to be made to create an overarching framework covering three levels, i.e.,  

  • primary healthcare centres (PHC) to district,
  • district to referral/super speciality hospitals and
  • issues vis-à-vis hardware/software requirements,
  • and bandwidth and connectivity needs to be fixed

As per the report, the secretary general of ASSOCHAM while releasing the findings of the chamber’s study said, “With limited resources and much of population living in remote, rural areas (68%), telemedicine has the potential to revolutionise delivery of healthcare in India.”

Further he mentions, “Providing quality healthcare to a large segment of population which does not have access to speciality physicians because of factors like geographic limitations or socio-economic conditions is the greatest challenge faced by the healthcare sector in India.”

During the course of past decade (2005-15) the number of primary health centres (PHCs) has increased by about 1,800 and there has been a rise of over 2,000 in the number of community health centres, noted the ASSOCHAM study highlighting extent of growth and development of rural healthcare in India.

“There is a shortage of about 32 per cent in terms of the number of CHCs in India at present while there is 23 per cent shortage of PHCs in the country.”

Late discovery of ailments, lack of experience in healthcare providers in rural areas and huge amount of time being spent in reaching urban health facilities make rural populace more vulnerable than their urban counterparts.

As such there is an urgent need for speeding up the process of building up healthcare infrastructure capacities especially in the rural areas.

“This could also been looked upon as an unexplored opportunity by private healthcare industry, here telemedicine has an important role to play by offering the possibility for remote diagnostics as technology will extend the reach of healthcare services and ease the pressure on overburdened systems.”

C. Lack of Legal Framework: In the Telemedicon 2016 conference held last year in Bangalore, the experts discussed about the lack of regulations to help the adoption of telemedicine in India. The lack of legal frameworks have a lagging effect in the adoption of Telemedicine in India. 

“Growth of a sustainable telemedicine network in India depends upon introduction of legal frameworks, development of national e-health policies, trained human resource and regular funding,” highlighted the study prepared by the ASSOCHAM Economic Research Bureau (AERB).

Dr. Milind Antani from Nishith Desai Associates in a recently concluded conference, “Revolutionising Healthcare with IT” spoke about the legal frameworks governing eHealth and Healthcare in India. 



Dr. Susheel from the George Institute and President at IAMI highlights the need for studying the cost effectiveness of the Telemedicine Services, “We just did a systematic review of telemedicine implementation in India (and found) very little evidence regarding outcomes or impact, most telemedicine efforts just report volume of transaction, nothing at all on cost effectiveness.”

Technology Initiatives from the Government: 

One of the initiatives from the government of India are the Common Service Centre is now spread over all the villages and is promoted by Ministry of Electronics and Information Technology. The information about the following service was shared by Dr. S.B. Gogia (Chairperson IMIA WG on Telehealth on the IAMI members group

It is interesting to note that Telehealth Services and Diagnostics have been initiated by CSC and Apollo Hospital is the Telecentre for this program. This is also interesting to note that PM Jan Aushadhi Scheme is linked this Telehealth program and the Generic Medicines to these Jan Aushadhi will be provided by Public Sector Pharma companies. Details are as below (the information is presented below is as per the updated provided):

Tele-health Consultations:
In order to provide grass root level access points for health consultation among communities through digital medium, CSC is offering video based tele-consultation service throughout India at affordable rates. CSC SPV partnered with Apollo Hospitals Limited in 2014 to allow the VLEs across the country to facilitate the tele-consultations with doctors from Apollo Hospitals. In 2016, CSC SPV launched its own tele-health consultation services throughout India through Allopathic, Homeopathic and Ayurvedic doctors across the country.

The ISRO’s Telemedicine Programme
The Indian Space Research Organisation’s (ISRO) telemedicine pilot project was started in 2001 to make telemedicine accessible to the population at the grassroots.This initiative was launched under the GRAMSAT (rural satellite) programme, in co-ordination with various system providers such as In nium, Apollo, OTRI, BEL- VEPRO, Tele Vital, etc. The telemedicine facility connects remote district hospitals/health centres with super speciality hospitals in cities, through the INSAT satellites for providing expert consultation to the needy and underserved population.

The valuable experience gained during the initial pilot projects encouraged ISRO to undertake further endeavours to enable speciality healthcare delivery to the rural populace. The focus has been to introduce satellite communications-based telemedicine technology in various parts of the country through pilot projects.

Pradhan Mantri Jan Aushadhi Scheme:
Pradhan Mantri Jan Aushadhi Scheme aims at making quality medicines available at affordable prices for all, particularly the poor and disadvantaged, through exclusive outlets called ‘Jan Aushadhi Medical Stores’. The scheme is implemented by the Bureau of Pharmaceutical Public Sector Undertaking (BPPI). CSC SPV partnered with BPPI in 2015 to set up generic medicine stores under the Jan Aushadhi Scheme at the CSCs across the country.

Diagnostic Services:
Hello Health Kits: Launched in September 2016 in collaboration with Hello Health, diagnostic kits are used to test parameters like Blood glucose, BP, ECG, BMI, Spyrometry, Pulse oximetry and Body Temperature. Hello Health kits have been piloted in West Bengal, Tamil Nadu, Punjab & Haryana.

3Nethra Kits: 
CSC SPV has partnered with Forus Health Private Ltd (3 Nethra) for eye testing services at CSCs. The service was launched in November 2016.

Tele-medicine Remote Diagnostic Kit – Control H: Control-H is an integrated wireless healthcare monitoring medical device that helps in monitoring Blood Pressure, Heart Rate, Blood Oxygen, body temperature, Total Cholesterol, Haemoglobin, and Blood Glucose.

Thyrocare: CSC SPV has partnered with Thyrocare to provide diagnostic services through CSCs. Thyrocare diagnostic services have been piloted in Aurangabad, Maharashtra and VLEs can offer following diagnostic tests at affordable prices:
• Blood Test – CBC, HBA1c & TSH
• Urine Test – Urinary MA, Creatinine and Albumin/Creatinine Ratio
• Water Test – Detection of physical & chemical impurities, elements, bacteria & pesticides in water

JIVA Ayurveda Scheme: 
CSC SPV has partnered with JIVA Ayurveda to bring Ayurveda consultation and over 150 Ayurvedic products to citizens through the CSC network. The service was launched in July 2016 in Haryana, Uttar Pradesh and Punjab. JIVA Ayurveda product sale is now live in Madhya Pradesh, Maharashtra, West Bengal, apart from northern Indian states.

Health Homeo 999: CSC SPV has launched a new service called Health Homeo 999 package, which contains the following:

9 doctor consultations via video call; after the 9th consultation, consultation fee of Rs. 50 will be charged for every additional consultation. Treatment for unlimited diseases and health problems throughout the year and unlimited German medicines for the patient for one year. No courier charges for up to six couriers of medicines; after six deliveries, Rs. 50 to be charged for every additional courier.

