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Friday 7 October 2016

Why we never noticed ZIKA?- Indian Research and Development

“Zika had 'disappeared' because it wasn’t worth worrying about and people weren’t paying attention.”

Zika virus was first identified in 1947 in a sentinel monkey that was being used to monitor for the presence of yellow fever virus in the Zika Forest of Uganda. At this time cell lines were not available for studying viruses, so serum from the febrile monkey was inoculated intra-cerebrally into mice. All the mice became sick, and the virus isolated from their brains was called Zika virus. The same virus was subsequently isolated from Aedes africanus mosquitoes in the Zika forest.

In 1950, when some serological studies were being done, it was found that we humans developed antibodies against this virus. Further studies revealed evidence of infection in other African countries, including Uganda, Tanzania, Egypt, Central African Republic, Sierra Leone, and Gabon, as well as Asia (India, Malaysia, Philippines, Thailand, Vietnam, Indonesia). The virus circulating in Brazil is an Asian genotype, possibly imported during the World Cup of 2014. As of this writing Zika virus has spread to 23 countries in the Americas.

India is vulnerable to Zika virus outbreak as the species of mosquito, Aedes aegypti, which carries the virus, is found across the country. It's the same mosquito that carries the viruses of Dengue and Chikungunya. The prevalence in the country of dengue and chikungunya can make it hard to gauge Zika’s prevalence early.

Dire need to digitize records and report early- The baseline prevalence of congenital microcephaly is difficult to determine because of underreporting, and the inconsistency of clinical criteria used to define microcephaly. Although population-based estimates of congenital microcephaly in Brazil vary, the number of infants with microcephaly currently being reported in Brazil is greater than would be expected???

During the first week of infection, Zika virus can be found in the blood and can pass from an infected person to another mosquito through mosquito bites. An infected mosquito can then spread the virus to other people. To help prevent others from getting sick, avoid mosquito bites during the first week of illness by strictly following steps to prevent mosquito bites.

Advanced Disease Analytics It is very hard to prove the linkage between Zika virus and microcephaly cases. The proposed link between Zika and microcephaly began taking shape in September after some pediatricians in northeast Brazil noticed an unusual number of babies born with microcephaly. This spike in microcephaly cases coincided with an outbreak of Zika, a virus related to the dengue virus and spread by mosquitoes, and when a task force set up a registry to track the problem, it discovered that in 26 of the first 35 cases entered, the mother had developed an illness with a rash potentially indicative of Zika during her pregnancy.

But confirming a link between Zika and microcephaly will take more research and time — months, if not years — and the confirmation may end up as a preponderance of evidence rather than a definitive link. What’s easy to forget about the oft-cited scientific mantra, correlation is not causation, is that causation is incredibly difficult to prove. When you’re a doctor who’s seeing an alarming number of infants born with birth defects, correlation may be all you have to go on.

Hope: There are currently no antiviral drugs or vaccines that can be used to treat or prevent infection with Zika virus. We do have a safe and effective vaccine against another flavivirus, yellow fever virus. Substituting the gene encoding the yellow fever E glycoprotein with that from Zika virus might be a good approach to quickly making a Zika vaccine. However, testing of such a vaccine candidate might require several years.

Hyderabad based lab claims breakthrough achievement in developing world's first Zika vaccine- Bharat Biotech, a Hyderabad-based vaccines and bio-therapeutic manufacturer, on February 3, claimed to have achieved a breakthrough in developing a vaccine to fight the dreaded mosquito-borne Zika virus. The two candidate vaccines are in an advanced stage of development and could be ready soon after pre-clinical studies are concluded in the next five months.

The World Health Organisation (WHO) has issued the Pre-qualification of Medicines Programme (PQP) certification to Chennai-based Green Signal Bio Pharma. The pharmaceutical company got the certification to manufacture a Bacillus Calmette-Guerin (BCG) vaccine, with which, it became the only Indian company to get PQP certification from WHO.

Zika virus has never been isolated in India. The only time any trace of the virus was recorded in India was in 1952-53. A study titled ‘Neutralising antibodies against certain viruses in the sera of the residents of India’, published in a journal called The Journal of Immunology, recorded among other viruses, antibodies to the Zika virus. The study, which went to 38 localities in six states in India, tested 15 vector borne viruses. “Significant numbers of the sera neutralised Zika,” noted the study authored by “KC Smithburn of the Rockefeller Foundation in New York, JA Karr, director, virus research centre in Poona and PB Gatne, Medical offer, Bombay State India.


  1. The Zika virus is heat-driven. The hotter it is, the more effectively the mosquitoes are able to spread diseases. India is a favorable climate.
  2. India is one of the countries where Aedes Aegypti - the mosquitoes that transmit both Dengue and the Zika virus are extremely prevalent.
  3. Storage of drinking water and other urban water, containers including plant-pot bases, guttering, tarpaulins and tyres and discarded containers can all collect rainwater and provide habitat for Aedes aegypti larvae.

