Monday, 1 November, 2010

Mhealth in India- Pharmaceuticals

The Technology Driven data channels offers a key opportunity for pharma companies to restructure their sales and marketing model, improving their relationships with physicians and increasing compliance among patients. At the same time, patients are demanding a greater role in treatment decisions and seeking information from a range of online sources, resulting in a new age of consumerism in healthcare.

If you take a look at the screenshots below, you will realize the biggest problems for Pharma companies today where mhealth can be a solution. Courtesy- Businessmonitor.

Potential areas where Mhealth can be of use and can be deployed to tap the captive market driving non linear revenue.

As far as returns are concerned in the Pharma sector in India, India has one of the largest pharmaceutical markets in Asia, currentlyvalued at US$16.32bn. However, due to the country’s vast 1.17bn population, individual spending is actually very low. Pharmaceutical expenditure in 2009 was 1.24% of GDP,
which is just below the global average of 1.40%.

Chemists are Doctors....

The separation of the prescription and OTC medicines remains problematic, given the large volume of prescription drugs available over the counter.

Counterfeit is Easy....

Given that a number of essential drugs are already imported due to their low profit margins at home, the move to include more drugs under the price-fixing system has potential to worsen access to products and put the local industry at a disadvantage. This would open the door to regional competition, especially from parts of South East Asia. Furthermore, industry sources claim the change may also encourage the counterfeit industry to the overall detriment of both legitimate pharmaceutical industry and public health. The development of the healthcare system should improve the situation with the respective sectors gradually becoming more clearly defined.

Market Problems:

  1. While prescription drugs account for approximately 85% of sales, the share of drugs prescribed by a doctor is likely to be far lower...
  2. Alimentary tract, antibiotics and respiratory drugs are some of the most prominent prescription segments...
  3. Cardiovascular and nervous system remedies, with vitamins lead the OTC sector.
  4. Traditional and Ayurveda medicines very popular.

Policy Problems:

  1. Prescription-only drugs are listed in Schedules H and X, which are included in the Drug & Cosmetics Act.
  2. Schedule G drugs – mostly antihistamines – do not require a prescription, but must carry a warning label.
  3. Drugs listed in Schedule H, X and G cannot be advertised to the public. Schedule K medicines (‘household remedies’) can be sold in certain non drug-licensed stores, but only in villages that have fewer than 1,000 inhabitants.
  4. All drugs that are not classed as prescription can be sold as OTCs, although the OTC category is not legally defined.
Awareness and Advertising Problems:
  1. Pharmaceutical advertising is regulated by the Drug & Magic Remedies (Objectionable Advertisement) Act, which bans advertising of certain conditions and misleading marketing.
  2. The Organisation of Pharmaceutical Producers of India (OPPI) and the DCGI’s office have produced a joint Voluntary Code on OTC Advertising, with the OPPI also creating a Code of Pharmaceutical Marketing Practices.
  3. While there is no formal ban on medical advertising, prescription-only drugs are not advertised by the industry, which is a general agreement. However, the DCGI is considering issuing a formal notification regarding the practice.
  4. *Vigilance Problems-The WHO has described the lack of adverse event reporting in India as ‘alarming’. The New Delhi-based federal regulator employs only 25 staff members to cover the entire country, which has a population of approximately 1.1bn. In comparison, Sweden – which has a population of 9.9mn people – has 250-300 drug regulators with the same responsibility.
Disease Burden
  1. non-communicable diseases – such as diabetes and cancer – have a slightly greater burden in India than non-communicable diseases – such as tuberculosis and HIV/AIDS.=Mhealth# Compliance and Adherence systems like Simpill to be deployed.
  2. Hypertension is a serious issue on the sub-continent. Driven by changing lifestyles, studies indicate that prevalence of the disease has risen from under 5% in 1960s to 12-15% in the 1990s.= Mhealth# Remote monitoring of the Affected populace.
  3. The WHO estimates that by 2020, a staggering 60% of the world’s cardiac patients will be found in India.In the past 50 years, rates of coronary disease among India’s city dwellers have increased from 4% to 11%.= Mhealth# Daily tips for self care, Drug reminders and Diet and exercise.
  4. India is said to have over 2.5mn people living with HIV. The Joint UN Programme on HIV/AIDS
    (UNAIDS) estimates that the number of AIDS cases topped 124,000 in 2006, with a third of patients
    being under the age of 30. Overall, 0.36% of India’s population lives with HIV and accurate figures are
    extremely difficult to gauge.= Mhealth# the number of cases has been falling in recent months, suggesting that the infection rate has effectively been decelerated by prevention campaigns and programs urging people to practice safe sex.
  5. More than 2.5mn Indians are reported to be suffering from cancer.Oncologists are expecting a five-fold increase in cancer cases in the next 10 years.=Mhealth# Information, Awareness, Remote diagnosis using Telemedicine.
Clinical Trials Problems:
One drawback to conducting clinical trials in India is that the country does not allow phase I clinical trials on the basis of patient safety, and began allowing phase II trials only a couple of years ago. Additionally, India lacks adequate numbers of research personnel.

