Friday 12 September 2014

Women Achievers in Information technology 2014

I feel proud when my name is included with the leading ladies in India today- Facebook, Walmart, Amazon and others. I however feel equally concerned about the future of IT in India. While I represented as the only lady to represent the healthcare industry, it is indeed a truth and a realization that we need much more of IT across industries.

At INTEROP, I had the privilege to meet with Prof F. C Kohli"Those were the days when we were provided with Russian computers. These computers used to heat up after every 4-5 hours and then we had to shut them down and let them cool off before we can use them again", said Mr F. C Kohli recalling his initail days toying with these machines called Personal computers then.

Those who have never heard his name- Well! Prof. F. C . Kohli is frequently referred to as the Father of the Indian Software Industry due to his significant contribution in Indian IT industry. Padma Bhushan, Faqir Chand Kohli completed 90, on March 19, 2014. It was a day to celebrate for many Indians whose life he has touched directly or indirectly. A workaholic, who scoffs at the concept of retirement and fading into the sunset and is deeply engaged in using technology and systems approach to solving societal problems at 90!

Mr Kohli continues to be proactive, focusing his energies on education. His current efforts are around using computer aided sounds and images to impart basic literacy, particularly to illiterate adults, in a matter of months.

I clicked a Selfie and Yes, I was lucky! It was "Teacher's Day" and I got this opportunity to be blessed by him as a "Woman Achiever in IT". Information Technology isn't that old in the country. I still remember my First Personal computer- Bulky with Cassette and Floppy drives!

The 1980s liberalization of the Indian informatics industry took place in the context of continued high levels of state involvement, but there was evidence that the character of that involvement was changing.In 1991 the Department of Electronics broke this impasse, creating a corporation called Software Technology Parks of India (STPI) that, being owned by the government, could provide VSAT communications without breaching its monopoly. STPI set up software technology parks in different cities, each of which provided satellite links to be used by firms; the local link was a wireless radio link. In 1993 the government began to allow individual companies their own dedicated links, which allowed work done in India to be transmitted abroad directly. Indian firms soon convinced their American customers that a satellite link was as reliable as a team of programmers working in the clients’ office. Today, advancements in IT has been of benefit in creating more jobs in India but the real revolution is yet to begin.

Those were the days. Quotes from Mr F.C Kohli:

"When we started, the Indian software industry was primarily focused on exports and 40 years later, it still continues to be so. The domestic market accounts for only 15% of the software industry's $100 billion annual turnover. The country has too few computers. This is because there are no computers in Indian languages. China has computers in mandarin, but India, for historical reasons, has stuck with English. The computer is but a tool and Indians should be able to use this tool in their own language. You express your ideas best that way. Innovative thinking comes in your own language. After all these years of speaking in English, I still dream in my own language.

Most people in India seem to have been carried away by the spectacular success in IT services ($ 70 billion exports in 2012-13 according to RBI). A decade ago, some politicians even started calling India, quite prematurely, an 'IT Superpower', in their own inimitable style. However the man who started it all is far removed from such pompous statements. He has been painstakingly advocating that India cannot be a significant player on the global technology map without a developed hardware industry.

He said, "Right now, India does not have a hardware industry. But we will have to develop one, once the computer reaches the masses. Using technology, I can go and make the small shopkeeper more efficient that a supermarket mall. A computer can handle a shop's supply chain management, from purchases to inventory control. It can bring down costs and collect customer data. In the USA, local shops don't necessarily close if WalMart comes to town. We need both."

Highlights!!
Ignoring your own produce- There is a huge talent that we produce in India. Number of graduates- three million a year, about 450,000 are engineers; 600,000 and more are commerce graduates and 1.1 million from humanities. We have 95 agricultural colleges and 15 agricultural engineering colleges, where do they go? They are not in villages; they are not in agriculture, it means we are not interested in what we have produced.
Practically Illogical Industry- ‘What computer has done for the country? Almost all the software is exported, we have about $50-60 billion out of exports and $10 billion revenues from the indigenous market, out of that again half the software is from Microsoft, Oracle and others, which we import and sell. So if we really see, hardly any software (made and sold) within the country.
If we are depending on IT, Do we have computer literacy? Everybody is making profit by exporting software and who wants to dirty their hands and focus on India? It is not easy to develop software for India, we have 22 languages, China has 2, Saudi Arabia has only one i.e. Arabic, and so software finally has to be made in local languages like European do. Our states are bigger than the many European countries, so you can’t even say that everybody should learn one language, we also wants to keep the diversity because it is an asset.
Skewed Numbers- The limit is your imagination.- If 900 million people of India becomes computer literate, than you need many more PCs than now, every year now, 6 million PCs are sold in India, which are imported or locally assembled. Then we need 25 million PCs a year, for that kind of number, we need indigenous hardware industries. We also need micro-electronics engineers for hardware industries, India is producing less 200 engineers and small country like Israel produces more than 1000 a year, when we will we be to produce 3000 to 5000 micro-electronic engineers?? Intel is having its design centre in Bangalore they are designing their 6 core chips here and not in the US.
The Indian IT industry is still young and the growth process is not going to stop anytime soon. It will certainly become more sophisticated. There will be new players, niche players, specializing in different applications. We are still doing a lot of lowend work for the global market, though we are also into some high-level development. The domestic market will also throw up low-end work. If you can't find growth avenues despite all this, it is a managerial problem.
Source:
Interop Mumbai, debate and Keynote
IBNLIve-http://ibnlive.in.com/news/tribute-fc-kohli-father-of-indian-software-industry-turns-90/458870-11.html
ET- Interview with Dr Kohli
http://goodbadnews.wordpress.com/2009/12/12/an-excerpt-from-an-interview-of-mr-f-c-kohli-the-founder-of-tata-consultancy-services-tcs/
 