Aedes aegypti

  1. Is a domestic mosquito
  2. Generally, lives indoors and near people
  3. Rests in cool shaded places in houses such as in wardrobes, laundry areas and under furniture
  4. Is hard to catch and moves very quickly, darting back and forth
  5. Often bites around your feet and ankles, and may bite repeatedly
  6. Has a bite that is often relatively painless, so you may not notice you are being bitten or you may think you are being bitten by sandflies or biting midges
  7. Feeds during daylight hours. Biting activity is higher in the two hours after sunrise or before sunset, but they will bite throughout the day. As a result, bed nets do not prevent dengue transmission.
  8. Stepping up action against Zika virus, Health Ministry on Monday said 10 new diagnostic facilities will become operational in different states by the end of February. In addition to the two diagnostic facilities at NCDC and National Institute of Virology (NIV) Pune, 10 new facilities will become operational by end of February. These are located in Tamil Nadu, Kerala, Puducherry, Karnataka, West Bengal, Uttar Pradesh, Gujarat, Madhya Pradesh, Odisha and Assam.

As a precaution, all aircraft are being disinfected as per the WHO guidelines. In addition, vector breeding in containers at the seaports is also being taken up and National Vector Borne Diseases Control Program and National Centre for Disease Control are checking for control of vector densities. Surveillance activities have been activated through the Integrated Disease Surveillance Programme (IDSP) network along with Rapid Response Teams in states. So far no Zika case has been reported in India. We urge the common public to keep a watch and report every Zika case to RRT teams in every state.

As Zika heads to India, an older strain in Indians prepare for a second coming- A virulent version of the Zika virus that has swept the globe is headed for India, where an older, more benign strain is likely to be quietly residing within some Indians, possibly preparing genetic ground for a quick, new second-coming, experts have warned.

In India, the Zika virus – which has no cure or vaccine – was first found in Pune 64 years ago, as part of a survey that was testing immunity to Japanese and Russian varieties of a virus-borne brain infection called encephalitis, according to a forthcoming paper authored by World Health Organisation (WHO) scientists.

The paper comes soon after this study in the Lancet, a medical journal, which used travel patterns to predict that India – where more than 67,000 air travellers arrive every year – and four other countries (China, Philippines, Indonesia and Thailand) were most at risk for year-round transmission of the Zika virus. China has more people, but more people are at risk in India. Read more>>

Chinkungunya wasn’t supposed to be in India; then it showed up

Zika’s cousin, chikungunya, first had a major outbreak across India – barring Kerala which had no Aedes aegypti mosquitoes then – between 1964 and 1967.

Chikungunya faded from public and scientific memory, and when it returned in 2002, “we were caught with our collective pants down”, said T Jacob John, a retired virologist who, along with two colleagues, documented India’s first HIV infection in 1986, and designed a national response.
The second coming of chikungunya in India came through a mutated and more virulent virus, John noted. “We missed a golden opportunity to document all that.”

Referrring to Zika, John described the feeling as “deja vu chikungunya”.

Friday 23 September 2016

Innovations that caught my attention recently-#Healthtech

No. 1- Lyme bacteria use the same technique as White Blood Cells to navigate and move in blood vessels

In an interesting case of convergent evolution Lyme bacteria use the same technique as White Blood Cells to navigate and move in blood vessels.To zip through the bloodstream and spread infection throughout the body, the bacteria that cause Lyme disease take a cue from the white blood cells trying to attack them. Both use specialized bonds to stick to the cells lining blood vessels and move along at their own pace, biologist Tara Moriarty and colleagues report September 6 in Cell Reports.

“It’s really an amazing case of convergent evolution,” says Wendy Thomas, a biologist at the University of Washington in Seattle who wasn’t part of the study. “There’s little structural similarity between the molecules involved in these behaviors, and yet their behavior is the same.”

No.2- Wearable Robot for people who lost their hand function

This wearable robot helps disabled patients regain control of their hands. The system consists of a glove that fits between the index finger, middle finger and thumb. Patients who have lost their hand functions due to injuries or nerve-related conditions, such as stroke and muscular dystrophy, now have a chance of restoring their hand movements by using a new lightweight and smart rehabilitation wearable robot.


This is what one customer wrote as feedback after going through the demo-

"To have personally come back from a spinal cord injury - to be able to walk again still blows my mind. changed my view on this power vessel called a body. I love my body- stretchmarks, cellulite and all. It is a wonderful machine. My passion is to continue to educate people on the word function and to truly explore what it means. Much of our society is based on the "look of things" and not the "function" it has damaged the very essence of life for many. This is a wonderful demonstration of dedicated people. Thank you for the service you have provided for many.."

No. 3 Stroke prevention Implant

I have seen many innovations that help predict a stroke and send info to a Doctor remotely to take action and rehabilitate.This new innovation called "Watchman" can be inserted in less than an hour and could save your life. A lot of people might think that it is like striking one thing off their list to worry about. However, good diet and exercise is something still beneficial and should be maintained.
The newly FDA-approved Watchman device is a small implant that reduces the risk of stroke and blood clots.

The blood thinner Warfarin is the standard way doctors try to prevent clots and strokes in patients with irregular rhythms, but the Watchman implant stops blood clots where they start. The majority of clots form in a pouch called the left atrial appendage.

When people have atrial fibrillation in the upper chamber of their heart, known as the atrium, it does not pump, but instead it quivers and that is why the appendage fills with blood. It does not squeeze out the blood and that's how clots are formed.

The Watchman is deployed through a vein in the right leg where the pouch is and it plugs the opening. "Blocking off this pouch is as good as, if not more effective, than taking the blood thinner Warfarin, which is the only other option that many of these patients have," said Dr. Shephal Doshi with the Pacific Heart Institute.

Doshi started the first clinical trial seven years ago. The procedure may not be for everyone with an irregular heartbeat, but it's another option that can be life changing for so many.

