InnoHEALTH magazine volume 4 issue 2 - April to June 2019 by innohealthmagazine

on VOLUME 4

ISSUE 2

APRIL-JUNE 2019

World Health Day: April 7

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Cybersecurity:Trends, Challenges,andThreats in Healthcare Cognitive development: Myths and Realities Gallstones: The Truth Underneath Impact of Cybersecurity on Healthcare Data Analytics to Improve Quality of Healthcare Type 2 Diabetes: A study in non-obese and Lean Indians

A Brief Review on InnoHEALTH Most liked article of the last Issue....

Testimonials from the InnoHEALTH Readers I ATTENDED the recent IC Club meeting and it was quite a meaningful presentation especially from legal standpoint. Thank you, Team InnovatioCuris. Rabin Majumdar Advocate, Supreme Court, New Delhi INDEED, a wonderful presentation on webinar. I really enjoyed it watching with my team. Thanks a lot. Benita Saklani Business Development Head Liveon Biolabs Private Limited (LBPL) New Delhi I RECENTLY became a part of a webinar. It indeed was a great and well-organized webinar. Thank you team InnovatioCuris. I watched each question up to the last question - answer discussion. Avinash Bharti Assistant Professor CharotarUniversity of Science and Technology Gujarat

I ENJOY reading your articles in InnoHEALTH magazine and thought it would be a good idea to reach out to you personally. We consider you an expert in the field, and we believe we could offer you a piece of visual content that might be engaging for your audience. Nikola Djordjevic Head of Content MedAlertHelp I HAVE just come across your highly insightful magazine on healthcare – ‘InnoHealth Magazine’ – today. The publication contains a wealth of information coupled with high production value. Thomas Antony Mumbai

Cyber4Healthcare:AnIssue of Today & Tomorrow I

t is a world of digital transformation with a large number of buzz words such as Innovation, Blockchain, AI, etc., spoken around within people on large. This is digital revolution where things change very rapidly with newer concepts, issues, challenges and solutions. One such major issue of digital world is Cybersecurity which relates to Ransomware, bitcoin, etc. Taking the cue, in the current issue of the magazine we intent to explore the trends, and challenges of Cybersecurity and address its need in the healthcare sector.

In a recent healthcare conference, the people were unaware when I spoke about how on October 21, 2013 the former US Vice President Dick Cheney’s doctors disabled his pacemaker’s wireless capabilities to thwart possible assassination attempts. To this, everyone had an issue on the accountability. It remains unanswered that who would be liable, the doctor, hospital, company which provided pacemaker or the insurance company. Amidst all this, nobody was concerned about the patient as none present there questioned it. Maybe we are awaiting a major catastrophe to happen to put our minds to work. It is our endeavor to equip the healthcare community to this aspect of digital health. Cybersecurity is major concern of patient safety and healthcare infrastructure. The health records, data, hospital information system and individual medical devices are all targets. The vulnerability is in technology and lack of awareness of staff. There are many examples to quote wherein hospitals have become victim of attacks. A recent audit of a corporate hospital in Delhi by our team revealed that 80% equipment is vulnerable to cyberattack, thus, risking the patients. Healthcare providers are not sensitised to issue as required hence this magazine is dedicated to Cybersecurity. We have named it Cyber4Healthcare and even launched a training program in healthcare domain to update knowledge of this extremely important topic. There is an immediate necessity that we invest in staff and equipment to make our systems robust enough to protect them from cyber-attacks.

We at InnovatioCuris always strive to sensitise the healthcare providers with new technologies and our next issue would focus on IoMT or connected healthcare which is overtaking the segment rapidly. However, we should always keep in mind that we are master of technologies and not the other way around. Can humane touch be replaced by technology? The trend nowadays is that we are leaving human ingenuity behind and are being heavily dependent on technology. There is a need to understand benefits and challenges of newer devices, technology and thinking. Let us consider how we can balance traditional to modern approach in today’s world and get best of both world. Let our readers share their experiences by writing for the magazine to benefit all.