Pricing Problems:
  1. Ayurvedic medicines, traditional Indian remedies based on natural and herbal ingredients, are also regulated by the Drugs & Cosmetics Act (DCA), but can be sold freely.There is no formal price control on ayurvedic medicines.
  2. The NPPA is responsible for fixing and controlling the prices of 74 bulk drugs and formulations under the Essential Commodities Act, although only a few OTC ingredients (such as ephedrine) are price controlled.Overall, price control covers only around 40% of the total pharmaceutical market in India.
India will continue to struggle to provide adequate healthcare services to its rapidly growing population, which is also exhibiting signs of ageing. According to the statistics recently released by Population Statistics Bureau (PSB), India is predicted to overtake China by 2050 as the most populous country in the world, with just under 1.63bn people. Such demographic changes will significantly alter and increase India’s demand for pharmaceuticals and health services, the needs of which still remain unmet.

Thursday, 21 October, 2010

The Health Website

Good Morning friends! Hope you are doing good.Today we will talk about a Health website. I keep getting these mails from Health care Enterprises and new entrepreneurs asking for some suggestions and help for their health website, and I really don't get time to revert to them. This post of mine will help them understand and pave their vision better.

Q1. How people are going to find you and notice you online?

Ans- Internet represents less than 10% of the total retail sales. Online Business is of importance to consumers just because of two things:
a. Speed
b. Quality of Information
People are loyal to discounts, not you. Bundle your packages and wow your visitors. Position yourself as an expert whether it is apparel, cosmetics, shoes or medicines. If one product you sell-> Keep your customers informed about its use, your degree of expertise in that, related offers -> if possible provide buy back and all.

Q2. How to beat the competitor?

Ans- The thing that will make you win on web is the convenience factor. Easier + faster+ relevant= Beat beat beat!!!!

1. Suggestions, Prompts, analysis, comparisons always sell. (Saves time= serve better)
2. User friendly websites, Less complicated with flow and navigation maps.
3. Most of the customers don't know what they want, therefore prompts and drop downs are better than a blank search box. Something what Google does.

1. Variety motivates, Specialty motivates along with a simple UI (User Interface) and a robust search engine- As people love to buy products that are personalized, unique and different ;same ways a website lures. So if you have a niche site, your participation is confirmed.
Convergence= Focus= Win!

1. We cannot define our products and packages- Customers do that- Demand does that.
2. It got to be relevant= People pay extra money for convenience and security. Also ,if they are hurrying up to meet the deadline, they will happily pay for their peace of mind and will transact from home.

Big Point: Once glued, come and show policy- Remember the last time when you tried to change to a new web browser??? People don't do it often either.

Q4. How to add the entertainment factor to your website. How to help your customers stay glued?
ntertaining and answering every customer need is a herculean task. However, there are certain things you can do based on the following:

1. Emotion= FUN- There are these emotional customers who are looking for details. Tell you story, Tell them more. Company history, employees, assets, nobleness, charity and Business benefits if somebody ties up or collaborates with you. Put a name behind every review, every description, assign a particular Customer service agent name to each product- They should feel familiar, like they are taken care of and that it is not virtual= dangerous to shop online!

2. Discounts- So what's more exciting shopping for the most expensive watch or getting an ARMANI for half the price that too on installments/monthly EMIs. Bidding is fun coz it throws a challenge. When you buy that piece, you are thrilled. It makes you feel like a winner.

3. Forums- Heard of a concept called assisted shopping or s-commerce? People love praising certain products and show that their knowledge is impeccable. Some people love pulling down products and comment each other as well.

4. Creativity- Very recent concept, but Fun! Certain games like apps on facebook who loves you? what color is you? your makeover! The comic you!, your wedding look!, Games, puzzles are also fun. Especially if there is a competition or a prize.

In one sentence, whether it is a health care website, a retail one or Drugs website? It's got to be Customer Responsive. Marketing and sales gotta be a s good at the front end as is transaction processing at the back end.