Wednesday 11 June 2014

No Big data in Healthcare?

The big data revolution is here, on an aggressive growth path, and the patient might truly be the biggest beneficiary of next wave. But hey! Where is that data?

1. More than 65% of data across the globe stay non-digitized.
2. 68% of digitized data isn't integrated with channels or inter-operable systems.
3. 99% problem in delivering effective healthcare is in bad data, old data and No data.

The health care system is filled with dreamers, from compassionate nurses and doctors to technology experts, researchers in the lab to people like us- mHealth experts. After careful evaluation of facts, we have arrived at this hypothesis:

The need to fully engage patients as a member of the care team is fundamentally about encouraging individuals to become more involved with their healthcare, so they will be motivated to make behavioural changes that can positively impact their health status. Today we do it in 3 ways:

1. Public health programs- where we don't spend much on pervasive technologies but paper, photocopies, fuel, per diem (per day) of health workers and volunteers.

2. Disease management/Wellness programs- where a patient buys self-help health check-ups like "a dress from fashionandyou.com" based on prize and tests that he has heard off or just go for a master health check-up .

Or a Hospital that puts a Diabetes patient on to a DM program which means 3 visits/month on to a clinic for repeat diagnostic tests, doctor consultation, Diet plan and exercise regimen. 90% patients show non-compliance here and the churn is more than 70%. All the data of-course will stay with the hospital and they will never share it with other Doctor or hospital.

3. By downloading an app, signing on to a health portal or designing a regular and timely healthcare plan and stick to it. (Surprisingly 23% people do manage their health like this). The problem is that it is very hard to track, monitor or quantify success or deterioration in the absence of proper matrices and without a Doctor's help at the other end.



If my healthcare data doesn't reside in a cloud, what will BIG Data analytics do for me?

I am unlike Retail, Banking, Advertising or any other vertical where there is loads of digital data. In Healthcare, there is very little data.

Any phase in the evolution of patient care cannot take place without sharing secure data with a wider group of constituents in the healthcare continuum. The need of the hour hence is:

1. Data Collection: There is a need to up the public health game by efficient data collection. Episurveyor--->;Magpi (DataDyne), Commcare, Formville, Cellife are some examples of such applications that exist today. Using a cell-phone to complete questions allows for information to be analysed in real time, built in skip logic, and the capturing of other media not possible on a paper form.

2. Provider + Government + Health Insurance Push- Obviously you can’t do much about 60% population of India where either there is no computer or no literacy. The need of the hour is to build healthcare models on ubiquitous technologies be it mobile phones, radio, community broadband centres, Zila panchayats, Schools, UID Kendra or areas where there can be a patient dashboard available. In the USA, with strong meaningful use process, organizations are required to offer patients online access to their electronic medical information.

To meet the MU2 requirements in the US, a provider must notify at least 50% of its patients of online access to medical records. In addition, the provider must have more than 5% of its patients view, download or transmit their health information as well as another 5% of patients send a secure electronic message to the provider organization. They do this via an online Patient Portal. Not only is the Patient Portal functionality a requirement for meeting MU2, but it extends a tremendous number of additional opportunities for the patient and provider.

With support of the provider, patients can use a computer or mobile device to schedule their own appointments, pre-register, select payment plans, share lab results, and of course, view their medical information. Each of these functions helps the patient become more involved in their care while eliminating costs associated with scheduling, sharing results and records, eligibility verification, collections and prescription renewal functions.


3. Attaching Data to Channels and Analytics- As per CHMI data every year we run more than 100+ technology driven healthcare programs in India (50+ of them are mHealth programs). Most of them show success and impact but fail to scale as funding or Government support run out. The data as well as the effort goes waste.