Dr. VK Singh Editor-in-Chief & MD, InnovatioCuris

vksingh@innovatiocuris.com

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Health and Wellness Coach Platform for 38 Industrial Workers

Indo-Danish Relationship in Healthcare

Healthcare: Handle With Care

THEME Cybersecurity: Trends, Challenges, and Threats in Healthcare

Cybersecurity Business Evangelist 14 Cybersecurity: The Vulnerability of Medical Institutions to CyberAttacks 20

TRENDS Latest Innovations!

Is “Smart” Technology a Saviour of Healthcare?

Data Analytics Will Increase the Quality of Care! How?

Medical IoT: Future of Connected Health, Are We Ready? 32

WELL-BEING ASHAs Set Up a Role Model in the Eradication Programme Against Malaria in Odisha

ISSUES Cognitive Development: Before and After Birth-Myths and the Realities 40 The Fertility Diet: Zero Stress Recipe

Gallstones: The Truth Underneath

Snakebite: A Public Health Problem You Don’t Hear Of ! 45

RESEARCH Can Millets Be the Answer to India’s Nutritional Problems?

Non-Obese and Lean Indians Also Prone to Type 2 Diabetes: A Study 50 Digital Diabetes Management Market 52

NEWSCOPE Diabetes and Digital: Discussion on Unmet Needs and How Digital Tools Can Help? 54 Healthy Lives: Everyone, Everywhere 56 Book Reviews

Global Editorial Board Dr. Shailja Dixit, Chief Medical Officer, Scientific Commercialization, Fellow of Health Innovation & Technology Lab, USA Ronald James Heslegrave, Chief of Research, William Osler Health System, Canada

Editor-in-Chief: Dr. V K Singh

Executive Editor: Sachin Gaur Editors:

Alok Chaudhary

Dr. Brijender Singh Dhillon Dr. Avantika Batish

Nimisha Singh Verma Dr. Garima Singh Dr. Jasmeet Kaur Sr. Designers

Suraj Sharma, Ritu Versha Circulation Manager Mayank Kumar

Advisors Amir Dan Rubin, Executive Vice President, United Health Group, USA Thumbay Moideen, Founder President, THUMBAY Group, UAE Tanya Spisbah, Director Australia India Institute, Delhi

Dr. Chandy Abraham, CEO, Healthcare Project, ITC Limited, India

Dr. Sharon Vasuthevan, Group Nursing & Quality Executive at Life Healthcare Group, South Africa Dr. Kate Lazarenko, Founder and Director, Health Industry Matters Pte. Ltd, Australia

Dr. Sarita Jaiswal, Ex-Research Officer at University of Saskatchewan, Saskatoon, Canada (currently in India) Printed and Published by Sachin Gaur on behalf of InnovatioCuris Private Limited Printed at Lippe Scan Private Limited 89, DSIDC, Phase-1, Okhla Industrial Area, Delhi 110020 Editor: Sachin Gaur DCP Licensing number: F.2.(I-10) Press/2016 RNI: DELENG/2016/69964

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All rights reserved. Neither this publication nor any part of it may be reproduced, stored in a retrieval system, or transmitted in any form or by any means, electronic, mechanical, photocopying, recording, or otherwise, without the prior permission from InnovatioCuris Private Limited.

Disclaimer: Readers are requested to verify and make appropriate enquires to satisfy themselves about the veracity of the advertisements before responding to any published in this magazine. Sachin Gaur, the Publisher, Printer and Editor of this magazine, does not vouch for the authenticity of any advertisement or advertiser or for any the advertiserâ&#x20AC;&#x2122;s products and/or services. In no event can the Publisher, Printer and Editor of this magazine/ company be held responsible/liable in any manner whatsoever for any claims and / or damage for advertisements in this magazine. Authors will be solely responsible for any issues arising due to copyright infringements and authenticity of the facts and figures mentioned in their articles. InnoHEALTH magazine is not liable for any damages/copyright infringements.

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Indo-DanishRelationship in Healthcare Peter Taksøe-Jensen is the Danish Ambassador to India, Bhutan, Maldives and Sri Lanka, Nepal since August 2015. Prior to this, he served as the Ambassador to the United States from 2010–2015. He has worked in various areas of ministry which include the Security Policy Department, Legal Service, and the European Union Law Department and on various government commissions. Taksøe-Jensen obtained his law degree from the University of Copenhagen. Dr. Jasmeet Kaur interviews him on his view point on the current scenario in healthcare.