Thursday, 7 October, 2010

Mhealth Model- Dr SMS in India- The Success Story

The... patient should be made to understand that he or she must take charge of his own life. Don't take your body to the doctor as if he were a repair shop. -Quentin Regestein
The World of “Speed- Living”! as simple, easy and compact as a mobile phone. Reminds me of Aircel’s popular advertisement “Pocket main Rocket hai”… I think”pocket main Rocket hai” is the right definition of Mhealth today! Many mobile projects struggle with scale and impact. While a mobile health project may run well with a small number of patients in one hospital, expanding the scope of a project until it is large enough to have real impact takes money, time, and widespread support of key stakeholders in a given community. And that is one of the biggest reasons why Mhealth is not keeping too well now-a-days and is suffering from “Pilotitis”.
Therefore, KSITM took this initiative to launch DR SMS in Kerala, aimed at improving health of the citizens of Kerala by improving access to health care resources by making available authentic information, providing timely information on medical and diagnostic facilities and providing informational alerts about emerging diseases. Kerala was also prompted to launch this m-Health project as it ranks as one of the leading States in India on mobile penetration. According to Telecom Regulatory Authority of India, in March 2008, Kerala has a tele-density of over 72 per cent as against the national tele-density of 32 per cent.
The project was piloted in Kozhikode (Calicut) in the district of Kozhikode in Kerala. The choice of Kozhikode was based on the fact that it is the third largest city in Kerala with a population of approximately 20 lakhs. Kozhikode was also chosen for the project piloting because it has the highest rates of mobile penetration in the State. Kozhikode also attracts huge migrant population/tourists, who are also one of the main targets of this project. The pilot project met with overwhelming success. The service was especially lapped by the large numbers of tourist population who did not know whom to contact in case of a medical emergency. During the pilot phase, an average of 200 daily transactions took place through the Dr. SMS facility.
The project has a credible and sound database on hospitals and emergency health centers drawn from a large data from the Health Infrastructure Survey, conducted by the National Commission on Macro economics and Health (NCMH), Ministry of Health and Family Welfare, Government of India. The system is supported by the National Informatics Centre and the State Information Technology Department. Encouraged by the success of the pilot project, the Government announced the launch of the project in all districts of Kerala.
What should be the Step 2 now?
I personally feel that Dr SMS can be very well linked with NRHM objectives for the State of Kerala. We actually have a lot to learn from a similar concept which Matt Berg described, during my visit to London. It’s called the ChildCount health monitoring system.
The project provides mobile phones to community health care workers who then use SMS to coordinate activities such as registering patients, transferring data to a central database, automatically alerting health workers to patients’ needs and facilitating communication among members of the health system. Roughly 100 community health workers at the Kenya site are equipped with mobile phones to monitor registered children for malnutrition and malaria.
The project’s five goals are to register every child under five in a given community into the ChildCount database, screen those children for signs of malnutrition every 90 days, monitor the children for the three major causes of death in children under five (malaria, diarrhea, and pneumonia), group all children into age groups in order to streamline immunizations, and record all local child births and deaths. The program has been meeting these goals with considerable success; for example, when the program incorporated a measles immunization awareness program, over 8000 children were vaccinated within seven days.
What will be the Business Model?
Though I am all set to pop a bill for this, I believe that NRHM should seek external funding as well. The ideology should be- “If the ultimate Goal is the same, Let us not work in silos, Let us work towards the common goal together”.Some of the Initiatives that could be of Interest to NRHM to collaborate with are:
Bill & Melinda Gates Foundation, Intel Digital Health Group,Robert Wood Johnson Foundation, McKesson Foundation, World Bank, UNICEF, UNFPA, European Commission, John Hopkins NCCC/GIAHC, U.S. Agency for International Development (USAID), Vodafone Americas Foundation, West Wireless Health Institute.
Reproductive & Child Health-II (RCH) program has already got funding from World Bank and the European Commission and We all know that the Rural Health Mission in Bihar recently got funding from Bill Gates Foundation.
According to the MoC, the Foundation will provide technical, management and program design support via NGOs in the areas of maternal, neonatal and child health; maternal and child nutrition; vaccine-preventable diseases, tuberculosis, pneumonia and Kala-azar, among others. While the MoC applies to all 38 districts in Bihar, the Foundation will initially start work in the nine districts of Patna, Banka, Khagaria, Begusarai, Gopalganj, Saharsa, Samastipur, and East and West Champaran. ..
To accelerate this momentum and fully unleash the potential of mHealth applications, dynamic multi-sector collaboration between groups as diverse as governments, multilateral organizations, and the private sector is needed.

Tuesday, 17 August, 2010

We talk about 600 million subscribers in India- Are these subscribers or Connections?