Hashem Al-Ghaili
Science age
Sciencenature/FB page

Thursday 15 September 2016

Let us go back in time- Let's go natural.

Yes this post of mine is not around Healthcare Marketing, Digital Innovation or Community Health programs.

I thought to write about this particular topic after studying trends related to people's ill health and the food we eat, the cosmetics we use and the bad additives that have done enough bad to us already. I remember those times when my Grandma used to mix Glycerine with rose water and it used to be our skin care staple for winters. Dry some Indian gooseberry and heat it up with home made coconut oil to get luscious locks.

Things were simple, fresh and homemade. Now Grandma is long gone and we are buying such products off the shelf knowing little about additives like mineral oil, LLP (Light Liquid Paraffin Oil ), perfumery compounds, preservatives and what not.People who have no connect to the cosmetics and food industry know very little about such compounds and need to be educated. For them a good brand name like Bajaj, Dabur or Patanjali serves the purpose. However, it is time that we take our home shopping a bit more seriously. The question is how? How many of us read labels? Do we have the time to?

Well, we have to make time. Our kids are suffering from rashes, baldness, premature greying and severe health problems. Mineral oils used in hair oils are associated with Cancer. Most of the commercially available hair care products today use harmful, potentially carcinogenic ingredients.

I was surprised to see that almost all hair products my sister was using lately had POLYETHYLENE GLYCOL (PPG/PEG) and Formaldehyde (probable carcinogen and irritant found in nail products, hair dye, fake eyelash adhesives, shampoos) in them.

Well, labels on cosmetics and body care products are a tough code to crack. The industry is so shockingly unregulated that it’s usually impossible to trust the claims that manufacturers place on their products.A word such as “natural” can be used by anyone for anything. Even “organic” is misleading. Companies are supposed to use an organic label only if all ingredients are certified-organic, but they can also say it’s “made with organic” if it contains a minimum of 70 percent certified-organic ingredients. Plus half of the chemicals are not tested, not listed and never discussed.

Hydroquinone: Asians are crazy about lightening creams-you will find this in most of these creams. Rated most toxic on several databases, and linked to cancer and reproductive toxicity.

Lead: Known carcinogen found in lipstick and hair dye, but never listed because it’s a contaminant, not an ingredient.

Parabens: Used as preservatives, found in many products. Linked to cancer, endocrine disruption, reproductive toxicity.

Paraphenylenediamine (PPD): Used in hair products and dyes, but toxic to skin and immune system.

Phthalates: Plasticizers banned in the EU and California in children’s toys, but present in many fragrances, perfumes, deodorants, lotions. Linked to endocrine disruption, liver/kidney/lung damage, cancer.

Mercury: Known allergen that impairs brain development. Found in mascara that asians are again crazy about.

Mineral oil: By-product of petroleum that’s used in baby oil, hair oil, moisturisers, styling gels. It creates a film that impairs the skin’s ability to release toxins.

Oxybenzone: Active ingredient in chemical sunscreens that accumulates in fatty tissues and is linked to allergies, hormone disruption, cellular damage, low birth weight.

Placental extract: Used in some skin and hair products, but linked to endocrine disruption.

Polyethylene glycol (PEG): Penetration enhancer used in many products, it’s often contaminated with 1,4-dioxane and ethylene oxide, both known carcinogens.

Silicone-derived emollients: Used to make a product feel soft, these don’t biodegrade, and also prevent skin from breathing. Linked to tumour growth and skin irritation.

Sodium lauryl (ether) sulfate (SLS, SLES): A former industrial degreaser now used to make soap foamy, it’s absorbed into the body and irritates skin.

And this is a long list....

http://www.ncbi.nlm.nih.gov/pmc/articles/PMC4387693/, http://www.treehugger.com/organic-beauty/20-toxic-ingredients-avoid-when-buying-body-care-products-and-cosmetics.html
The Agency for Toxic Substances and Disease Registry (ATSDR), based in Atlanta, Georgia, is a federal public health agency of the U.S. Department of Health and Human Services. http://www.atsdr.cdc.gov
http://naturalhaireverything.tumblr.com/post/3253973196/10-ingredients-to-avoid-putting-on-your-hair, http://thehairoine.com/pages/chemicals-to-avoid
Image: So Malicious

Wednesday 7 September 2016

Are you a Healthcare Innovator? Join the Partnership at IPIHD

Innovations in Healthcare (founded as the International Partnership for Innovative Healthcare Delivery) is a nonprofit organization hosted by Duke University and founded in 2011 by Duke Health, McKinsey & Company, and the World Economic Forum. I am an IPIHD innovator myself and the learnings I had not only assessing my own innovations but engaging with other innovators is impeccable. At the heart of Innovations in Healthcare is our network of 60+ innovators from around the world working to expand access to affordable, quality healthcare. Every year, IPIHD identifies and recruit entrepreneurs with promising models of healthcare to apply to join their network as innovators. Through a highly competitive process, they then select the best organizations to join them. They help connect these innovators with opportunities, information, and contacts they need to scale up their work.

Nominations are open and the deadline is 16th September 2016. Do you know an organization that wants to be part of a global network of entrepreneurs working to innovate new solutions in healthcare? Would they like to connect with and be part of conversations about healthcare innovation with leading funders, corporations, academics, and other experts?