Free Homoeopathic Family First Aid kit.
Treatment provided by World’s largest Homoeopathy treatment portal, ‘welcomecure.com’.​

In addition to the above initiatives by the government, here is an article we published earlier on other Digital Health initiatives which will help in delivery of Affordable, Accessible, Accountable care to the patients as India aims to be a Global Leader in #DigitalHealth by Rajendra Pratap Gupta

Healthcare apps that help deliver telemedicine services to the patients are also part of the tele-medicine delivery network that have been in play since that past 5 years in india. The B2C nature of these apps ensures the delivery of care at the palm of the patient. However, the number of patients’ that are covered by these apps from a Bharat I, II and III perspectives needs to be seen. We have seen the presence of these apps across the continuum of care, covering various categories such as appointment scheduling, medication adherence, etc.

In a report published by PWC

India ranks 2nd among developing countries studied on maturity for mHealth adoption. Widespread adoption of mobile technology in healthcare, or mHealth, is now viewed as inevitable by more than half of doctors and healthcare payers in developed and emerging markets around the world, including 60% in India.  The pace of adoption will likely be led by emerging markets that rank highest among ten countries on a score of mHealth maturity, according to a new global study conducted for PwC Global Healthcare by the Economist Intelligence Unit (EIU).


In the same report, David Levy, MD, Global Healthcare Leader, PwC, said:

“Despite demand and the obvious potential benefits of mHealth, rapid adoption is not yet occurring.  The main barriers are not the technology but rather systemic to healthcare and inherent resistance to change.  Though many people think mobile health will be ancillary or bolted on to the healthcare industry, we look at it differently:  mHealth is the future of healthcare, deeply integrated into delivery that will be better, faster, less expensive and far more customer-focused.”

Future of Telehealth & Connected Care Initiatives: 

In a talk delivered at the Singularity University event, Jeroen Tas, Chief Innovation and Strategy Officer, Philips; talks about the need to create an omni-channel care pathway to deliver healthcare 24×7 network around the globe. Similar to the experience the banking industry has gone through in terms of their digital transformation. Two interesting observations from that talk are shared below as an interesting point to bolster the need for telehealth or connected health tech:

“To identify a Digital Ventures Success: Fragmented consumer experience, friction and waste in the value chain – Jeroen Tas”

Technology in the near future will enable Digital Twins, using BioPhysical  Computer Models of Patients, using patients’ health data using ambient intelligenceAI and analytics – Jeroen Tas

https://www.politico.com/agenda/story/2017/10/25/role-of-physician-in-healthcare-000554



Sangita Reddy, Joint Managing Director, Apollo Hospitals Group provided a compelling vision of Tomorrow’s Technology enabled Healthcare.



According to Dr. S.B. Bhattacharyya, “Telemedicine technology helps bridge the physical distance between patients and their care providers and enable the two to remain in touch 24 x 7 irrespective of their physical location. Here in India, travel is always a challenge and in the major cities with traffic and pollution and the sheer number of patients visiting doctors, the requirement to physically visit the doctor by an ill person poses a significant challenge. 

Through the use of telemedicine technology, a number of patients can be remotely cared for, thereby cutting down not only on the need for travel that inevitably means incurring a certain cost in terms of both money and time spent in the activity, but also help in reducing the number of patients who visit their doctors just for reviewing of past results and current condition and to get the advice of “continue same treatment” or worse, “stop treatment as you have recovered now”, something that can safely be done from a distance provided they and their doctors are able to interact using video technology to both see and hear. 

In case the doctor feels that the case merits a physical evaluation, a nurse can be sent over to do that and report back to the doctor through the video call. This way the specialists can concentrate on those cases that would benefit more from his careful attention, something that lack of time does not permit.” 

In his recently published book “A DIY Guide to Telemedicine for Clinicians”, Dr. S. B. Bhattacharyya (https://link.springer.com/book/10.1007/978-981-10-5305-4#toc) asks the questions, “How can I set up a telemedicine facility at my centre?” It does not however help provide the answer to “What is telemedicine and how can it be used in healthcare?”. Its important to note, today its not about the question, “Should I have a telemedicine center?”, rather its about figuring out how can a doctor, care provider, ASHA worker put together a Telemedicine Service offering for the consumer. Further Dr. Bhattacharyya notes, “The primary focus (of this book) is to guide the reader in using telemedicine technology to provide a level of care that increases customer satisfaction, which in turn increases revenues” 

Dr. Milind Antani, however is hopeful of changes being made to the various laws governing Telehealth and Telemedicine services in India. I asked him about the changes he invisages in the legal framework governing Telemedicine services in india? 

Dr. Milind Antani: “I would consider e-Health more relevant than Telemedicine as e-Health has broader scope of activities. India has been witnessing significant upward surge in e-Health recently. However, regulations have not evolved completely or not matching the pace. However I am envisaging the following changes/new laws, in India, in near future

  • Electronic Healthcare Data Privacy legislation
  • E-Prescription guideline/ amendment to allow e-prescription
  • Amendment to allow e-Pharmacy
  • Telemedicine Act ( may not happen in near future but required)
  • Amendment in MCI Code to allow Audio Video consultation for doctors
  • Central license by MCI to practice in every state of India


With the Healthcare moving out of the four walls of the traditional hospital, its safe to assume that the Health and care will be delivered at the point of care for each patient. Therefore moving Telemedicine to the realm of connected care. We found some interesting usecases for Telemedicine Delivery based on our search for new age contexts for delivery of Healthcare to consumers: 

1. An often stated usecase has been the use of Pharmacies to be used to provide in-store telemedicine http://ow.ly/7imu30hdpCj

2. There are proposals for making the first visits or follow-up visits to the doctors as completely on-video, http://ow.ly/liUw30hdpFn. The NHS has rolled out such a service in the UK. We have seen some of the hospitals in india providing these services to their patients. 

3. With ASHA workers being at the front-line of Healthcare accessibility and delivery in India, they can be fortified with Digital Health tools to help provide Telemedicine services to the patient’s they cover. They can be connected to the state/ district based hospitals with the “command center” that house specialists providing telemedicine services. With the help of the ASHA workers the doctors can provide their advice, order tests and prescribe medications.

4. Another important area that should be explored by the hospitals and healthcare organisations is the delivery of Telehealthcare to the Seniors. With convenience being the predominant factor for seniors efforts should be made to provide specialist services. With the Here’s a guide to enabling senior care via telemedicine. However, a study found only 28% of senior citizens were users of social media, requiring efforts that need to be put in place by healthcare organisations to enable remote delivery of care to this population group.

5.  Healthcare Apps will continue to play an important role in creating new care delivery frameworks that will make provide a “Phygital” Transformation of Healthcare that comprises of a physical and digital collaboration of resources to help acheive the “3A’s of Healthcare Delivery in India”: Accessibility, Affordability, Accountability. By incorporating payment gateways in Telemedicine apps, another area of customer friction to use the services provided by the healthcare organisations can be removed and allow for a much streamlined approach to providing Telemedicine services.

6. “Thanks to the emergence of consumerism, patient-centricity is now at the core of healthcare delivery. Nowadays, patients increasingly prefer extended follow-up care delivered at their homes, or at a step-down facility rather than in a hospital. 