There is a need to connect redundant systems with appropriate channels, knowledge blocks and derive influence out of these. While the availability of Mobile apps, patient portals and digitisation of health records does not necessarily translate into active provider or patient use, the technology is emerging as the key platform for various efforts around patient engagement such as access to medical records, communication with providers, education, wellness tracking and e-visits.

We need a system that will incorporate registration of births, deaths and cause of death. Maternal and infant death reviews, nutrition surveillance, particularly among under-six children and women, service delivery in the public and private health system, hospital information services besides improving access of public to their own health information and medical records.

Big Data analytics can clearly provide---;Great Insights (i.e. trends, impact, markers and analysis)------; A clear Business objective-----------;Change management------;Good project management----;Desired quality and results? (this one is debatable!)

The Big Data Success story (Prospective):
In the United States, the independent Blue Cross and Blue Shield were planning to provide healthcare financing for almost one in three citizens. But accurate research data is critical to providing effective treatment, improving outcomes and helping reduce spiralling costs.

Challenge
Blue Cross and Blue Shield faced the challenge of creating the world's largest healthcare informatics data warehouse to enhance benchmarking capabilities and enable advanced predictive analytics.

Blue Health Intelligence
A renowned IT company designed, developed and implemented a system, dubbed Blue Health Intelligence that would integrate data from up to 40 member companies. They built an overall architectural design incorporating "continuous certification," providing the most comprehensive source of accurate healthcare research data to be found anywhere.This company is CSC.

Warehouse Is Key
The data warehouse is key to the Blue Health Intelligence's overall 10-year strategic plan. No other consortia-based analysis tool exists at this scale: The warehouse is capable of processing medical and other types of claims for 90 to 100 million people, while providing the client with huge competitive advantage. Recognized by both BHI and industry as a one-of-a-kind solution, the BHI data warehouse will lead to greater healthcare transparency by delivering unmatched detail about trends and best practices.

This certainly sounds good! Big data analytics help have a direct dialogue with consumers, provide tailored healthcare, perform surveillance and risk analysis, reduce maintenance costs, offer population wise and enterprise- wise insights and customize offerings in real-time.

IBM is teaming up with the New York Genome Center to develop Watson so that it can help tailor treatments to specific terminal cancer cases, using what IBM calls "cognitive computing."

Comments welcome.


Credits:
Health Information Security and Privacy Collaboration (HISPC). http://healthit.hhs.gov/
Meaningful use american recovery and reinvestment act, hrsa.gov
Privacy and security guide, Healthit.gov, The Office of the National coordinator for Health Information technology
CSC corporation, Blue shield, Blue Cross, Predixion software, Logicworks.net
DataDyne presentation by Joel Selanikio; Dan Stoke, Vice President of Client Sales and Service, Intellect Resources
A Health Care Provider’s Guide to the HIPAA Privacy Rule: Communicating with a Patient’s Family, Friends, or Others involved in the Patient’s Care.
Andrew Gill, UK retailer Waitrose takes a different approach to in-store loyalty cards & big data

Saturday 1 March 2014

Healthcare On Mobiles: Featured post- mHealth fighting malnutrition


Malnutrition is a byword in the forested hills of the Melghat region inhabited mostly by Korku Adivasis. Every year 400-500 children between the ages of 0 and 6 die in the region, comprising Chikhaldhara and Dharni taluks, according to official figures from 2005.


The Problem: Thousands of kids die every year in the tribal area of Melghat (Maharashtra, India) due to lack of medical attention and nutritional support. Increased incidence and rapid spread of infectious diseases such as pneumonia, typhoid, and dysentery are primary cause of high child mortality. Situation worsens during monsoon when the food supplies are low and the communicable diseases are at their peak.

Melghat is also a place known for high infant mortality rate. Some reasons for the health crisis in Melghat include lack of infrastructure, under-equipped and under-staffed public health and ICDS centres, the tradition of early marriages and early motherhood, lack of sanitation and clean drinking water facilities and the tribals' blind faith in bhumkas (quacks).

Failed Operations of the past: When the Maharashtra government first recorded the figures of child deaths due to endemic malnutrition in the remote villages of Melghat, shocking numbers were revealed.Almost two decades later, even though the government figures show a substantial drop in the number of malnutrition deaths, social activists and health-coordinators working in the impoverished area say that the authorities pass off such deaths as still-births.

The reality continues to bite with the data recorded just before monsoon this year, indicating 509 malnutrition induced deaths during past year, until March 2011. Every year, hundreds of children of Korku tribe in the tehsils of Melghat in the Satpura ranges fall prey to starvation and malnutrition. While the government records indicate figures ranging from 400-525 in the last five years, health activists working among the tribals tell a different story.