A recent report by India Mobile 2010, shuns TRAI for claiming a base of 621.28 million mobile subscribers at the end of March this year.India is without doubt the fastest growing telecom market in the world, but it had only 304 million subscribers at the end of May this year, according to a report by Juxt Consult. While Juxt survey measures and reports both the mobile users (subscribers) and mobile connections (subscriptions, ie who take new connections), TRAI data reports only the mobile connections, (which it mistakenly calls ‘subscribers’).

Apart from that, while TRAI data indicates a 75:25 split in urban and rural mobile connections, the split at both the subscriber level and the active connection level as found in the Juxt report is closer to 50:50. The report says that the mobile subscriber base in rural and urban India is 146 million and 158 million, respectively.

Also, according to the Planning Commission, 27.5 per cent of the population was living below the poverty line in 2004–2005, which means that only around 70 per cent of the Indian population can be the target subscribers.

There is little clarity on how the urban-rural split is recorded and reported by operators, and TRAI, and whether all SIMs in use in rural areas are recorded as rural, as many such connections may actually be getting bought in the urban areas.

Talk about a world of FREE SMS- (If you pay for an SMS, it got to be delivered. However there is no guarantee today, that is the reason why emergency or crisis management communication can't happen on SMS.- so why Operators are not giving SMS FREE- Is there something Handset providers can do- Yes yes Yes!.)

Wynncom has entered an exclusive agreement with a free SMS service application provider The agreement will allow users to send free SMSs from their mobile phones through an embedded application.

Wynncom mobile phones will have a preinstalled application developed by, one of India’s largest free SMS service providers. This unique application enables mobile phone users to send free SMSs to any mobile in India and in the UAE, Kuwait, Saudi Arabia, Singapore, Malaysia and the Philippines.

This application will use a GPRS connection to send the SMS, and the charge for data use will be miniscule.

Sometimes, I wonder why Mobiles are the only effective source of communication Today? - Think of the engorging Deaf and Dumb population in India!

In Australia, more than 50 percent of the general population sends at least one text message a day.The result is a nearly universal, text-based communications medium that connects the deaf to the hearing world. By using text messaging, deaf mobile users can order a pizza or invite friends for a beer. It's great for younger people because their group of friends is extended to their peer group, and not just other deaf people.

I remember visiting a Deaf and Dumb village in Kashmir. People in Dadkai Gandoh village of Indian administered Kashmir's mountainous district Doda are becoming victims of an incurable genetic disease, which renders them deaf and dumb. At least 72 such cases have surfaced so far from the village and its adjoining areas. The figures are feared to rise in near future.

But here is a good news!Soon, deaf and dumb can talk on mobile using sign language.- Result: Better education facilities, Health related Information dissemination and much more...

Developed by engineers at the University of Washington (UW), MobileASL uses motion detection technology to identify American Sign Language (ASL) and transmit video images over cell networks in the US.

The tool, which can be integrated to any high-end mobile phone with a video camera, is undergoing field tests involving 11 participants and the researchers plan to launch a larger field study this winter.

Earlier, speaking in the valedictory function of E-India, Union Minister for Communications and Information Technology, Mr A Raja said M-health was the fastest growing part of e-health and its importance was increasing.

The rapidly increasing importance of mobile phones as a platform for healthcare delivery in recent years is mainly attributable to substantial price reductions and the resulting rapid expansion of mobile phones used around the world, he said.

Mobile Vas in India - Statistics and Trends

  • Almost 63 million urban Indians accessed Internet using their phone in February, 2009.
  • Checking emails and searching information using search engines are the two most popular reason cited by almost 3 in 4 urban Indians.
  • 16 million urban Indians access Internet on their phone almost on a daily basis.

As per TRAI predictions, mobile VAS revenue growth contributing to telecommunication industry is expected to grow to 30% in next 5-7 years, which is way beyond the current contribution of 10-12%. Many experts are predicting mobile VAS in India to be 1 billion USD market by 2011. Let us wait to watch, what is there for Mobile VAS service providers in 2011.

Useful Links:

Monday, 21 June, 2010

Public Partnership- Mobile Healthcare India

Was busy the last weekend preparing for the GTF conference in Delhi.You can learn more about this by clicking on the emblem on the left . Government Transformation Forum is first of its kind forum aimed at enhancing collaboration and exchange of learning practices among the industry, academia, civil society organizations and the public sector in India. Through this forum, the organizers intend to keep the stakeholders abreast of the latest trends and cutting edge technologies so that the e‐Government programs are designed keeping in view the needs of the next generation. You can expect a lot of action here...