With the adoption of the technological trend of serverless architecture, the implementation of RPM solutions for healthcare service providers can be cost-effective and much faster than ever before. Beyond the obvious IT advantages, it also facilitates better patient engagement through real-time alerts and it also enables proactive care delivery resulting in effective and high quality of patient care in the 21st century.” 
Guruprasad. S, Sr. General Manager, Business Domain Healthcare, Robert Bosch Engineering and Business Solutions Private Limited  [7]

7. Mayo Clinic’s telemedicine offerings have significantly expanded since their inception in 2013. The health system’s enhanced-intensive care unit uses video monitors and advanced technology that allow a team of specialists to remotely monitor ICU patients from eight regional sites. Sean Caples, DO, and his team staff the command center 24/7, adding additional physicians during the busier night hours. The E-ICU has improved Mayo’s mortality index by 40 percent in the first year after its 2013 implementation. The Mayo program is also using telemedicine services to aid in prenatal and postnatal care. [8]


References

[1]: Gartner Hype Cycle: https://en.wikipedia.org/wiki/Hype_cycle

[2]: Telemedicine market in India may cross $32 mn by 2020: Study
http://www.assocham.org/newsdetail.php?id=5728


[3]:On The Road to Digitization:

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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. 


The report, ‘Rewire for Growth,’ estimates that AI has the potential to increase India’s annual growth rate of gross value added (GVA) by 1.3 percentage points, lifting the country’s income by 15 percent in 2035. To avoid missing out on this opportunity, policy makers and business leaders must prepare for, and work toward, the AI revolution. 


The era of AI has arrived. Established companies are moving far beyond experimentation. Money is flowing into AI technologies and applications at large companies. The number of patents filed on AI technologies in G20 countries has increased at a more than 26 percent compound annual growth rate since 2010. Funding for AI startups has been growing at a compound annual growth rate of almost 60 percent.

AI is a new factor of production that can augment labor productivity and innovation while driving growth in at least three important ways:

Mobilize Intelligent Automation
Automate complex, physicalworld tasks that require adaptability and agility.

Empower Existing Workforces
Complement and enhance the skills and abilities of workforces.

Drive Innovations
Let AI be a catalyst for broad structural transformation of the economy. Do things differently, do different things.


The report points out AI is expected to raise India’s annual growth rate by 1.3 percentage points—in a scenario of intelligent machines and humans working together to solve the country’s most difficult problems in 2035

AI TENDING TO INDIA’S HEALTH
India’s healthcare providers have embraced artificial intelligence, recognizing its significant value in better diagnostics with data intelligence and in improving patient experience with AI-powered solutions.

Take Manipal Hospitals, headquartered in Bengaluru, which is using IBM Watson for Oncology, a cognitive-computing platform, to help physicians identify personalized cancer care options across the country.

In cardiac care, Columbia Asia Hospitals in Bengaluru is using startup Cardiotrack’s AI algorithms to predict and diagnose cardiac diseases, disorders, and ailments.

And in eye care, Aravind Eye Hospital is working with Google to use AI in ophthalmology for diabetic retinopathy screening. Also, the government of Telangana is planning to use Microsoft Intelligent Network for Eyecare (MINE), an AI platform, to reduce avoidable blindness, which would make it the first state in India to deploy AI for eye care screening as part of the Rashtriya Bal Swasthya Karyakram program under the National Health Mission.

Accenture, for its part, has developed an AI-powered smartphone solution to help the visually impaired improve the way they experience the world around them and enhance their productivity in the workplace. The solution, called
Drishti, was initially developed and tested through a collaboration with the National Association for the Blind in India.


AI has the potential to have a broad-based disruptive impact on society, creating a variety of economic benefits. While some of these benefits can be measured, others, such as consumer convenience and time savings, are far more intangible in nature. Our analysis focuses on measuring the GVA impact of AI.

Read the press release here >> 
https://newsroom.accenture.com/news/artificial-intelligence-could-add-957-billion-to-indian-economy-according-to-new-research-by-accenture.htm

Read the complete report here >> 
https://www.accenture.com/in-en/insight-ai-economic-growth-india

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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. 



Gartner in their recent report defines Blockchain as a Digital Platform. And healthcare industry has been perennially on the lookout for a Digital Platform that will allow for an efficient and secure way to share patient data. Providing access to the healthcare data involves providing access to the patient data to relevant stakeholders at the right time and to the right person, not only ensuring the privacy but also providing the patient control of their data. 

Another problem that remains evasive in healthcare is driven by privacy of the patient data, and has been at times been seen to be impeding the flow of patient data between disparate systems, (i.e., Interoperability). 

We now have the Blockchain Technology and various companies are working to apply the technology to help solve not only the interoperability problem but also applying the same technology to solve various usecases in the Care Continuum, to save costs, improve efficiency, ensure privacy.

So what are the problems Blockchain is being applied to in the Healthcare context? What are the benefits one would accrue by applying Blockchain to Healthcare and what are the pitfalls.

The past august, ONC in the US setout a Blockchain challenge with the objective, 

The goal of this Ideation Challenge is to solicit White Papers that investigate the relationship between Blockchain technology and its use in Health IT and/or health-related research. The paper should discuss the cryptography and underlying fundamentals of Blockchain technology, examine how the use of Blockchain can advance industry interoperability needs expressed in the Office of the National Coordinator for Health Information Technology’s (ONC) Shared Nationwide Interoperability Roadmap, as well as for Patient Centered Outcomes Research (PCOR), the Precision Medicine Initiative (PMI), delivery system reform, and other healthcare delivery needs, as well as provide recommendations for Blockchain’s implementation. In addition to a monetary award, winners may also have the opportunity to present their White Papers at an industry-wide “Blockchain & Healthcare Workshop” co- hosted by ONC and NIST.”

As part of the Ideation Challenge, the following papers were the declared winners:

1. Blockchain and Health IT: Algorithms, Privacy, and Data: cThis papers discusses the need to create a peer-to- peer network that enables parties to jointly store and analyze data with complete privacy, based on highly optimized version of multi-party computation with a secret-sharing. An auditable, tamper-proof distributed ledger (a permissioned blockchain) records and controls access through smart contracts and digital identities. We conclude with an initial use case of OPAL/Enigma that could empower precision medicine clinical trials and research. 
Authors:  Ackerman Shrier A, Chang A, Diakun-thibalt N, Forni L, Landa F, Mayo J, van Riezen R, Hardjono, T.
Organization:  Project PharmOrchard of MIT’s Experimental Learning “MIT FinTech: Future Commerce.”


2. Blockchain: Securing a New Health Interoperability Experience: Blockchain technologies solutions can support many existing health care business processes, improve data integrity and enable at-scale interoperability for information exchange, patient tracking, identity assurance, and validation. This paper suggests these processes can be supported by three most important applications: Creating secured and trusted care records, linking identities and recording patient consent decisions and patient directives within the secured patient record.
Authors:  Brodersen C, Kalis B, Mitchell E, Pupo E, Triscott A.
Organization:  Accenture LLP


3. Blockchain Technologies: A Whitepaper Discussing how Claims Process can be Improved: Smart contracts, Blockchain, and other technologies can be combined into a platform that enables drastic improvements to the claims process and improves the health care experience for all stakeholders. The healthcare industry suffers from an inability to clearly communicate costs in a timely and easy-to-understand format. This problem is a symptom of interoperability issues and complex agreements between providers, patients, health plans/payers and government regulators. These agreements are encoded in legal language with the intent of being defensible in court. However, the focus on legal enforceability, instead of understandability, creates problems resulting in hundreds of billions of dollars spent annually to administer an inefficient, outdated and complex process for adjudicating and paying health plan claims. 