If so, recommend an organization to join our network! Again, the deadline for nominations is September 16th. You can nominate an organization you think should be in our network here: https://duke.qualtrics.com/jfe/form/SV_4OA6hxGc5uU6ANT

Currently, our network is comprised of 67 healthcare innovators working across 49 countries. Through a competitive annual selection process, innovators are chosen to join our network based on their innovation, readiness to scale, and the financial sustainability of their approach. Last year, we received more than 160 nominations and selected the top 12 organizations from this pool.

For more details about our network and selection process, please click here.

Questions? Please contact Logan Couce at logan.couce@duke.edu.

We look to grow our network to include companies working in some of the geographies and health care areas listed below, as part of our efforts to scout for the best healthcare innovators globally:

• Geographies of Focus: Brazil, Southern and West Africa, Southeast Asia, India, East Africa, Mexico

• Type of Care Focus: population health management, chronic management for non-communicable diseases (especially as connected with primary care), healthcare financing models

What should innovators expect from here?

Innovations in Healthcare has a two tiered selection process:

• July 25th-September 16th, Nomination Period: Interested innovators can self-nominate through the short online form. Finalist candidates will be notified by October 1st.

• October 1st-October 31st, Application Period: Finalist candidates submit more detailed applications. Internal and external review committees help to assess the finalists. Organizations selected to join our network will be notified in mid-December.

Tuesday 29 March 2016

EdisonChallenge by GE Tech India- A Great experience

You may have come across sayings such as, “Nothing is permanent but Change.” Also a few others would say, “If Change was permanent, it would have stayed”. We evolve and so does our needs and priorities and in the Indian market it makes so much more sense because as a nation we yearn for access, empowerment and rights.

Recently, growing attention has been devoted to the concept of “Open Innovation”, both in academia as well as in practice. Open innovation is “the use of purposive inflows and outflows of knowledge to accelerate internal innovation, and expand the markets for external use of innovation, respectively.” The concept has emerged from the belief that growth just like innovation has to be inclusive.

Recently, I was at the GE Edison Challenge venue in Bangalore, India where GE invited college/university students to showcase promising innovations that can aid in achieving these goals by a digital-physical solution across industries. The audience and mentor group came from the esteemed pool of GE scientists, leaders and engineers.

From the GE’s manifesto we learnt that GE believes that it’s impossible for any organization to have all the best ideas, and hence they strive to collaborate with experts and entrepreneurs everywhere who share the same passion to solve some of the world’s most pressing issues.

As simple it may seem, I was astounded to see the enthusiasm and array of technology categories these students applied in.

“Collaboration between academia and private sector is a necessity of our times”, states Ms. Sukla Chandra. She also highlights how GE’s Edison Challenge is helping bridge the gap and encouraging innovation.”

DRISHTI- a wearable for blind population to assist in Navigation.
Navigation in indoor environments is highly challenging for the severely visually impaired, particularly in spaces visited for the first time. Several solutions have been proposed to deal with this challenge. Although some of them have shown to be useful in real scenarios, they involve an important deployment effort or use artifacts that are not natural for blind users. Drishti (Veermata Jijabai Technological Institute) presented an indoor outdoor navigation system that was designed taking into consideration usability as the quality requirement to be maximized. This solution enables one to identify the position of a person and calculates the velocity and direction of his movements. Using this information, the system determines the user’s trajectory, locates possible obstacles in that route, and offers navigation information to the user.

Health Category dominated with some really quirky innovations that were worth a consideration.

Here is a collage of the interesting ones:

For patients suffering from respiratory diseases, an intelligent remote health monitoring system was proposed by Mesh Bees, Pondicherry Engineering College. The AndroLung app records breath sounds and sends the same to a cloud for diagnosis. Any audible noises associated with breathing as occasionally, wheezing or the gurgling caused by secretions in large airways are audible to the "naked" ear. Lung sounds, also called respiratory sounds or breath sounds, can be auscultated across the anterior and posterior chest walls with a stethoscope. Adventitious lung sounds are referenced as crackles (rales), wheezes (rhonchi), stridor and pleural rubs as well as voiced sounds that include egophony, bronchophony and whispered pectoriloquy. Descriptions and audio recordings for all of these sounds are available with several algorithms and as reference in medical guides. A prescription approval, modification and further course of treatment is advised based on the same.

For people suffering from disabilities and especially the ones that are dependent on wheel chair for movement and tend to spend a lot of time on it- the IIT Kharagpur team came out with an innovative solution. The wheel chair is equipped with Bio potential signal and Magneto Plethysmography (MPG) for Heart rate monitoring and other sensors as well.

The 5 finalist teams of the GE ‪#‎EdisonChallenge 2016 were Out of control (Indian Institute of Science), TechieCardia (IIT Bombay), Agaaz (Malaviya National Institute of Technology Jaipur, Rajasthan), 2Pi Radians (R.V. College of Engineering) and Flame (Zakir Husain College of Engineering and Technology, AMU, Aligarh) and all of them battled it out for the win.

Team FLAME from Zakir Husain College of Engineering and Technology (#‎ZHCET), AMU, Aligarh presented an idea related to home health/ domestic checkup. The service delivery point is at home where blood testing is done without a prick and AI algorithms are applied. These algorithms are then deployed to the hardware (device). The solution also demonstrated smart data sharing and communication back and forth in the healthcare ecosystem. TEAM FLAME is the winner of #EdisonChallenge 2016.

The idea also indicated a possible use of Predix platform from GE which is built on cloud foundry and is optimized for secure connectivity and analytics at scale - in the cloud and on the edge.