I was thinking while discussing the mobile health care concept with my peers, that if in case my Medical Insurance can't give me freedom from long waiting periods; my prescription delivered at home; Nurse and physiotherapy facility and continuous monitoring for my old parents and Real time Emergency Response in seconds, probably I will not opt for one.

But in India, is it too much to ask for??

Well, to cite a feasible example, Jon Pearce and his partners have created a technology called Zipnosis, which allows patients to get diagnosed and treated for minor health issues using a computer or mobile device. They call it “Health Care in Your Pocket.”

The process they’ve created is quite simple. The patient arrives at the site-->A series of questions are asked—>>>similar to what a patient might be asked in a normal office visit—>>that should take about five minutes to answer. This first step is referred to as “bullet-proof medical.” He means that the questions are designed to give a medical clinician the information they need to diagnose the problem—without the need for a physical examination.(Applicable for a few diseases only but can be lifestyle diseases like Diabetes, asthma, hypertension, arthritis to start of with.)

After the patient has submitted their answers, Zipnosis sends a text-based communication back to one of their on-call clinicians. The clinicians usually will have one of three general responses:

(1) suggesting an over-the-counter medication and get-well plan;

(2) prescription for an antibiotic; or

(3) a recommendation to see a physician for further examination.

Lastly, the patient receives a response from the clinician regarding their diagnosis and recommendation.

If a medication is prescribed, a map will be presented, indicating where the closest pharmacy is located, based on the GPS location of the patient.

This means that a patient could be almost anywhere when they receive their diagnosis. If I live at Karol bagh but when I am seeking help I might be driving close to Aurangzeb Road and thus would be looking at a pharmacy within 800 meters from there, once a prescription is received.

Now the Question is, who will enforce something like this in India...and through what?

Telecom Operators are "the king" in India. Telecom Regulatory Authority of India (Trai) is planning to introduce spectrum audit to ensure efficient use of spectrum by telecom operators. Now what is the meaning of Efficient? Government is the only entity that can enforce Health, Prevention, Reach and Outgrowth. 6.2 MHz spectrum is available in 2G in most of the cities while in metro cities 10 MHz is available. The word efficiency clearly indicates:

1. Smaller number of operators. (New operators are coming up and ready to give 3G Spectrum linked one time fee)(Bharti Airtel, Vodafone Essar and Bharat Sanchar Nigam (BSNL), stand to lose tens of thousands of crore if the government accepts suggestions Trai to charge 3G-linked one-time prices for spectrum already allocated to these firms many years ago.)

2. If we talk about taking mobile health to Rural India the government should implement this with Telecom operators by giving subsidies to private operators rather than a centrally owned government authority being given the responsibility to do that.

3. The Rural India- On a per circle basis, it is clear that India’s growth largely depends on rural demand and how fast mobile operators can connect the unconnected. Nevertheless, even though we believe there is clear evidence that 3G can help to bridge the so-called 'digital divide' in India, it will take time for mobile operators to develop users’ appetite for data services. A number of factors will influence the rate of adoption, but pricing is the most important.

Sunday, 6 June, 2010

Move ahead on MHealth

I have many many people, many startups and several small and big firms working on mhealth today. UHC is coming into it, Vodafone, Ericcsson, Nokia and many others have already participated in the same. The upcoming news boards like mobihealthnews, telecareaware etc. are also up.WHO is into it, so is World bank, mhealth alliance is formed by UN and much much more. But why aren't we moving ahead on it ...what is required?
The first thing is strategising. We need to go step by step especialliy in developing countries, coz here its the Operator's market unlike other countries.

What I and Vikas were debating about was whether you do the technical work (software) on the ground or build solutions beforehand. As usual, it depends on the circumstances of a particular situation and project. My belief is that each country should have a platform available for launching national health services.

Governments should either enable the process by working hand-in-hand or fund and get out of the way of the private industry. Just like roads and electric grids, health platforms should be a matter of national importance and unless there is this realization, the fragmentation of technology will continue.
Thanks a lot for the consulting opportunities, I will get back to you one by one. Thanks for bearing with me. In case you are looking for face to face meetings, I shall be presenting at mhealth conference and Expo, 14th-15th september in UAE. for more see

Saturday, 22 May, 2010

512 kbps of Mobile Healthcare

The other day I was sitting with my Mentors and I realised that Doctors in India can do wonders if we provide them with 512 kbps bandwidth on mobiles. Apollo Telemedicine Network Foundation and Ericsson started a program sometime back in 2007 called "Gramjyoti" in rural India and that was considered to be a big foray of telemedicine in rural healthcare.Thousands of people within the Gramjyoti project area covering 18 villages and 15 towns were able to use broadband applications. Ericsson worked in partnership with Apollo Hospitals, Hand in Hand (a local NGO), Edurite, One97, CNN and Cartoon Network to deliver a range of services including telemedicine, e-education and e-governance.