The process results in errors and often leaves the patient unclear on how much they need to pay. If these agreements were instead translated into computer code (smart contracts) leveraging Blockchain technologies, the claim process would not only be interoperable, but also drive standardization, research and innovation. Transparency and trust can be injected into the process when both the logic and the data driving these decisions is stored permanently and made available to all stakeholders through a peer-to- peer distributed database like blockchain. The result will be a paradigm shift toward interoperability and transparency, enhancing the speed and accuracy of cost reporting to patients. This paper discusses how smart contracts, blockchain and other technologies can be combined into a platform that enables drastic improvements to the healthcare experience for all stakeholders.
Author:  Culver K. 


4. Blockchain: A new model for Health Information Exchanges: Presentation of an implementation framework and business case for using Blockchain as part of health information exchange to satisfy national health care objectives.


Authors:  Krawiec RJ, Barr D, Killmeyer K, Filipova M, Nesbit A, Israel A, Quarre F, Fedosva  K, Tsai L.
Organization:  Deloitte Consulting LLP

5. A Case Study for Blockchain in Healthcare: “MedRec” Prototype for Electronic Health Records and Medical Research Data: A long-standing focus on compliance has traditionally constrained development of fundamental design changes for Electronic Health Records (EHRs). We now face a critical need for such innovation, as personalization and data science prompt patients to engage in the details of their healthcare and restore agency over their medical data. 

In this paper, the authors propose MedRec: a novel, decentralized record management system to handle EHRs, using blockchain technology. The system gives patients a comprehensive, immutable log and easy access to their medical information across providers and treatment sites. Leveraging unique blockchain properties, MedRec manages authentication, confidentiality, accountability and data sharing—crucial considerations when handling sensitive information. A modular design integrates with providers’ existing, local data storage solutions, facilitating interoperability and making our system convenient and adaptable. 

MedRec incentivize medical stakeholders (researchers, public health authorities, etc.) to participate in the network as blockchain “miners”. This provides them with access to aggregate, anonymized data as mining rewards, in return for sustaining and securing the network via Proof of Work. MedRec thus enables the emergence of data economics, supplying big data to empower researchers while engaging patients and providers in the choice to release metadata. 

The purpose of this paper is to expose, in preparation for field tests, a working prototype through which we analyze and discuss our approach and the potential for blockchain in health IT and research.
Authors:  Ekblaw A, Azaria A, Halamka J, Lippman A. 
Organizations:  MIT Media Lab, Beth Israel Deaconess Medical Center


6. The Use of a Blockchain to Foster the Development of Patient-Reported Outcome Measures (PROMs): This paper suggests the use of Cognitive Behaviour Therapy as a modality to treat Mental Health disorders. This the author suggests is achieved by the use of various applications that allow the patient to record information using SMS or applications. These applications keep track of any emergencies, provides patient coaching and guidance, recording of daily progress and medication adherence. While many patients feel ashamed of their mental state and feel a stigma associated with conditions such as depression and anxiety, the anonymous nature of these applications may make it more likely for them to seek help. 

These types of use cases are the first step in implementing blockchain technology as they help identify the system requirements and looks at the interactions between users and systems. In this case, the focus would be on personal health information that is highly sensitive and coming from mobile applications that require direct interaction between the patient and providers, as well as those involved in the care of the patient. 

Each scenario that involves a transaction, or data being transferred from the application to those who have “signed” the transaction would be documented so the information flow and usage is understood. In this manner, the appropriate permissions would be granted and provenance could readily be established. Use of the Internet of Things in combination with Blockchain technology for Patient Reported Outcome Measures (PROMs).
Author:  Goldwater JC.
Organization:  National Quality Forum

7. Powering the Physician Patient Relationship with ‘HIE of One’ Blockchain Health IT: ‘HIE of One’ links patient protected health information (PHI) to Blockchain identities and Blockchain identities to verified credential provider institutions to lower transaction costs and improves security for all participants. 

HIE of One, (Health Information Exchange of One) shifts the trusted intermediary role away from the hospital and into the blockchain. The blockchain can also provide the link between physician credentials and patient identity.
Author:  Gropper A.

8. Blockchain: The Chain of Trust and its Potential to Transform Healthcare – Our Point of View: This paper talks about Potential uses of Blockchain technology in health care including a detailed look at health care pre-authorization payment infrastructure, counterfeit drug prevention and detection and clinical trial results use cases. The paper also highlights what Blockchain is not. Some of the additional usecases as presented in the paper are listed below:


Organization:  IBM Global Business Service Public Sector

9. Moving Toward a Blockchain-based Method for the Secure Storage of Patient Records: Use of Blockchain as a novel approach to secure health data storage, implementation obstacles, and a plan for transitioning incrementally from current technology to a Blockchain solution. The author suggests a practical first step towards moving towards a blockchain enabled world, here is a suggested workflow by the author, from the submission: 

Author:  Ivan D.

10. ModelChain: Decentralized Privacy-Preserving Health Care Predictive Modeling Framework on Private Blockchain Networks:   ModelChain, to adapt Blockchain technology for privacy-preserving machine learning. Each participating site contributes to model parameter estimation without revealing any patient health information (i.e., only model data, no observation-level data, are exchanged across institutions). 

We integrate privacy- preserving online machine learning with a private Blockchain network, apply transaction metadata to disseminate partial models, and design a new proof-of-information algorithm to determine the order of the online learning process. 

We also discuss the benefits and potential issues of applying Blockchain technology to solve the privacy-preserving healthcare predictive modeling task and to increase interoperability between institutions, to support the Nationwide Interoperability Roadmap and national healthcare delivery priorities such as Patient-Centered Outcomes Research (PCOR).
Authors:  Kuo T, Hsu C, Ohno-Machado L.
Organizations:  Health System Department of Biomedical Informatics, University of California San Diego, La Jolla, CA Division of Health Services Research & Development, VA San Diego Healthcare System.


11. Blockchain for Health Data and Its Potential Use in Health IT and Health Care Related Research: A look at Blockchain based access-control manager to health records that advances the industry interoperability challenges expressed in ONC’s Shared Nationwide Interoperability Roadmap.
In this usecase the authors discuss the use of blockchain technology with a data lake for scalability. All medical data would be stored off blockchain in a data repository called a data lake. Data lakes are highly scalable and can store a wide variety of data, from images to documents to key- value stores

When a health care provider creates a medical record (prescription, lab test, pathology result, MRI) a digital signature would be created to verify authenticity of the document or image. The health data would be encrypted and sent to the data lake for storage. Every time information is saved to the data lake a pointer to the health record is registered in the blockchain along with the user’s unique identifier. The patient is notified that health data was added to his blockchain. In the same fashion a patient would be able to add health data with digital signatures and encryption from mobile applications and wearable sensors.