Q. What are the updates for 2019 regarding Indo-Danish relationship in Healthcare? The relationship between India and Denmark is becoming better each day. In December 2018, the Foreign Ministers of both the countries met in New Delhi and relaunched the Indo-Danish Joint Commission, which provides the framework for all strategic sectors’ cooperation including healthcare. This breakthrough paved the way for the Danish Prime Minister’s visit to India in January this year. Among other things, he participated in Vibrant Gujarat spearheading a Danish business delegation, where he also met with Prime Minister Modi. The purpose of these visits was to strengthen political and economic ties between India and Denmark, because both countries will benefit tremendously from increased interaction and business collaboration.

In this regard, healthcare is a key focus area for 2019. This decision is based on the success of two large projects in 2018; one is focused on non-communicable

diseases and the other on attaining the SDGs within healthcare. We were able to develop concrete grounds for working in a focused manner in this field and assist Danish companies looking to gain a footing in India. Several Danish companies are already established in the Indian market including Novo Nordisk, Widex, Coloplast, Fertin, Falck and many more are expressing their interest. Q. The Danish Health System is incorporating changes for good in recent past with new hospitals and other delivery mechanisms, can you share your view-point on relevance of them to India? The Danish health system is a publicly funded scheme, which covers all Danish citizens. There is a lot Denmark can contribute with to India in terms of know-how and sharing of best practices. Areas where

PERSONA THEME TRENDS • India has a lot of data available and Denmark could collaborate with India to develop solutions and therapies.

• The Danish hospital system is undergoing unprecedented expansion and restructuring. Denmark has spent years of research and gathered expertise from all over the world to develop 5 new national super hospitals and renovating 11 existing hospitals. India can leverage this knowledge while it is at a stage where there are still new hospitals getting on. Q. What can India offer to Denmark, your opinion? One of the common areas of work between Denmark and India is dealing with NCDs. It is a global challenge. Denmark is currently investing a lot in developing solutions to address this global multifaceted issue. Our research environments, universities and companies are trying to create products that could be

India being a bigger country with much bigger amount of data; this can be utilized to further make the Danish healthcare sector more effective. Furthermore, private players dominate the Indian healthcare sector, which has created different incentives and a quicker implementation time. Both learnings from private players and data from India can be beneficial to the Danish healthcare sector. Q. Any message for the readers of InnoHEALTH Magazine that you want to share? Healthcare is a global challenge, and we need global solutions to attain the Sustainable Development Goals. Having in mind that 17 percent of the world population lives in India, it is safe to say that if India fails, the world will not succeed. Therefore, the strategic sector cooperation between Denmark and India is very important.

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• Empowered its patients allowing them to access all relevant information about their health and well-being. I believe that the Indian government’s launch of Ayushman Bharat Scheme is also a move in the similar direction and with the similar intent of providing better

• Other areas where Denmark has done exceptionally well is use of Telemedicine for connecting patients in remote locations and reduce time at the hospitals.

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• Digitalization has helped Denmark save both time and money. These learnings can be adopted in India to bring down costs in public as well as private set-ups.

suitable not only for Denmark but across the globe. One of the very specific things Denmark could explore is:

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• Digitalization of some solutions to address the challenges that exist in current healthcare system. Denmark is a leader when it comes to digital workflows and working with electronic health records. Like in India, there are multiple stakeholders within the healthcare system (doctors, patients, nurses, local and state authorities, pharmacies, etc.) that are bound to work together but at the same time operate as individual entities as well. Denmark managed to achieve a high level of efficiency by digitalizing processes and thus, improve efficiency.

healthcare access to all. Therefore, I see a great scope of collaboration and partnership between the two countries.