Predix is more than just cool new technology. It's a fundamental platform for the next kind of industrial company. - Bill Ruh, SVP and Chief Digital Officer, GE Digital

And then there were others to detect stroke (Team Chaperone, VIT University), fetal monitoring at the convenience of your home (Priceless brains, Madras Institute of Technology), data driven ICU tracking and alarm system (Order Zero, IIT Guwahati), safe and pure water system (NIT, Karnataka), digital health networks (Vikings, Manipal Institute of Technology) etc.

Outside the health category the challenge also brought other sectors’ related innovations. Team TraFix, IIT Kharagpur, West Bengal presented a unique solution to control traffic congestion on roads. VSM, CMR Institute of Technology presented a solution on vehicle safety based on smart sensors placed on the bumper of the car that help initiate a trigger in cases of collision, accidents etc. and has been integrated with SOS/Ambulance on alert services. Ambulance is guided to the location via GPS system in the car.

Team Out‐of‐Control from Indian Institute of Science, Bangalore showcased a solution based on prediction analytics based algorithms that help reduce traffic congestion and mitigate jams. It also has an interesting incentive model and is coupled with short term active measures like ramp metering, dynamic speed limit control and adaptive traffic signal control. Team Out-of-control walked away with the runner up prize.

Some of the ones that I personally like were around:

• Digitally enabled farming (Agaaz, Malaviya National Institute of Technology Jaipur, Rajasthan),
• Smart Gas (Green Tech, IIT Roorkee),
• Emission monitoring (NuaJoog Labs; National Institute of Technology Silchar), Smart Parking (Team Chrysalis, NIT Karnataka)
Special mention and Congratulations to the two winners of the 'Social Squad'- Team Phoenix, NIT Raipur and Team ArdIoT, NIT Durgapur.

My Heartiest congratulations to the Team Flame and all others who participated for their valiant efforts and ingenuity throughout the course of GE’s #EdisonChallenge 2016!

Saturday 13 February 2016

The Formula of Driver and Demand- Indian Startups story

The healthcare industry is currently experiencing change at an unprecedented rate. Change is not only occurring in the technology used in diagnostics and care delivery, but this change is so fundamental that it could, and likely will, fundamentally alter the business model of the industry.

Today we have fitness bands, healthcare apps, appointment schedulers, health chats and several such means to access healthcare but one thing that all of this does not necessarily correlate with high quality of care or better outcomes.

We need to understand that “Not even a Ferrari will get us to our destination without a driver.”

Formula of Driver:

Driver = (Need + Incentive) where;

Incentive = (Value + Reward)
Need = (Gap + Demand)

To define the best drivers, we need to first address the need. Need might not make economic or business sense but it is the best opportunity to leave an impact. No one remembers how much business a “Mughal-e-Azam” or “Usual suspects” did but everyone remembers that these were great movies with splendid performances.

In India, we have several such needs today. A survey conducted by HCG on several pressing issues in the field of health and safety highlighted the following:

1.       Women safety
2.       Elderly concierge services
3.       Child safety
4.       Personalized nutrition
5.       Health Insurance for OPD services
6.       Cancer support/ early detection
7.       Infertility
8.       Fitness (scientifically monitored) and performance

This list is not exhaustive. I don't need to look at statistics to confront the horrid truth. News stories of women from all over India being raped, beaten, killed are flashed across us day after day – and we all are aware of it. The fatal Nirbhaya gang-rape saw an outpouring on the streets of Delhi – protests decrying the fragile status of women in India. Candle light marches, editorials examining the patriarchal and sexist traditions of our country, an awakening on social media – even conversations on streets revolve around the night they cannot forget: the night that took Nirbhaya. We need to do something about women safety. Devices, trackers, processes, helplines- whatever little or more we can do. If you are an innovator in this area, please get in touch with me.

For elderly even small accidents can be deadly. While simple falls, such as slipping while walking off
a curb, may seem relatively harmless, they can actually lead to severe injury and death in elderly individuals, according to a new study published in The Journal of Trauma: Injury, Infection, and Critical Care. As the population continues to age, it is important for physicians and caregivers to be aware of and prepared to deal with this issue, which could significantly impact the overall health and well-being of older adults.  In addition to it, low blood pressure, low blood sugar, heart attack and other things can be very worrisome and need constant monitoring. Innovators call to action here is to come out create and raise awareness about such bracelets, devices and jewelry that can be adorned for a purpose.

Without calorie count possible, limited heart rate tracking and availability of other vitals; performance management and fitness efforts are less effective. Measuring your heart rate using a heart rate monitor is a good way to gauge the effectiveness of your workout because as you strengthen your body through exercise, you also strengthen your heart. Measuring the rate of your heart during exercise can help you determine when you're pushing your body too hard or need to push it harder to achieve the level of fitness you are seeking. 

I love the work Hexoskin and Kenzen are doing. I am looking for something more affordable and focused for Indian market.

Health tech is blazing hot right now and there's no shortage of companies working on innovative products designed to change the face of healthcare as we know it. That's a good thing, considering Indians are as unfit as ever and bureaucracy continues to muck things up for physicians and patients alike. As technology evolves, it could upend some of these problems. One thing that's certain: Consumer-driven healthcare is coming. And these companies are helping make it happen.
All the best!

Saturday 19 December 2015

Leveraging Cloud Technology in Healthcare- The Indian Tweetathon

Digitization of health information is soaring, particularly in the areas of electronic health records (EHRs), storage of images, e-prescriptions, patient admissions, registration, and scheduling.
The health industry is adopting new care models such as value-based care to enable more targeted and preventative care.