Authors:  Linn L, Koo M.

12. A Blockchain-Based Approach to Health Information Exchange Networks: 
Sharing healthcare data between institutions is challenging. Heterogeneous data structures may preclude compatibility, while disparate use of healthcare terminology limits data comprehension. 

Even if structure and semantics could be agreed upon, both security and data consistency concerns abound. Centralized data stores and authority providers are attractive targets for cyber attack, and establishing a consistent view of the patient record across a data sharing network is problematic. 

In this work we present a Blockchain-based approach to sharing patient data. This approach trades a single centralized source of trust in favor of network consensus, and predicates consensus on proof of structural and semantic interoperability.

The authors describe the Healthcare Blockchain as: 

Because a blockchain is a general-purpose data structure, it is possible to apply it to domains other than digital currency. Healthcare, we believe, is one such domain. The challenges of a patient record are not unlike those of a distributed ledger. For example, a patient may receive care at multiple institutions. From the patient’s point of view, their record is a single series of sequential care events, regardless of where these events were performed. This notion of shared state across entities, inherent to the blockchain model, is congruent with patient expectations. Also, it is reasonable to assume that each patient care event was influenced by one or more events before it. For example, a prescription may be issued only after a positive lab test was received. The notion of historical care influencing present decisions fits well into the blockchain model, where the identity of a present event is dependent on all past events.

Much like the Bitcoin approach, our block is a Merkle Tree-based structure[21]. The leaf nodes of this tree represent patient record transactions, and describe the addition of a resource to the official patient record. Transactions, however, do not include the actual record document. Instead, they reference FHIR Resources via Uniform Resource Locators (URLs). This allows institutions to retain operational control of their data, but more importantly, keeps sensitive patient data out of the blockchain. FHIR was chosen as a exchange format not only because it is an emerging standard, but also because it contains inherent support for provenance and audit trails, making it a suitable symbiotic foundation for blockchain ledger entries. FHIR in conjunction with the blockchain can serve to preserve the integrity and associated context of data transactions.


A Blockchain-based approach to sharing patient data that trades a single centralized source of trust in favor of network consensus, and predicates consensus on proof of structural and semantic interoperability.
Authors:  Peterson K, Deedvanu R, Kanjamala P, Boles K.
Organization:  Mayo Clinic


13. Adoption of Blockchain to enable the Scalability and Adoption of Accountable Care:  A new digital health care delivery model that uses Blockchain as a foundation to enable peer-to-peer authorization and authentication.

The recent trends in Accountable Care based payment models have necessitated the adoption of new process for care delivery that requires the co-ordination of a “network” of care providers who can engage in shared risk contracts. In addition, the need for sharing in the savings generated equitably is key to encourage the network providers to invest in improved care paradigms. 

Current approaches to digitize healthcare focus on improvement of operational efficiency, like electronic records as well as care collaboration software. However, these approaches are still based on the classical centralized authorization model, that results in significant expense in implementation. These approaches are fundamentally limited in their ability to fully capitalize on the peer-to-peer digital work- flow revolution that is sweeping other segments of industry like media, e-retail etc. 

In this paper the author formulates a new digital health care delivery model that uses block chain as the foundation to enable peer-to-peer authorization and authentication. The author will also discuss how this foundation would transform the scalability of the care delivery network as well as enable payment process via smart contracts, resulting in significant reduction in operational cost and improvement in care delivery. 

In addition, this block-chain based framework can be applied to enable a new class of accountable tele-monitoring and tele-medication devices that would dramatically improve patient care adherence and wellness. Finally, the adoption of block chain based digital-health would enable the creation of varifiable “personalized longitudinal care” record that can form the basis of personalized medicine.

Author:  Prakash R.



14. A Blockchain Profile for Medicaid Applicants and Recipients: A solution to the problem churning in the Medicaid program that illustrates how health IT and health research could leverage Blockchain-based innovations and emerging artificial intelligence systems to develop new models of health care delivery. The solution envisions a Smart Health Profile by thinking of the blockchain profile simply as a broker that can answer questions about you as the need arises, your identity remains distributed. No one can ever see everything about you at once, including yourself. 

What makes the profile smart is that the services it provides can be quite intelligent. It can make sophisticated queries and actually trigger an action when certain conditions are met. For example, suppose you had a smart drug dispenser that recorded every dose you take as a transaction on the blockchain. A profile service might check everyday to see if you’ve taken your pill and automatically order a refill when you’ve used up all the pills. Over time, however, an AI service might become much more sophisticated to use a combination of information about your vital statistics from your wearable device and population studies of people using the various medications for your condition and either recommend a different regimen to your physician or simply cut out the middleman and direct your pharmacist to deliver you a new prescription.

The solution goes on to discuss the use of Blockchain in a medicaid scenario and a much more comprehensive solution as a distributed infrastructure for health.
Authors:  Vian K, Voto A, Haynes-Sanstead K.
Organization:  Blockchain Futures Lab – Institute for the Future


15. Blockchain & Alternate Payment Models:  Blockchain technology has the potential to assist organizations using alternative payment models in developing IT platforms that would help link quality and value.
Author:  Yip K.


References
The content provided in the examples above have been collated from the various submissions to the ONC’s Blockchain Ideation Challenge. You can write to me or connect with me, in case you are interested in receiving the copy of the documents.

In my previous article on Blockchain I shared whats Blockchain and types of Blockchain. I also discussed some of the usecases companies and startups have focussed on developing Blockchain based solutions. In this article I will share some of the usecases based on Blockchain technology, in healthcare. 

Alternatively, you could follow the links here

You can also review the various articles on Blockchain on the HCITExpert Blog.

[1]: Blockchain Articles by David Houlding:
https://www.linkedin.com/in/davidhoulding/detail/recent-activity/posts/

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Manish Sharma

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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.
Rapid Increase in the Investment in Cybersecurity
  • According to Gartner, worldwide spending on cybersecurity increased by 7% as compared to last year and will reach $86.4 billion in 2017.
  • Spending on both cybersecurity services and products is expected to keep growing into 2018, reaching $93 billion by the end of the year.
  • An Enterprise Strategy Group (ESG) survey found that for 39% of organizations, improving cybersecurity is the most important business initiative driving IT spending in 2017 and that 69% of organizations are increasing their cybersecurity budgets in this year alone. 
  • 81% of cybersecurity professionals agree that improving security analytics and operations is a high priority at their organizations.
  • Cybersecurity startup funding hit an all-time quarterly high in terms of number of deals in the first quarter of 2017, up 26% from the previous quarterly high. The trend held through the second quarter, which saw just one fewer deal (145 total) compared to the previous quarter. 
  • The amount of disclosed equity funding to cybersecurity companies has also recently broken records, reaching an all-time quarterly high of $1.6 billion in the second quarter of 2017, according to CB Insights.