Thursday 19 December 2013

Top 10 Tech Leaders- Perspectives by Information week

Mobility poised to play a significant role in healthcare’: Dr. Ruchi Dass, Founder & CEO, HealthCursor Consulting Group

An mHealth Evangelist, and Founder & CEO, HealthCursor Consulting Group Dr. Ruchi Dass, has been involved in specific healthcare IT, e-learning and ICT projects for the public/private sector in India.

In an exclusive interview with InformationWeek, she discusses how mobile phones have transformed the entire healthcare landscape and shares how mobile technology is propelling innovation in healthcare.


According to you, how is mobile phone penetration transforming healthcare landscape in India?  
While the Government is building more and more hospitals, the gap between the patient-doctor ratio is huge. For the next 20 years, the infrastructure will not be able to match the growing population of India. Hence, the next step is to create a model where one hospital supplies its service to 10 -15 nearby villages through the use of technology. Technology facilitates remote patient monitoring, enables safe data collection and dissemination, while reducing service costs.  To give a data point, every citizen in rural area has to travel a distance of 20 kilometers to avail healthcare facility. The need is to decrease the travel time, decrease the cost and make it more affordable and convenient. For this, the government started disseminating information and awareness through mobile phones. It also started educating rural citizens about the various free campaigns being conducted in their district.  Also, today the mobile phones worth only Rs 5,000-6,000 have smartphone capabilities. One can run apps that tell us if a person has got flu or not. This has empowered the rural population too. 

Saturday 14 September 2013

10 Influential Women in Health IT -By Dan Bowman

From government officials to hospitals administrators to patient advocates, women are making an impact in health IT by leading innovation and change in all facets of healthcare. We asked our readers to nominate the most influential women in health IT for our second annual list.

And boy, did they respond--it was tough to keep the list to 10. We received nominations for women who are changing the face of personal health data and patient engagement, advancing nurse informatics, promoting mHealth and tele-medicine, using technology to improve global healthcare, developing healthcare apps and more. 



Read more: 10 (More) Influential Women in Health IT - FierceHealthIT http://www.fiercehealthit.com/slideshows/10-influential-women-health-it#ixzz2es3FJS1D
Subscribe at FierceHealthIT

Sunday 18 August 2013

mHealth India- Insurance and technology

Inspite of low penetration of Health Insurance in India, inclination towards Prevention and wellness products and services is on the rise. Penetration of private healthcare insurance policies is less than 0.5% in India (Health insurance penetration in India is as low as 5%). If you live in the U.S, you would have come across this tagline many a times "Health Insurance companies investing in Wellness products to reduce claims and cut consumer costs". In India, it is Flipped!!!

As there is not enough health cover, more than 70% expenditure on health is out of pocket. Hence the consumer is now becoming more aware of his/her wellness and is taking initiative to invest in prevention and health checks himself. No wonder, there are a million wellness companies that have mushroomed up in the last 3 years and most of them are making money on a B2C/Retail approach for obvious reasons. We are starting to look at some Technology driven wellness companies including mhealth based ones and I thought it would be worthwhile to know more about the stakeholders, current trends and market dynamics in detail.


There are several reasons because of which the healthcare insurance penetration in India continues to be low over years in India. It is a shocking fact that some of the most poverty stricken countries have better insurance coverage than India. In some of the African countries, Insurance has joined hands with telecom companies to provide coverage, access and telephony as well. While most of the insurance companies wish to expand their access through every distribution channel, it is imperative that we learn from some of the new age models to dispense health insurance in India too.

Existing examples:

Simplee- A Palo Alto, Calif., startup unveiled Simplee, a free mobile app that enables you to carry your medical bills, outstanding claims and health insurance data on your Apple device when you visit the doctor, as well as pay your bill from your smartphone.

HealthCoach- Companies such as Healthrageous, Keas and ShapeUp are busy selling the idea of mobile health coaching to U.S. companies desperate to cut both their health insurance costs and losses due to absenteeism.

Bluebutton-The feds offer their own version of a mobile "medical wallet" called Blue Button, which enables Medicare recipients and U.S. veterans to access, download and store up to three years' worth of personal health records onto their computer, tablet, smartphone and other mobile devices.


An ideal mHealth framework may require the use of mobile technology for:
1. Awareness building
2. Policy comparisons
3. Market research
4. Marketing
5. Risk Modelling
6. Sales/Purchases
7. Policy administration
8. Billing
9. Claims settlement
10. Customer service

Inspiring trends:

Distribution and Marketing- Mobile network operators in Africa have identified the growing demand for financial services and micro insurance . Airtel Africa has partnered with MicroEnsure for Mobile Micro Insurance. The range of Airtel-branded insurance products includes life, accident, health, agriculture, and other forms of cover. 