Real time and predictive analytics, improved management and security and enhanced decision making through enterprise grade devices empowered by the cloud is helping healthcare enterprises #Reimagine

• their internal operations and make it more efficient
• their service delivery and improve the quality of patient care
• their costs by reducing the cost of ownership.

On 17th December, we organized a tweet-a-thon amongst Microsoft India and Industry thought leaders. We tried to highlight the role of technology - specifically cloud computing in Healthcare.

Doctors, Providers, Software vendors, HIT experts and KOLs from the industry participated and the Tweet-a-thon gathered over 11 million impressions. 

This encapsulated some of the technological trends and changes in the healthcare industry, benefits of moving to the cloud, why healthcare is/should be embracing the cloud etc.

Here are the highlights of some of the questions asked and answered during the tweet-a-thon. Also please don’t miss the case studies highlighting how Indian hospitals are using cloud technology to provide to undertake epidemiological studies, clinical research, provide quality care and support public health efforts.

@RHYD007 How is Fortis leveraging cloud tech at point of care? #Reimagine

@healthemerge Wat is the incentive for LVPRASAD to move to cloud? Which companies help comprehend critical healthcare data in INDIA? #ReImagine @drruchidass

@SMobilestaff Doc @drruchibhatt Hospitals in India were never ready to share data with each other- how will they agree to cloud? #Reimagine

@alishervani How can cloud increase availability of healthcare services in our rural areas? @drruchibhatt #Reimagine #cloud

@bioingine @drruchibhatt #Reimagine Healthcare - regarding the anonymization of the health data - is there any health policy to protect the health data

@bioingine @drruchibhatt #Reimagine Healthcare - is Indian govt leveraging cloud for public health studies

@PublicHealthIN1 Dr Dass why there was such a delay in adopting something this imp #cloud policy? or investment?

@manavsahay Are Hospitals ready to share data and invest in cloud tech? #Reimagine @antonvipin @rfrancis888 @v_sood @drruchibhatt @TsyAravind

@sanwar1 @drruchibhatt @TsyAravind @antonvipin @rfrancis888 and how would this integrate with current HIS maintained by pvt hospitals? #ReImagine

@piykumar @drruchibhatt for analytics, data collection has to happen & we see challenges in collecting data which can be analysed #Reimagine #India

Case Studies:

Fortis Hospitals Group, India

Fortis hospitals is harnessing the power of the #cloud to #Reimagine diagnostic & clinical care for all.

LV Prasad Eye Hospitals, India
Microsoft Azure is empowering the LV Prasad Eye Institute with advanced analytics and machine learning in delivering quality care.

Coming to the hospital is not enjoyable for people. If we can keep them out of it, that would be great. We need to create a sustainable health system. India is gearing up to adopt cloud technology in Healthcare and leverage the knowledge that is still redundant and disconnected.An important strategy here is the development of the necessary models that showcase the benefits of cloud computing adoption to both healthcare providers and consumers. 

This involves a continual examination and monitoring of the key technology factors in the context of the healthcare operating model. A truly ubiquitous transformation of health can only happen if even more health organizations take advantage of the powerful opportunities offered by advanced analytics and machine learning powered by the cloud.


Tuesday 20 October 2015

Investor red flags- always logical?

A few of my interns recently did a brain-storming session with me. They were all enthusiastic to do something of their own and had many questions. Many of them I met at several accelerator competitions and hackathons.

I am not an authority or a VC. So far, I have invested in 9 companies globally- all in healthcare or education. One thing that I have come across in almost every transaction is when seed funded companies go for Series A- Investor raise red-flags about

1. Recurring revenue
2. Team
3. Valuation

One such situation came in today when I was asked How do you anticipate growth of 15%-20% YOY when in a force of 200 employees you have only 5 sales guys and 2 marketing people. What are you relying on? Most start-ups find it hard to answer such a question.

When you cannot rely on sales and marketing to be your driver of growth, you rely on your customer to be your driver of growth. Hence when the service and the product keep evolving imparting better and sustained value- one needs to rely less on marketing. I think it actually builds a much deeper foundation when you don’t rely on a very large sales and marketing team to get your brand out.

This MIT guy asked me- How would you measure the value of a company? Especially, a company that you started a month ago – how do you determine start-up valuation?

My answer was simple Valuation need not show the true value of the company. Actually what it defines is about investor share in the company.  At the time of investment, valuation is the core determinant of return for investors. In other words, the return to investors is based on the increase in the valuation of shares they receive in exchange for their capital. Understanding valuation is critical to successful investing. Unfortunately, valuation is the most misunderstood part of the investment process and often leads to contentious negotiations that get the entrepreneur investor relationship off on the wrong foot.Valuation depends on how much money you need to say run 3 pilots and have 8-12 months of runway. As an Investor, I expect growth in 18 months.

Valuation matters to entrepreneurs because it determines the share of the company they have to give away to an investor in exchange for money.  At the early stage the value of the company is close to zero, but the valuation has to be a lot higher than that. Why? Let’s say you are looking for a seed investment of around $100, 000 in exchange for about 10% of your company. Typical deal. Your pre-money valuation will be $ 1 million. This however, does not mean that your company is worth $1 million now. You probably could not sell it for that amount. Valuation at the early stages is a lot about the growth potential, as opposed to the present value.