From cybersecurity operations into strategic Digital Risk Management

Organizations today generally think of cyber-risk as internal network penetration and defense. But there is now a shift towards developing a more comprehensive risk management strategy that includes all the digital assests such as – websites, social networks, partner exposure, branding and reputation management and compliance. 
Says ESG: “Comprehensive Risk Management Strategy is a more holistic digital risk strategy designed to analyze threat intelligence, monitor deep web activities, track the posting of sensitive data, and overseeing third parties and partners.”
With the transformation of cybersecurity into comprehensive risk management, Gartner predicts that by 2020, 100% of large enterprises will be asked to report to their board of directors on cybersecurity and technology risk at least annually, which is an increase from today’s 40%. 
The key in presenting to the board, says Gartner, is to connect the cybersecurity program goals to business risks. An example would be a discussion of implementing a process for managing third-party risk to support a business’s cloud strategy.
Cybersecurity skills shortage, a problem needing attention
There are currently more than 348,000 open security positions, according to CyberSeek. By 2022, there will be 1.8 million unfilled positions, according to the Center for Cyber Safety and Education. And The industry needs and will continue to need new kinds of skills as cybersecurity evolves in areas such as data classes and data governance, says Gartner
According to the ESG Survey, Things aren’t improving at all, some survey results:
In 2016, 46% of organizations reported a problematic shortage of cybersecurity skills. In 2017, the research is statistically the same as last year; 45% of organizations say they have a problematic shortage of cybersecurity skills.
According to 2016 research conducted by ESG and the Information Systems Security Association (ISSA), 33% of respondents said that their biggest shortage of cybersecurity skills was in security analysis and investigations. Security analysis and investigations represented the highest shortage of all security skill sets.
Recent ESG research reveals that 54% of survey respondents believe that their cybersecurity analytics and operations skill levels are inappropriate, while 57% of survey respondents believe that their cybersecurity analytics and operations staff size is inappropriate.
The ramifications of skills and staff deficiencies are also apparent in the research. Cybersecurity operations staffs are particularly weak at things like threat hunting, assessing and prioritizing security alerts, computer forensics, and tracking the lifecycle of security incidents.
CISOs propose an easy fix: companies must work towards hiring more cybersecurity staff to bridge the knowledge and staffing gaps. In fact, 81% of the cybersecurity professionals surveyed say that their organization plan to add cybersecurity headcount this year.
However, its not that simple to do. According to the ESG research, 18% of organizations find it extremely difficult to recruit and hire additional staff for cybersecurity analytics and operations jobs while another 63% find it somewhat difficult to recruit and hire additional staff for cybersecurity analytics and operations.
Gartner recommends focusing the cybersecurity team on the most important tasks and automating the manual ones, such as log reviews. It tells CISOs to review their job listings to see if they are hiring for positions that can be outsourced.
Managed Security Services, SaaS and ITO route to managing security
All organizations need cybersecurity help, says ESG. When companies buy security tools, the product contracts include a professional services component that allow the companies to manage and ensure optimal usage of their security portfolio. CISOs can leverage the MSSPs and SaaS providers to outsource the relevant areas of their security portfolio.
According to Gartner, 40% of all managed security service (MSS) contracts in 2020 will be bundled with other security services and broader IT outsourcing (ITO) projects, up from 20% today. 
To deal with the complexity of designing, building and operating a mature security program in a short space of time, says Gartner, many large organizations are looking to security consulting and ITO providers that offer customizable delivery components that are sold with the MSS. 
As ITO providers and security consulting firms improve the maturity of the MSS they offer, customers will have a much broader range of bundling and service packaging options through which to consume MSS offerings. The large contract sizes associated with ITO and security outsourcing deals will drive significant growth for the MSS market through 2020.
IDC estimates that services will be the largest area of security-related spending over the next five years, led by three of the five largest technology categories: managed security services, integration services, and consulting services. 
Together, companies will spend nearly $31.2 billion, more than 38% of the worldwide total, on these three categories in 2017.
Increased confidence in cloud cybersecurity
Just about 5 years ago, concerns about adequate security were cited as one of the top reasons for not moving IT operations and assets to the cloud. This thinking has recently changed, accompanied by rapid cloud adoption by many large corporations. A recent survey by analyst firm ESG has found “improved security” reported as a benefit that has been realized by 42% of organizations that already leverage cloud-based data protection services.
Gartner explains the potential key benefit of cybersecurity in the cloud: Today’s data centers support workloads that typically run in several different places—physical machines, virtual machines, containers, and private and public cloud. Cloud workload protection platforms provide a single management console and a single way to express security policy, regardless of where the workload runs.
While there are known benefits of moving the security services to the cloud, Gartner warns that as the cloud environment reaches maturity, it’s becoming an increasing security target. As with most services, possibility of the cloud based security services being targeted and the rendering the service unstable and insecure. Organisations therefore should work on developing security guidelines as to how they use private and public cloud and prepare a cloud risks model.
AI and machine learning (ML) driven Cloud Security
ML algorithms have the ability and potential to help with employee productivity & security analytics, but the technology is in its infancy and not well understood, says ESG.  A survey of 412 cybersecurity professionals asked them to assess and characterize their knowledge of machine learning/artificial intelligence as it relates to cybersecurity analytics and operations technologies. Of the total survey population, only 30% of respondents claim to be very knowledgeable in this area. In other words, 70% of cybersecurity professionals really don’t understand where machine learning and AI fit their security portfolio.
Additionally, cybersecurity pros were asked about the status of deploying or are planning to deploy machine learning/AI technologies for cybersecurity analytics and operations in their respective organisations.
Only 12% say that their organization has done so extensively and 6% of respondents have no plans to deploy machine learning/AI technologies for cybersecurity analytics and operations. In the long run, most of the cybersecurity professionals did see the potential of AI and machine learning to help with automating manual tasks and ensure the management of skill shortage in the area.

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Its is important that organisations take the effort to gain knowledge about AI and ML and how it will impact Cybersecurity Services and Products. This way they will be able to be more proactive to understanding the adversarial capabilities of hackers. Many companies employ ethical hackers to find out the loop holes in their security portfolios and protocols.

Author
Team HCITExperts

Your partner in Digital Health Transformation using innovative and insightful ideas

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]


The wearables market is entering a new phase


In the first phase of the market development, it was about getting the product out, to generate awareness and interest and getting the customers accustomed to the idea. This opportunity remains to be explored by the traditional and fashion brands as the scale of consumer electronics market evolves. Now, the wearables market is entering a new phase, opines IDC’s Ramon T. Llamas.