Connecting intermediaries, customers and surveyors- ICICI Lombard India's mobile initiative started simply enough, with a set of basic applications that gave customers a consolidated view of all their policies, a reminder service to renew a policy, and a way to track the status of a claim. But as they matured with the mobile platform, they re-visited the paradigm and devised new ways to provide customers with more value-added and user-friendly features. This is however restricted to Auto insurance only.

 Encryption, Transactions and handling customer grievance- Public sector general insurance company United India Insurance launched a mobile-based real-time fund transfer facility for payment of premium. M-Power enables customers to renew their policies and also remit the premium for approved proposals. To use this facility, one has to get an MMID (an identification number called - mobile money identifier) from his/her bank and enable one’s mobile with the application given by the bank. However, there are only 10 banks on board with this platform. This initiative follows the launch of its Internet-based sales, customer grievance portal and information-cum-sales kiosks.

Sales, awareness and providing access- Bima, a young Swedish microinsurance company, is using mobile phones to sell as many as three billion new insurance policies to the global poor. Bima, that has begun to access this untapped market, is now one of the largest mobile insurance platforms in the world. In just three years, Bima has acquired 4 million clients in Africa and Asia and is adding 400,000 new subscribers per month. Bima has been tackling many of the obstacles—education, pricing, premium collection—that prevent poor people from obtaining such benefits. For instance, Bima products such as life, accident and health insurance cost "as little as $0.20 to $6.00 a month. Last month, Leapfrog invested $4.25 million in Bima, which will allow the company to expand even further within Africa and Asia as well as reach into new markets in Latin America.


                                                                                                                                 
                                                                                                                                To be contd..

Interesting read:
CareFirst BlueCross BlueShield taps Cognizant to support its mobile technology initiatives.
RelianceLife eyes expansion in health insurance space


Sunday 21 April 2013

Health startups that interests @HealthCursor @medmocha



Zipdial | India ZipDial is a unique company from Bangalore, India, that monetizes from missed calls. Its business model has caught the attention of Singapore-based Jungle Ventures who invested in the startup this week. Plus, ZipDial unveiled some expansion plans.

Wish.vn | Vietnam Wish.vn is a healthcare social network community in Vietnam. It is basically a combination of electronic health records, a social network to allow patients to rate health care, healthcare information, promotions connecting with partners, and tools to help you keep up your health.

Operation Smile | India Operationsmile.org.in is a healthcare social impact organisation. Cleft Care Centres provides year-round free reconstructive surgeries to children who suffer from cleft lips, cleft palates and other facial deformities.

Podimetrics is developing a high-tech shoe insole for diabetics

Simplee helps people manage their out-of-pocket healthcare costs which, on average, run about $3,600 a year for a family of four. The platform shows you how much money you’ve spent on healthcare, the status of your insurance deductible, your health savings account balance and transactions, and where there may be errors in your bill—an important feature considering some sources say about 80% of bills contain them.

GAIN is an iPhone and Web app that lets you quickly create custom, pro-quality workouts to do at home or the gym. The app instructs you on how to perform each exercise and how many sets and reps to do for each, depending on your goals and fitness level. The app also quantifies your performance using an in-built tracking and analytics system.

alt12 apps‘s pink pad is a health and lifestyle tracker with an  integrated online community to connect women.
Gilbert Guide is a comprehensive senior housing guide and homecare directory for aging parent
Evoz allows for remote baby monitoring
Docphin allows health care providers to access, organize, and share medical news research
UnitedPreference has developed Tailored Spend, a virtual currency used to purchase only items conducive to a healthy lifestyle
Medmonk is the easiest way for pharmacies to get their patients discounts of 90% or more on prescription medications

Medmocha is a new concept to link health innovators with small angel investors. www.medmocha.com

Friday 18 January 2013

Innovations in healthcare-A report published by HealthCursor Consulting Group













Mr. Pranab Mukherjee, The Honorable President of India unveiled a 50 page report at the ASSOCHAM's 10th Knowledge Millennium Summit on Jan 16th 2013. The report was titled "Innovations in Healthcare" and was authored by Dr. Ruchi Dass, Founder and CEO, HealthCursor Consulting Group. HealthCursor was the exclusive knowledge partner to ASSOCHAM for the event. The analysis and the findings in the report were well appreciated by the Industry leaders during the event.