The biggest determinant of your startup’s value are the market forces of the industry & sector in which it plays, which include the balance (or imbalance) between demand and supply of money, the recency and size of recent exits, the willingness for an investor to pay a premium to get into a deal, and the level of desperation of the entrepreneur looking for money.

The follow-up questions was- Does valuation also depend on who you are taking money from? - I laughed it out. The answer to that is a big "YES" - we all know that.

We have an acquisition offer from a large hospital chain- Tim said- they are interested in Acqui-Hire- Should we take it? How to decide between getting acquired and acqui-hire.

Well. It depends on how your company is doing? Acqui-Hire is offered when you have a great team together but product isn't going anywhere. Acquisition is the best move when we realise that the product has traction, but the company does not generate enough revenue to qualify for an IPO.

And last but not least- What does an Angel like me look for returns?

Some angels target 5x to 10x ROI (cash-on-cash return on their investment) in four to eight years, which yields an internal rate of return of between 25 and 75 percent. (In the accompanying table, the target numbers assume that divergence of between 3x and 5x times is factored in.) Other angels simply target 30x ROI without divergence. The two approaches are effectively equivalent:

If you assume 4x divergence (the midpoint between the expected range of 3x to 5x) and multiply that by a return of 7.5x (midway between the 5x and 10x range), then you get 30x, which factors in divergence. These rules of thumb are not sacrosanct; they reflect two common approaches.

Divergence is the difference between the growth rate of the company’s valuation and the
valuation of the shares investors receive due to dilution by subsequent investors and other factors. Even in successful ventures, divergence, in fact, tends to be between 3x and 5x.
A simple example may help make the point: An investor funds at a $4-million post-money valuation and receives shares valued at $2 each. The company is sold in five years for $60 million, which is a 15x increase in company valuation. Due to dilution, however, the value of the investor’s shares will almost certainly not have increased 15x to $30 per share. They might instead have increased only 3x to $6 per share. In this example, the increased valuation of 15x divided by the increase in the investor’s share value of 3x demonstrates a 5x divergence.

A startup company’s value, as I mentioned earlier, is largely dictated by the market forces in the industry in which it operates. Specifically, the current value is dictated by the market forces in play TODAY and TODAY’S perception of what the future will bring.

Effectively this means, on the downside, that if your company is operating in a space where the market for your industry is depressed and the outlook for the future isn’t any good either (regardless of what you are doing), then clearly what an investor is willing to pay for the company’s equity is going to be substantially reduced in spite of whatever successes the company is currently having (or will have) unless the investor is either privy to information about a potential market shift in the future, or is just willing to take the risk that the company will be able to shift the market.

Therefore, when an early stage investor is trying to determine whether to make an investment in a company (and as a result what the appropriate valuation should be), what he basically does is gauge what the likely exit size will be for a company of your type and within the industry in which it plays, and then judges how much equity his fund should have in the company to reach his return on investment goal, relative to the amount of money he put into the company throughout the company’s lifetime.

Comments welcome.

Ewing Marion Kauffman F Foundation

Monday 5 October 2015

Dr. Ruchi Dass on Role of Analytics in Healthcare

Quick Snapshot of our work in the field of Analytics- shot at the Healthcare IT Summit, Mumbai, India. What do we do there with Predictive analytics tools- serious work!!

Predictive analytics (PA) uses technology and statistical methods to search through massive amounts of information, analyzing it to predict outcomes for individual patients. That information can include data from past treatment outcomes as well as the latest medical research published in peer-reviewed journals and databases.

In medicine, predictions can range from responses to medications to hospital readmission rates. Examples are predicting infections from methods of suturing; understanding Patient’s patterns,  bias and compliance;  determining the likelihood of disease, helping a physician with a diagnosis, and even predicting future wellness.

The statistical methods are called learning models because they can grow in precision with additional cases. There are two major ways in which PA differs from traditional statistics (and from evidence-based medicine):

First, predictions are made for individuals and not for groups
Second PA does not rely upon a normal (bell-shaped) curve.

Prediction modelling uses techniques such as artificial intelligence to create a prediction profile (algorithm) from past individuals. The model is then "deployed" so that a new individual can get a prediction instantly for whatever the need is, whether a bank loan or an accurate diagnosis.

1. Help increase the accuracy of diagnoses.

Physicians can use predictive algorithms to help them make more accurate diagnoses. For example, when patients come to the ER with chest pain, it is often difficult to know whether the patient should be hospitalized. If the doctors were able to answers questions about the patient and his condition into a system with a tested and accurate predictive algorithm that would assess the likelihood that the patient could be sent home safely, then their own clinical judgments would be aided. The prediction would not replace their judgments but rather would assist.

2. Helps preventive medicine and public health.

With early intervention, many diseases can be prevented or ameliorated. Predictive analytics, particularly within the realm of genomics, will allow primary care physicians to identify at-risk patients within their practice. With that knowledge, patients can make lifestyle changes to avoid. As lifestyles change, population disease patterns may dramatically change with resulting savings in medical costs. With Predictive Analytics, our future medications would be more personalised because predictive analytics methods will be able to sort out what works for people with "similar subtypes and molecular pathways."

3. Provides Physicians with intuitive insights planning treatment methodology for individual patients.

Evidence-based medicine (EBM) is a step in the right direction and provides more help than simple hunches for physicians. However, what works best for the middle of a normal distribution of people may not work best for an individual patient seeking treatment. PA can help doctors decide the exact treatments for those individuals. It is wasteful and potentially dangerous to give treatments that are not needed or that won't work specifically for an individual. Better diagnoses and more targeted treatments will naturally lead to increases in good outcomes and fewer resources used, including the doctor's time.