Now it’s about getting the experience right – from the way the hardware looks and feels to how software collects, analyzes, and presents insightful data. What this means for users is that in the years ahead, they will be treated to second- and third-generation devices that will make the today’s devices seem quaint. Expect digital assistants, cellular connectivity, and connections to larger systems, both at home and at work. At the same time, expect to see a proliferation in the diversity of devices brought to market, and a decline in prices that will make these more affordable to a larger crowd.” [1] 


The phase 2 of the wearables development appears to be about taking the user data and provide analytics around the data to provide insights to the user, like step counts translate into a healthier heart. In this phase its about getting the customer to see the devices that actually augment the abilities to make lives easier, healthier and more productive, rather than another screen for the user. [3]

    Top Wearable Products [1]


    Watches: account for the majority of all wearable devices shipped during the forecast period. The report however shows that the basic watches (devices that do not run third party applications, including hybrid watches, fitness/GPS watches, and most kid watches) will continue out-ship smart watches (devices capable of running third party applications, like Apple Watch, Samsung Gear, and all Android Wear devices), as numerous traditional watch makers shift more resources to building hybrid watches, creating a greater TAM each year. The report suggests that the Smart watches, however, will see a boost in volumes in 2019 as cellular connectivity on the watches becomes more prevalent on the market.

    Wrist Bands: The report indicates a slow down in the market for the wristbands from 2016 onwards, but the market will be propped up with low-cost devices with good enough features for the mass market. However, the trend seems to focus on the users transitioning to watches for additional utility and multi-purpose use.

    Earwear: (this excludes the bluetooth headsets) are not counting. Instead, the report focusses on those devices that bring additional functionality, and sends information back and forth to a smartphone application. Examples include Bragi’s Dash and Samsung Gear Icon X. The report, also suggests the increase in the uptake of smarter earwear that centers on collecting fitness data about the user, real-time audio filtering or language translation.

    Clothing:  The smart clothing market took a strong step forward driven by the chines vendors providing connected apparel. The growth in this segment is seen to be driven by the adoption of the connected clothing by the professional athletes and organizations have warmed to their usage to improve player performance. For instance, the upcoming release of Google and Levi’s Project Jacquared-enabled jacket.

    Others: include lesser known products like clip-on devices, non-AR/VR eyewear, and others into this category. It will include vendors catering to niche audiences with creative new devices and uses.

    Top Wearable Devices by Product, Volume, Market Share, and CAGR [1]
    Product Shipment Volume 2017 Market Share 2017 Shipment Volume 2021* Market Share 2021* CAGR (2017-2021)*
    Watches 71.4 56.9% 161.0 67.0% 26.5%
    Wristbands 47.6 37.9% 52.2 21.7% 1.2%
    Clothing 3.3 2.6% 21.6 9.0% 76.1%
    Earwear 1.6 1.3% 4.0 1.7% 39.7%
    Others 1.6 1.3% 1.4 0.6% -16.0%
    Total 125.5 100.0% 240.1 100.0% 18.2%
    Source: IDC Worldwide Quarterly Wearables Device Tracker, June 21, 2017

    Global wearables market to grow 17% in 2017, 310M devices sold, $30.5BN revenue: Gartner | TechCrunch http://ow.ly/YFVu30eWQHL

    Like any technology market, the wearables market is changing [2]
    “Like any technology market, the wearables market is changing,” noted Ramon Llamas, research manager for IDC’s Wearables team. “Basic wearables started out as single-purpose devices tracking footsteps and are morphing into multi-purpose wearable devices, fusing together multiple health and fitness capabilities and smartphone notifications. It’s enough to blur the lines against most smart wearables, to the point where first generation smartwatches are no better than most fitness trackers, he says.

    Beyond the top 5 vendors of the wearables market, new entrants like fashion icons Fossil along with their sub-brands and emerging companies like BBK and Li-Ning, are tapping into niche segments of the wearables market. Fossil, is coming up with a luxury/fashion device, BBK focuses on child-monitoring devices and Li-Ning on step-counting shoes.

    “With the entrance of multiple new vendors with strengths in different industries, the wearables market is expected to maintain a positive outlook, though much of this growth is coming from vendor push rather than consumer demand,” said Jitesh Ubrani senior research analyst for IDC Mobile Device Trackers. “As the technology disappears into the background, hybrid watches and other fashion accessories with fitness tracking are starting to gain traction. This presents an opportunity to sell multiple wearables to a single consumer under the guise of ‘fashion.’ But more importantly, it helps build an ecosystem and helps vendors provide consumers with actionable insights thanks to the large amounts of data collected behind the scenes.”

    Top Five Wearable Device Vendors, Shipments, Market Share and Year-Over-Year Growth, 4Q 2016 (Units in Millions) [2]
    Vendor 4Q16 Unit Shipments 4Q16 Market Share 4Q15 Unit Shipments 4Q15 Market Share Year-Over-Year Growth
    1. Fitbit* 6.5 19.2% 8.4 29.0% -22.7%
    2. Xiaomi 5.2 15.2% 2.6 9.1% 96.2%
    3. Apple 4.6 13.6% 4.1 14.1% 13.0%
    4. Garmin 2.1 6.2% 2.2 7.6% -4.0%
    5. Samsung 1.9 5.6% 1.4 4.7% 37.9%
    Others 13.6 40.1% 10.3 35.5% 32.1%
    Total 33.9 100.0% 29.0 100.0% 16.9%
    Source: IDC Worldwide Quarterly Wearable Device Tracker, March 2, 2017

    Implications of Wearables in Healthcare


    Llamas, IDC. “Health and fitness remains a major focus, but once these devices become connected to a cellular network, expect unique applications and communications capabilities to become available. This will also solve another key issue: freeing the device from the smartphone, creating a standalone experience.”

    Its important to note here the scalability of wearables in a clinical setting requires Intention, Education and collaboration[7]. Some of the usecases highlighted for wearables in healthcare: 

    1. Managing Chronic Conditions of patients who might develop a secondary or tertiary complication because of a pre-existing condition (diabetic undergoing hip replacement surgery)
    2. Tracking vital signs
    3. Manage patients recovery at home (defensive medicine) instead of the recovery in a general ward, with help of remote monitoring
    4. Detecting Alzheimer’s, most common form of dementia
    5. Monitoring patients with chronic diseases and after hospitalization or the start of new medications for a decline in daily activity may help detect medical complications before rehospitalization becomes necessary
    6. Clinical Trials: Monitoring of recruits
    7. Smart Stethoscope for patients with cardiovascular disease
    8. Ear device to track body temperature fluctuations
    9. Temporary tattoo that senses vital signs
    10. Smart Glasses with AR enabled patient records and physician information system


    Finally, here is an interesting Infographic on Wearable Technology. 

    References

    1. Worldwide Wearables Market to Nearly Double by 2021, According to IDC: http://www.idc.com/getdoc.jsp?containerId=prUS42818517
    2. Wearables Aren’t Dead, They’re Just Shifting Focus as the Market Grows 16.9% in the Fourth Quarter, According to IDC 

    3. Xiaomi and Apple Tie for the Top Position as the Wearables Market Swells 17.9% During the First Quarter, According to IDC: 

    4. EXCLUSIVE: Fitbit Working On Atrial Fibrillation Detection | Time.com http://time.com/4907284/fitbit-detect-atrial-fibrillation/
    5. The 8 Best Fitness Trackers You Can Buy Right Now: http://time.com/4553111/best-fitness-trackers-fitbit-jawbone-2016/
    6. Can Your Fitness Tracker (Fitbit®) Save Your Life in the ER?: http://www.prnewswire.com/news-releases/can-your-fitness-tracker-fitbit-save-your-life-in-the-er-300246408.html
    7. Advocating for clinical wearables, the new normal in healthcare http://medcitynews.com/2017/08/advocating-clinical-wearables-new-normal-healthcare/?rf=1
    8. Global wearables market to grow 17% in 2017, 310M devices sold, $30.5BN revenue: Gartner: https://techcrunch.com/2017/08/24/global-wearables-market-to-grow-17-in-2017-310m-devices-sold-30-5bn-revenue-gartner/?ncid=rss
    9. What smartwatches and other wearables can’t track today— but might in the future – https://www.cnbc.com/2017/11/05/wearables-future-track-glucose-blood-pressure-mental-health.html

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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).