A considerable amount of time was spent in  amalgamating the vast amounts of knowledge banks from the different actors in the healthcare ecosystem to present an innovation led heath care vision 2020 for India. The report envisages the theme of "Curing the Incurables-sharing of Innovations" for the 10th Millennium summit of ASSOCHAM. The Event drew attendance of the Who's who in the industry with Noble Laureates like Prof. Aaron Ciechanover, Recipient of Nobel Prize in Chemistry, for his revolutionary work on characterizing the method that cells use to degrade and recycle proteins using ubiquitin; President of India Honourable Shri Pranav Mukherjee ; Mr. RajKumar Dhoot, President ASSOCHAM, Dr. Rana Kapoor, Founder, Managing Director and CEO, Yes Bank Ltd. and Padma Bhushan Dr. B. K. Rao, Chairman, Knowledge Millennium Committee, Ex –Chairman, Sir Ganga Ram Hospital, Dr. H. K. Chopra, Chief Cardiologist, Mool Chand Medcity as keynote speakers.



The report is a practical document. The concepts, case studies and knowledge summaries mentioned in the report focus on action and their immediate purpose is to help policy-makers and program managers turn promises into implementations by 2020. There are many things we should and can change to get better value from the significant resources we dedicate to health care. If we could cite just one change that would make health care more sustainable, it would be transforming the front door to the health-care system. With this report we aim to highlight successful examples for a health-care system that thrives on efficiency, productivity and best practices. The clarion recommendations from the report intend to suggest an infrastructure and policy framework which will bring about a transformation into the Indian healthcare system.

With this report, Healthcursor's vision is to bring this transformation in the healthcare enterprise of the future defines an approach which will support alignment and integration of key sectors affecting healthcare performance, innovative strategies ensuring all members of healthcare ecosystem work in synchronicity. A health innovation framework for action which can guide the design and implementation of policies to bring about this definitive change and boost national capacity for innovation is also being proposed. 

The current economic crisis provides an opportunity to reshape current healthcare system but the recent economic turmoil coupled with the high cost of economic recovery will likely limit the availability of health-care rupees. Hence, innovation that reduces the spiraling health-care costs, raises productivity and improves health outcomes is the best option for delivering a sustainable and scalable healthcare system.

We at HealthCursor strongly recommend innovation which is all encompassing, at every corner of the system and every level of the organization. These innovations should be held to an evidence standard but without holding them hostage to resistant establishments. In this report, it is not our purpose to grade  Indian healthcare system on its performance as many studies have already addressed this quantitatively and qualitatively.

There are huge challenges in bringing together bodies of technical knowledge in just a few pages for such a diverse audience. As such, these recommendations represent a first modest attempt to rise to the challenge. And much has been learnt in the preparation process – several valuable lessons for future summaries and for making the HealthCursor's knowledge management system dynamic and responsive.

Ultimately, the best lessons will come from reactions and feedback from the wide range of actors who read this report. We welcome all comments and suggestions (please submit to: drdass@healthcursor.com).

Thanks,                                                                                                                   
Dr. Ruchi Dass
CEO, HealthCursor Consulting Group, INDIA

Comments:




Very informative and also very focused. - K.Chandrasekhar, CEO, Forus Health Pvt. Ltd.- Winner of the Samsung's Innovation quotient award.



Excellent insights on the path breaking work happening on ground in healthcare - nice work!- Dr (Maj) Satish S Jeevannavar, Director- NationWide Primary Healthcare Services Pvt Ltd.- Company that bought the Family Physician concept back in Primary care in India.




Found the report to be very comprehensive. One report that touched upon all aspects of health from an innovation perspective whether it being service models, technology led initiatives or public private programs.- Pankaj Vaish- CEO, Healthfore (Religare Technologies)- IPIHD Innovators




Gives a good overview.- Dr. Zeena Johar, President, IKP Centre for technologies (ICTPH)




Report Reviews:


Professor - Healthcare IT, International Institute of Health Management Research (IIHMR )- Dr. Dass’s  ASSOCHAM report on “ Innovations in Healthcare”  has showcased on the strings of frugal innovations in the last decade that has happened in the Indian diaspora,  quite comprehensively. This report would certainly inspire every  reader and health professional  to strive and contribute towards making healthcare in India  more accessible, affordable and accountable to the masses. The message is clear and simple, more and more technology driven frugal innovations using 'Public- Private- Participative frameworks' in healthcare is bound to alleviate health indices in India !




Hospital Administrator and NABH empanelled Assessor and a prolific writer on healthcare matters.