Point to be noticed is the prolem area. Sometimes the main factor itself is not the sole criterion on which the success of a project depends and that is what we learnt. Those were the days of GSM technology and the conditions of roads in India was bad especially in the rural areas. Consider a van where people are coming to Be treated/Operated.This van was well equipped but a small ditch or bump on the road, and the wireless transmitter used to turn 360 degrees and we could see nothing...Trust me if we can get 512 kbps on mobile, It will be like a boon for us Indian doctors to serve those patients who live in far-flung areas and need medical attention.

"In India, there are 1 million people that die each year purely because they can't get access to basic healthcare," said Dan Warren, director of technology for the GSM Association, the umbrella organisation that hosts the MWC.

For people in Rural areas, prevention still starts with Good roads, Better electrical and water supply, Proper Sanitation and then we can talk about Health and wellness with them.Through video conferencing, doctors based in Chennai, 70 km away, held surgery with patients in village citizen centres and the Gramjyoti broadband van. The patients were supported by paramedics who could administer ECG tests, blood pressure and injections. Overall 200 patients were treated like this during the trial.Ninety percentwere givenmedicines on site, and 35% have been referred to consultants.We used the UETR and GPEH to track for any problems that arise during drive test activity.

Lesson/Tip for a Rural Healthcare Project (If one is planning to start one):If you want to roll out 3G in a cost effective way, you need to attack capex and opex costs. Seventy percent of these are in the towers.Gramjyoti project with the help of network operators showed that site sharing works.The site sharing experiment showed that what we did in 20 villages, we could do in 250,000 villages without any problems.This is roughly the number of GSM cells in India and each one could share a tower with a 3G cell without interference. Operators came, the regulator came and people fromthe government came to see the trial and they left convinced that site sharing works. With site sharing and refurbished 3G handsets,we can bring the same economics to 3G that have made 2G such a success. It’s a myth than 3G HSPA is only for urban environments.

There's a business case for it now; you have to have the experience of the Healthcare Providers + Telecom Providers and on the ground talking to the big corporates out there and creating real business models, and that's the only way to success.

Monday, 17 May, 2010

mhealth in developing countries

The potential of mobile telephony to bring health care to the majority
Acute and emerging epidemiological challenges are encouraging public sector to welcome and support the development of increasingly innovative health care initiatives. Given that nearly 70 out of every 100 people carry a mobile phone in the region, if the easy-to-use mobile platform can be applied to health care to contribute to increased equity, mobile care could also contribute to improved clinical outcomes and productivity, as well as to better public health monitoring and education.

Oh yeah! we know about the potentials but then where does mhealth exactly fit in? Is it for Prevention?- Disease management or Real time monitoring?..

Actually Mobile Health is gonna be everything- Mobile health is a recently coined term, largely defined as health practice supported by mobile devices. For purposes of this note, mobile health practice includes public health, clinical medicine, and self-monitoring supported by mobile phones and personal digital assistants (PDAs).Currently active mobile health applications include the use of PDAs in collecting community health data; using the mobile phone to deliver health care information to practitioners, patients, and nonpatients; and real-time monitoring for citizens, both patients and nonpatients.Mobile health services tend toward preventive care and support for wellness, essentially helping individuals take care of their health before they become patients.

Ok! So if we talk about India what will support its growth, PPP?

Acute and emerging epidemiological and demographic challenges to health care systems are pressing the public sector to welcome and support the development of increasingly innovative approaches and initiatives. Emerging fields in health care include biotechnology (gene therapy, etc.), nanotechnology (instrumental in drug delivery), and information and communication technologies (mobile health). Together these offer a basket of new tools to address health care issues.

Need of the Hour?
The potential benefit of the mobile phone as a tool in widening access and improving health care is clear. Increasing penetration, combined with a wider range of possibilities for communication and an easy-to-use platform, allows access to less technology-literate groups.
So as the increasing subscriber base is in rural India, there is pressure to bring on best value benefits to the rural Consumer. No wonder Nokia Life tools Agri services forecasting weather to farmers and fishermen is such a hit. The mobile market in rural India has significant potential with number of subscribers anticipated to grow at a CAGR of around 32% during 2009 to 2012. When we talk about bad terrains , climate and remotely located areas. More than Mobile commerce, More than Location based services- The prime and the most important are Occupation related VAS (that's why lifetools is a hit) and Healthcare Value add services.
I think that's the way to go ahead...Need and supply....