    The report indicated that by introducing more connectivity, remote monitoring, and information gathering IoHT can encourage more informed decisions, better use of resources and empowering healthcare users.

    According to estimates, the value of IoHT will top US$163 billion by 2020, with a Compound Annual Growth Rate (CAGR) of 38.1 percent between 2015 and 2020.[1] Within the next five years the healthcare sector is projected to be #1 in the top 10 industries for Internet of Things app development.[2]

    What is Internet of Health Things?

    Internet of Health Things (IoHT) is the integration of the physical and digital worlds through objects with network connectivity in the healthcare industry. IoHT transforms raw data in simple, actionable information and communicates with other objects, machines or people. IoHT can be leveraged to improve access to health, quality of care, consumer experience and operational efficiency 

    Source: Accenture Report
    Source: Accenture Report








    The report lists four major takeaways for the payors and providers

    The Time is Now

    Despite challenges with security and privacy, inaction is not an option. There are players outside of traditional healthcare organizations looking at these same industry challenges and considering ways to capture the opportunity. If providers and payers do not invest in demonstrating IoHT value now, they risk losing out to non-traditional players. Going forward, providers and payers must identify parts of the business where IoHT solutions may be applied to do things differently—and do different things to grow in the long-term.

    Measure and Build on Successes

    Providers and payers have already demonstrated value through IoHT—but they need to continue investments to better understand where programs are successful to prepare for future scaling. They need to measure effectiveness beyond the technology and then build on those areas of effectiveness quickly to offer value across the business. By demonstrating the benefits and best practices, providers and payers can strengthen business cases, encourage adoption and drive interoperability.

    Put consumers First

    Providers and payers must continue to incorporate IoHT solutions that drive better experiences and healthier patient outcomes, along with key medical and administrative cost savings initiatives. IoHT solutions offer the seamless collection of patient-generated health data, enabling providers and payers to provide more convenient, personalized and effective care. They must train their workforces to make IoHT a part of the “new normal.”

    Form Nimble Partnerships

    Technology and innovation partners can help payers and providers quickly test and learn how IoHT can drive business value to inform future scaling requirements. Strategy and change management partners can help to integrate these new technologies into their workflow, culture and training. 

    Key Findings of the Survey

    • 73% consider IoHT to be a major change, and consider IoHT to be a major disruptor in three years. 
    • however, 49% say the leadership at these organisations are yet to understand the potential of IoHT. 
    • As IT investments are going up so are the IoHT investments seeing to become a major budget line item.
    • Healthcare providers and payors are investing in IoHT in three areas of their businesses – RPM, wellness and operations. And these organisations are reporting real benefits from the initial programs.
    • While 57 percent of healthcare organizations surveyed say that their IT departments lead the IoHT charge, 26 percent say their research and development (R&D) divisions are leading their IoHT efforts and one in ten organizations even have dedicated IoHT subsidiaries or business units.
    • RPM Based IoHT: 33% of PROVIDERS report extensive operational cost savings from their RPM IoHT programs. 42% of PAYERS report extensive medical cost savings from their RPM IoHT programs. 
    • The majority of both providers’ (76%) and payers’(75%) RPM IoHT investments are focused on cardiac conditions. Interestingly, in the past, behavioral health has not received investment at similar levels to traditional high-cost areas such as cardiac, but the spotlight appears to now be shining on this area. Mental health, including behavioral health, is a relatively high priority for both providers (48 percent) and payers (55 percent)
    Source: Accenture Report, [2]


    References

    [1] “The Internet Of Medical Things–What Healthcare Marketers Need to Know Now,” January 2016, Victoria Petrock: Contributors: Annalise Clayton, Maria Minsker, Jennifer Pearson, eMarketer.

    [2] Accenture 2017 Internet of Health Things Survey 
    https://www.accenture.com/us-en/insight-accenture-2017-internet-health-things-survey


    And there you go, its fairly simple and we look forward to you sharing your experiences with our community of readers. We appreciate you considering sharing your knowledge via The HCITExpert Blog

    Team @HCITExperts
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    Your partner in Digital Health Transformation using innovative and insightful ideas

    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

    //platform.twitter.com/widgets.jsWhenever 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. 


    The Connected Care #PhilipsChat questions follow and I Look forward to You sharing your thoughts and point of view on the role of Connected Care in Healthcare: 

    1. How would you explain connected care in one line? 
    2. Is the healthcare industry ready to embrace connected care?
    3. How are your organization using connected care? Since when?
    4. Based on your experience, what are the elements to enable connected care further?
    5. How are you involving policy makers to embrace connected care?

    If we take these questions with an india context, how connected care can enable the affordability and accessibility to healthcare in India. These are the most often mentioned aspects of Healthcare, that needs to be addressed by not only the government, but also the Startup community willing to disrupt the Health Tech / Digital Health industry. 

    I have attempted to share my thoughts on Connected Care questions put forward during the tweetchat and I hope you will consider sharing your insights by filling in the form below

    1. How would you explain connected care in one tweet?

    An always connected channel of communication of care between the patient and provider, from “touch time” to “face time”  

    2. Is the healthcare industry ready to embrace connected care?

    In India, with the major push for digital services by the govt and private healthcare facilities, and with 350+MN internet users connected care is the only way to solve the accessibility to healthcare problem (1:3200 doctor to patient ratio)

    4. Based on your experience, what are the elements to enable connected care further?

    The connected care needs to bring about change in thought of how to use a connected care framework for the patient as well as the doctor. 

    For the patient, connected care is about 
    – experience that enables an ease of access to care
    – Ability to build their own healthcare record’s completeness 
    – Have a better set of processes and #workflows to manage their health and care 
    – Have the ability to find “patients like me” and be part of the community 

    For the Doctor, I believe it will be about 
    – how to glean new insights from the data stream
    – How to collaborate with a patient via an always connected model? What signifies the end of a consultation? 
    – To build constantly evolving care plans for their patients, based on realtime, near-realtime, time-delay, or frequency per day/week month updates
    – To evolve more treatment plans based on the insights that can be drawn from the raw patient data feed (an e.g.)
    – How to build a community and be part of a community of specialists to keep themselves up-to-date on the current research and practices.


    I am including the Questions as a Google Form, do consider sharing your insights into what is Connected Care? And how do you see it being enabled for the benefit of the patients and clinicians.

    Author

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    Connect with me via any of my Social Media Channels

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