Read Report review by Dr. Sanjeev Sood here

The salient features of the report ‘Innovations in Healthcare are-
1. It offers practical and actionable insights into delivering innovations in healthcare. The focus of this report is to highlight the low hanging fruits to deliver an innovation led health framework using technology and also define road map for the future.
2. It discusses the innovations in the sphere of public health and providing primary healthcare services to the rural population to achieve MDGs by enhancing accessibility, affordability and quality in healthcare delivery.
3. The report is comprehensive in its scope and content and covers the entire spectrum of healthcare services and players in ecosystem at various levels to improve healthcare outcomes and reducing disease burden at community level.
4. The report is well illustrated with recent success stories and case studies in innovations in  healthcare.
5. The report makes a lucid reading along with well illustrated diagrams, pictures and boxes.
Overall, it shall serve as a useful resource and companion  for HCOs, healthcare executives and managers, physician executives, public health administrators , biomedical engineers , medical device manufacturing companies and policy makers.

Critics:





Monday 10 December 2012

Featured post- mHealth fighting malnutrition


Melghat: a synonym for malnutrition

Malnutrition is a byword in the forested hills of the Melghat region inhabited mostly by Korku Adivasis. Every year 400-500 children between the ages of 0 and 6 die in the region, comprising Chikhaldhara and Dharni taluks, according to official figures from 2005.

The Problem: Thousands of kids die every year in the tribal area of Melghat (Maharashtra, India) due to lack of medical attention and nutritional support. Increased incidence and rapid spread of infectious diseases such as pneumonia, typhoid, and dysentery are primary cause of high child mortality. Situation worsens during monsoon when the food supplies are low and the communicable diseases are at their peak.

Melghat is also a place known for high infant mortality rate. Some reasons for the health crisis in Melghat include lack of infrastructure, under-equipped and under-staffed public health and ICDS centres, the tradition of early marriages and early motherhood, lack of sanitation and clean drinking water facilities and the tribals' blind faith in bhumkas (quacks).

Failed Operations of the past: When the Maharashtra government first recorded the figures of child deaths due to endemic malnutrition in the remote villages of Melghat, shocking numbers were revealed.Almost two decades later, even though the government figures show a substantial drop in the number of malnutrition deaths, social activists and health-coordinators working in the impoverished area say that the authorities pass off such deaths as still-births.

The reality continues to bite with the data recorded just before monsoon this year, indicating 509 malnutrition induced deaths during past year, until March 2011. Every year, hundreds of children of Korku tribe in the tehsils of Melghat in the Satpura ranges fall prey to starvation and malnutrition. While the government records indicate figures ranging from 400-525 in the last five years, health activists working among the tribals tell a different story.

Madhukar Mane, Health Coordinator with NGO Maitri, which organises monsoon campaigns to prevent deaths in the precarious season, says: "The figures are certainly better than the late 90s but the numbers are still very high in the tehsils of Dharni and Chikhaldhara. Government records child deaths under two categories: still birth and neonatal. What happens is that they write off several deaths as still births so that the infant mortality rate (IMR) could be kept under check.

Ray of Hope: mhealth is now bringing about a change in India. My two adopted ones- Bongu and Priti along with several others are now fighting malnutrition in their region..I adopted these two angels with the help of World vision India.

The community health workers in Melghat are given the latest weapon to fight against the silent killer – malnutrition. It's a mobile phone pre-loaded with an application called CommCare. "Whenever a pregnancy is reported, I register the women's name and other details via the phone," a community health worker explains.

Once the registration is done, the software gives her the woman’s expected delivery, check-up and immunisation dates. The phone also has pre-recorded messages on maternal and child health that can be played for the women.

Once data is collected, it is saved on a central server of World Vision India, a non-profit organisation that works closely with the government, which distributed these phones. The information then helps in monitoring the health of pregnant women, lactating mothers and young children. The government is now toying with the idea of expanding this successful service to other districts of the state.

Recommendations: Government need to provide access to basic healthcare using mHealth/Telemedicine. About 50 per cent families in Melghat are below poverty line with a high rate of unemployment. Weak mothers often deliver children in grade 1 malnutrition.

It almost instantly deteriorates to grade 2, and then 3 & 4. The nearest emergency health care is about 120 km away that too without a child specialist or medical equipment. About 39 children are suffering from grade 4 malnutrition while 442 fall under grade 3 here.

Here are some of the basic needs of the people in Melghat:
  • Proper Scientific Nutrition, including Micronutrients.
  • Preventive Health
  • Mother and Child Care
  • Reactivating Comprehensive Education system
  • Transportation & Roads
  • Availability of permanent Employment Guarantee during the non-agricultural season.

The health of Melghat cannot change overnight. But tough monitoring and creative solutions along with the State-led ones, the primary being the crucial Right to Food law, can hopefully nurse it back to good health in future.

Comments welcome!