Thursday, 29 April, 2010

Health on Mobiles

Mobiles have revolutionarised Healthcare, a big way, They are further going to make a mark in developing countries like India because of its reasonable penetration, Good subscriber base and ease to use.
The availability of low-cost mobile phones and the already broad coverage of GSM networks in India is a huge opportunity to provide services that would trigger development and improve people’s lives.

Today's Newspaper (Times of India) says- "3G Handsets to cost less thanRs. 5000 In a year"..Read more on Page 17 tuesday, September 15, 2009.

Yesterday, When a friend asked me - How secure will be the consultations provided by doctors over mobiles??, Say if somebody changes or tampers the prescription before it reaches the target consumer?, If there is some error in despatch , some inaccuracy etc., So till the time HIPAA compliance or HL7 server capacity is leveraged, Mobiles based Healthcare delivery will continue be a falcy. The Good News , Dr Neelesh shared with me on Health on Mobiles that there will be HIPAA compliant Doctor Diagnosis/consultations available now. The mVisum Medical Communication System is a communication tool that allows medical professionals to securely receive, review and respond to patient data recorded at the point of care.Information is transmitted via secure HIPAA compliant internet servers then transmitted through mobile technology to the required physicians’handheld smartphone.
Lets take an example , Have you heard of EKG, something like the picture below.We know this by ECG. A very common diagnostic procedure.
Using this service from mVisum, Of 600 EKGs read on a Blackberry mobile device, 599 were correct diagnoses.Great Accuracy. But is that 1% difficult to digest??

Lets move to privacy now, In order to take advantage of the technology, they use a GE Muse server and digital EKG. The mVisum software knows when an EKG is taken and grabs a copy (as does its internal EHR). If a call is placed regarding a patient, the cardiologist can scroll through the EKGs, locating the patient of interest and view the image off-site. Everything is server-based, so the EKG does not reside on the phone-when the physician logs out, there is no accessible data left on the phone. This is Great!

I was also impressed by's new concept. The Concept looks very interesting, But It costs a bomb, so not for rural market or to support connectivity in far flung areas. Folks in the UK have a new way to access medical assistance, i.e. via a 3G cell does not replace having a regular primary care MD, but it does cost...35 pounds per consultation...and accepts credit cards, pay pal, etc. It also offers the opportunity to create a personal health record prescriptions given here. Once you have completed your Medical Questionnaire your answers will be sent for review by a registered Medical Doctor who is insured to practice by the Medical Defence Union or Medical Protection Society. Video conferences should be started within 1 hour of the request and are 24/7...365 days a year...and if you miss you call after 2- attempts, you will have a cancellation fee of 15 pounds. To Read more click here.

Successful examples like Aarogyasri and DrSMS in India suggest utilising mhealth for social causes, Health awareness and prevention.
Some better examples for developing nations like India come from Frogdesign and Frontline SMS.


They Say -“In the developing world, lack of infrastructure prevents health workers from delivering efficient healthcare to rural areas. As health workers travel from clinics to reach isolated patients, they are often as disconnected from central clinics as the patients they are trying to serve. The mission of FrontlineSMS:Medic is to advance healthcare networks in the developing world by building and distributing innovative, appropriate mobile technologies. The centerpiece of our system is FrontlineSMS, a free, open-source software platform that enables large-scale, two-way text messaging using only a laptop, a GSM modem, and cell phones. We are also developing several applications for the FrontlineSMS platform that will enable better patient management, electronic medical records via the cell phone, cheap mobile diagnostics, and mapping of health services.”

Project Masiluleke

“Project Masiluleke (which means “lend a helping hand” in Zulu) is using mobile technology to tackle the worst HIV epidemic in the world in KwaZulu Natal, South Africa, where infection rates are over 40%. [frog design] is envisioning a solution that uses mobile technology in three crucial ways: 1) to encourage usage of low-cost diagnostic tools; 2) to walk patients through the testing process; and 3) to guide them into care should they need it, and encourage healthy preventative behaviors even if they don’t.”

Feedback and Suggestions Welcome!

1. How Should the Evolution of Mobile Healthcare Take Form? Simple or Advanced Services Development?

2. Where does mobile play a role - Limitations and Advantages, Extent of digitalisation, and support infrastructure required ?