4. Provide employers and providers with predictions concerning insurance product costs.

Employers providing healthcare benefits for employees can input characteristics of their workforce into a predictive analytic algorithm to obtain predictions of future medical costs. Predictions can be based upon the company's own data or the company may work with insurance providers who also have their own databases in order to generate the prediction algorithms. Companies and hospitals, working with insurance providers, can synchronize databases and actuarial tables to build models and subsequent health plans. Employers might also use predictive analytics to determine which providers may give them the most effective products for their particular needs. Built into the models would be the specific business characteristics. For example, if it is discovered that the average employee visits a primary care physician six times a year, those metrics can be included in the model.

5. Helps researchers develop with even lesser data that can become more accurate over time.

In huge population studies, even very small differences can be "statistically significant." Researchers understand that randomly assigned case control studies are superior to observational studies, but often it is simply not feasible to carry out such a design. From huge observational studies, the small but statistically significant differences are often not clinically significant.
For example, small to moderate alcohol consumption by women can result in higher levels of certain cancers. Many news programs and newspapers loudly and erroneously warned women not to drink even one alcoholic drink per day.

In contrast with predictive analytics, initial models in can be generated with smaller numbers of cases and then the accuracy of such may be improved over time with increased cases.

6. Helps Pharmaceutical companies to plan and best meet the needs of medications for the masses.

There will be incentives for the pharmaceutical industry to develop medications for ever smaller groups. Old medications, dropped because they were not used by the masses, may be brought back because drug companies will find it economically feasible to do so. In other words, previous big bulk medications are certain to be used less if they are found not to help many of those who were prescribed them. Less used medications will be economically lucrative to revive and develop as research is able to predict those who might benefit from them. For example, if 25,000 people need to be treated with a medication "shotgun-style" in order to save 10 people, then much waste has occurred. All medications have unwanted side effects. The shotgun-style delivery method can expose patients to those risks unnecessarily if the medication is not needed for them.

7. Leads to better Patient outcomes.

There will be many benefits in quality of life to patients as the use of predictive analytics increase. Potentially individuals will receive treatments that will work for them, be prescribed medications that work for them and not be given unnecessary medications just because that medication works for the majority of people. The patient role will change as patients become more informed consumers who work with their physicians collaboratively to achieve better outcomes. Patients will become aware of possible personal health risks sooner due to alerts from their genome analysis, from predictive models relayed by their physicians, from the increasing use of apps and medical devices (i.e., wearable devices and monitoring systems), and due to better accuracy of what information is needed for accurate predictions.

Tuesday 8 September 2015

Driving Innovation the GE way- GETech Mela Coverage

‘Reverse innovation,’ a principle well established in the business world, describes the flow of ideas from emerging to more developed economies. Reverse innovation refers to the process of first identifying and/or fostering a successful innovation in a LIC that addresses an unmet need in a HIC, then adapting and spreading the innovation from the LIC to the HIC. It is, in a nutshell, learning from and investing in poorer settings as one way to tackle problems in wealthier settings that require out-of-the-box solutions.

The realization that the American health care system must simultaneously decrease per-capita cost and increase quality has created the opportunity for the United States to learn from low- and middle-income countries. 

At GE Tech Mela, I came across GE's Stripped-down, portable ECG machine- GE Healthcare's MAC i is an ultra-portable, battery-operated electrocardiogram machine, designed for use in rural clinics in India, where mains electricity is either intermittent or non-existent. The cost is only 25,000 rupees (£320). It is a boon for the Indian market where electricity and primary healthcare access is a big problem.

The concept of Reverse Innovation and Glocalisation (Global- Local) is not new to GE. In 2010, I came across a dual-slice computed tomography imaging system called HiSpeed Dual with GE. It was the first CT system that the health care arm of U.S. conglomerate General Electric had made in India, and the first high-end CT imaging system that anyone had made in the country. GE Healthcare had previously imported the system for Indian customers. By manufacturing it in Bangalore, GE Healthcare cut the price by 10% and  reduced an 8- to 10-week waiting period as well.

Mr Shyam Rajan, CTO, GE Healthcare has contributed significantly over the last two decades towards the development of Maternal and Infant Care products such as infant warmers, incubators, and phototherapy equipment. He is a firm believer that “low cost” does not translate to “low technology”, and that the opposite can often be true.

I was at the Healthcare Pavilion called "Odyssey Hospital" that showcased GE Heathcare's key capabilities and solutions in an integrated manner. A mini hospital prototype enacting GE touch points at every level.

I thoroughly enjoyed my conversation with him as I have used most of the portable devices on the ground especially while I was involved with WHO’s PMNCH program on Mother and child health. We hit off a banter when I realised how value packed their offerings are keeping in mind insights they derived from the ground and real life challenges.

I also interacted with Mr. Munesh Makhija, Managing Director, GE India Technology Centre Chief Technology Officer, GE South Asia.

Munesh and myself talked at length about GE Superheroes, the concept of organizing Tech Mela every year, GE's vision and how they celebrate everything they do.

It was a power-packed day and definitely a weekend well spent. You can catch up on more moments at #TechMela on Twitter handle @GE_ITC or take a look at this infograph that reiterates the vision- “Design and Make in India”.

Disqus for Healthcare India