References
Dr A. Ghosh- Team BHP
Commcare
http://www.hindustantimes.com/News-Feed/Columns/Spoon-feeding-Melghat/Article1-953028.aspx
http://indiatoday.intoday.in/story/government-fudges-mortality-records-in-melghat/1/153486.html
http://supriyassule.com/en/projects-and-developments/melghat

Saturday 24 November 2012

The Real India-mHealth & beyond Part 3


Tuberculosis- TB is caused by a bacterium, Mycobacterium tuberculosis, that the WHO says infects one third of the world’s population. Between five and 10 percent of infected people develop the disease and become contagious at some point in their lives. (For those with HIV or AIDS, however, the rate is much higher.)

The Bigger problem- India is the highest TB burden country with World health Organisation (WHO) statistics for 2010 giving an estimated incidence figure of 2.3 million cases of TB for India out of a global incidence of 9.4 million cases. The WHO statistics also show that India is 17th out of the 22 high burden countries in terms of TB incidence rate. The estimated TB prevalence figure for 2010 is given as 3.1 million. It is estimated that about 40% of the Indian population is infected with TB bacteria, the vast majority of whom have latent rather than active TB.
Compliance issues in Treatment- To treat TB, the WHO recommends the so-called DOTS (Directly Observed Treatment Short-course) strategy, where patients take medication under supervision from health staff. Daily supervision of treatment is too demanding for most of our patients and instead implements self-administered therapy with patient education and support to ensure adherence. In many countries affected by conflict, access to health structures is limited for the population. Conflict interrupts travel and makes people fearful of leaving their shelters to seek assistance. It can also lead to the collapse of existing health systems.In India in 2010 292,972 people needed TB re-treatment because of initial treatment relapse, failure or default.

In Focus- Operation ASHA

Operation ASHA is a registered non-profit that has taken TB treatment to the doorsteps of 5.37 million individuals living in disadvantaged areas. It operates in over 2,053 villages and slums in six states spread across India and Cambodia. The effort is self-sustainable and is using technology to reach out to millions everyday.

Establishing Centres- Operation ASHA establishes tuberculosis (TB) treatment centers within existing community locals (for example, strategically placed shops, homes, temples, or health clinics). Under the World Health Organization’s Directly Observed Therapy (DOTS), patients must take their medicines under the supervision of a health care worker. The model is designed to help patients procure their medicines conveniently without wasting time, spending money on transport, and losing wages. This also drastically reduces the effort, time and money that patients have to invest in taking their medication, which is key to ensuring that patients complete the entire course of treatment.

Training- Operation ASHA trains community members (often former patients) to become tuberculosis health workers who are responsible for identifying new patients, ensuring adherence to the drug regimen, and carrying out regular educational campaigns. Operation ASHA works closely with the Government of India, who provides them with free medicines and diagnostic services. After a center has been established for two years, the government provides a grant for every patient cured, making OpASHA’s centers financially self-sustaining.

Building Compliance through technology- Ensuring patient compliance is important because of the threat of multi-drug resistant tuberculosis (MDR-TB), which has become one of the world’s largest public health issues. Resistant strains of the disease can take up to two years to treat (in comparison to the standard 6 month regimen). Second line medicines have more severe side effects and can also cost 50-200 times more. Such unrealistically high costs are essentially a death warrant to those below the poverty line. To combat the rising MDR-TB epidemic, OpASHA launched eCompliance, a biometric initiative in collaboration with Microsoft Research, which uses fingerprint scanners to track patient visits.


The system consists of three parts: 
  • a netbook computer, 
  • a USB fingerprint reader (from Digital Persona), 
  • and a GSM modem that uploads the visitation logs (via SMS) to a central location. 


Patients scan their finger every time they take medication, and these logs are visualized in the central office to monitor medication delivery. Missed doses trigger an SMS notification to managers, who ensure timely supervision or counseling to the patients and health workers involved. The health worker is then required to do a follow-up visit within 48 hours to deliver the medicines and supplementary health education. 

These home visits are also confirmed by biometrics. Currently the terminal is used daily in over 40 treatment centers, spanning Delhi, Mumbai, and Jaitpur; Operation ASHA is aggressively expanding the deployment to over 225 centers around the world. To date, the technology has enrolled about 2,700 patients and logged over 50,000 supervised doses. The biometric records are used to automatically generate reports to the government and other stakeholders.

With the help of eCompliance, Operation ASHA has reduced its default to 1.5%, which is much lower than other institutions. The cost of treating a patient for the entire therapy of is US $50.


References/Credits:

TB statistics of India- TB India 2011 Revised National TB Control Programme Annual Status Report, New Delhi, 2011 www.tbcindia.nic.in/documents.html#

Doctor without borders- http://www.doctorswithoutborders.org/news/issue.cfm?id=2404

Operation ASHA- http://www.opasha.org/



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