3. Consumer Needs, Information Gaps and Role of the Ecosystem Player in the Healthcare Value Chain?

4. Challenges and things to watch out?

5. Exploration of Services and Evaluation of New Business Models?

Friday, 8 January, 2010

Mobile Healthcare scenerio in India

India is the second most populous country of the world and has changing socio-political-demographic and morbidity patterns that have been drawing global attention in recent years. Despite several growth-orientated policies adopted by the government, the widening economic, regional and gender disparities are posing challenges for the health sector. About 75% of health infrastructure, medical manpower and other health resources are concentrated in urban areas where only 27% of the Indian population live.

The new buzz is Mobile Health; in simple words it means access to valuable information and consultation for preventive and post treatment advice targeted at doctors and end users. The idea is to use telecom as a backbone tool to leverage the current brick and mortar model of Healthcare delivery across the country.

The scope of Telecom as well as technology to disseminate valuable and personalised Health information is now evolving. Better practices are expected to rely heavily on telecommunications services. Most of the high costs inherent in the current system are related to the proximity of the patient and provider, as well as to the archaic administrative systems used to manage records and exchange information. Telecommunications can bridge these proximity gaps as well as provide a normalized set of baseline data that can remain secure and yet be shared among healthcare workers.

While a major step was taken by Dr. Brilliant to eradicate even the smallest remnants of Small Pox from India, digital technology was used to predict and prevent this infectious disease depending on information that fed in from the grassroots. Teledensity in India is increasing at a phenominal rate and Soon Mobile handsets will emerge as a Mass targeted Medium, and hence various Health awareness and Information programs can be penetrated amongst the end users using the same.
Today, 90% of operator’s revenues come from Voice and Rentals. Of the balance 10%, about half comes from Person-to-Person (P2P) SMS. So, VAS accounts for only about 5% of revenue. Operators have primarily focused on voice. I see a new breed of companies emerging who will create direct-to-consumer services and focus exclusively on VAS. They will have multiple revenue streams - not just from subscribers, but also from advertisers and businesses. 3G will be a big enabler for richer services, and can actually drive higher ARPUs (Average Revenue Per User). Consumer will sit at the locus, and Healthcare services will become more consumer oriented, consumer driven and on demand.
The major need gap which can be addressed to, using Mobile based Information is Preventive Healthcare i.e. measures taken to identify and minimize risk factors for disease, improve the course of an existing disease and screening for early detection of disease. It is been said that by the end of 2009 3/4th of the Indian Population shall be covered by a mobile network, many of these new subscribers are from Rural India and hence the next possible market for derived revenue and penetration for Healthcare is the rural and semi urban population along with the urban saturated market which will possibly grow with VAS.An SMS on your mobile Phone is more personal and targeted, it forces you to take a moment to think and may be act.
The Consumer advantage scenario will take into account the seven major considerations of Cost, Quality & Relevance, Reach, Real time, on demand and Convenience.

Nominal subscription fee of say Rs. 30/month for Healthcare information and Tips on mobiles will be perceived as far more relevant when compared to spending the same on ring tones, Jokes or entertainment. The Challenge here lies in creating awareness as to how an early detection of disease will control your Health Insurance premium and lower your hospitalization costs. Also, a continuous follow up of an already detected disease using subscribed health information will reduce frequent doctor visits and in turn incurred cost.

The Quality of information dispensed should be from a reliable source, should be relevant and of local disposal. Partnership sources should include private and government participation using a strong and well branched out data collection network and a team of doctors.
People in rural areas usually have basic handsets, where literacy concerns are not paramount text messaging offer significant advantages in terms of convenience and flexibility. Information dispensed in local language with the ability to store and send data on ways to stay away from the possible ailments is the key.
As is the distribution and prevalence of certain ailments, so are the demand options, for e.g. Ulcerative Colitis is common in Punjab in north India, Cardiovascular diseases are more common in South India. Therefore, either data taken from the consumers can be utilized to develop an On Demand service or MOHFW or WHO Information base can be used to target risk factors in a particular community. An interesting publication in WHO Global Infobase indicates high prevalence of Multiple Coronary risk factors in Punjabi Bhatia community.
Convenience is probably the signature mega trend of the next era since the consumer desire for time saving plus the insistence on simplifying complexity coincides with technology developments able to deliver precisely the desired information in real time
. Early detection of a disease always pushes early response and management. The information provided should enable the End User take informed decisions as a part of Primary Healthcare Module. In this model, Consumer convenience and rights to access the information is the major gap, which needs to be bridged.

The whole process of Mobile Healthcare not only requires knowledge of applicable requirements but also a thoughtful combination of technology, laws, policies, Insurance, procedures, appropriate contract provisions and regulations.

Maximizing the mobile and technology benefits in the coming era will offer effective Healthcare Management at the commencement of such a venture and beyond.

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