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Denmark can assist India include:

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Healthcare: Handle With Care Karnal Singh, the Former Director of Enforcement Directorate opens up with the Sachin Gaur, Executive Editor, InnoHealth about his opinion on trends of cybercrime and threats in 2019 Karnal Singh, a 1984 batch IPS officer and Engineer from Delhi College of Engineering (DCE) and Indian Institute of Technology (IIT), has over 34 years of experience in investigation of corruption, terrorism, money laundering, and cyber-crime cases. He is a recipient of Presidentâ&#x20AC;&#x2122;s medal for distinguished service and Police medal for meritorious service. Q. Given your important assignments for the Government of India in the past, share with us the big picture. What are the trends you see in terms of cyber crime and threats for 2019? The world is getting more connected and technology has seeped into every aspect of our lives. On one hand, these advancements make our lives easier and on the other bring a lot of

vulnerabilities with them if security isnâ&#x20AC;&#x2122;t strong enough to tackle cyber criminals. Hackers today are welleducated and have the capabilities to develop new methods and tools to exploit the vulnerabilities on the computer systems and networks. Few do it for their academic interest and thrill and inform the person concerned about the vulnerabilities

so that the same can be plugged. They are known as white hat hackers. While the others do it with malice and self-gain and are known as Black hat hackers. To gain access to the computer systems, the cyber criminals and hackers will continue to deploy already existing tools (called as exploits) with enhanced

A. Internet of things(IoT): Considerable number of smart gadgets (such as TV, plugs, IP cameras, smartphones, tablets, network video recorders, heaters, refrigerators) are used at homes and industries. When these gadgets are connected to the Internet, they are termed as Internet of Things. The hackers will increase their attacks on IoT using vulnerability in cloud infrastructure and hardware

D. Social media content compromise: There will be increased use of Botnets to compromise the social media to influence the public opinion. Q. Being a healthcare publication, our readers would be interested in healthcare specific cyber threats. What is your opinion on the health sector threats? The health sector offers life critical services. It maintains the identity and clinical records of a large number of patients. The following factors make the health sector more vulnerable as compared to the other sectors. â&#x20AC;˘ IoT (Internet of Things) devices are used extensively for the treatment of the patients viz. smart continuous glucose monitoring, connected inhalers for asthma, apple watch

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4. Injection Attack: Protective systems installed on computers look for malicious files to detect cyber-attack. The injection attack is file less; the hacker directly inserts the malicious code in the memory, thereby compromising the machine, without ever dropping a file onto the infected

The above-mentioned techniques will be sharpened to attack numerous utility services (some of which are listed below) by the black hat hackers for malicious purposes:

Besides the cyber criminals, who would use such hacking for ransom, terrorists and even nations can use it against public or adversaries.

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3. Discover and target organizations outside the firewall: Most of the commercial organizations deploy firewalls, intrusion detection systems and intrusion protection systems; thereby making hacking difficult. But they use third-party software, which may be having vulnerabilities. Hackers can attack the third-party systems used by the commercial websites.

7. Rouge AP(access point) and Evil Twin: Rouge AP is an access point installed on the network without the knowledge of the administrator, while the evil twin is identical network.

C. Real world damages: There will be more and more attacks on services providing community services viz, municipality, health sector, electricity supply, water supply and sewer systems.

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Botnets can be put to perform some distributed function viz, crypto jacking (mining bitcoins) or distributed denial of service attack.

6. Application of artificial intelligence: Artificial intelligence techniques will be used more and more to avoid detection by the intrusion detection tools. For example, Waterminer, a cryptocurrency mining tool injected as malware, stops mining when task manager or antimalware scan is run.

B. Attack on identity platforms: Identity platforms offer centralised secure authentication of users, devices and services across IT environment. It could be database of banks, hospitals, social media sites, etc. Identities of large number of persons would be attempted to be stolen for extortion, impersonation or proving the inadequacy of the commercial organization in securing the important data (so as to blackmail).

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If there are more than one compromised device, then it is called botnet.

5. Biometric Hacking: Cybercriminals use brute force attack, dictionary attack or social engineering, etc., to crack the passwords. Many people have shifted to biometrics. The academic research suggests that a number offinger print authentication systems could be spoofed, even highly sophisticated facial recognition system have been proven vulnerable to more advanced hacking efforts.

to threaten the users physically or mentally.

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2. Bot and botnet: The hackers have been successful in remotely taking control of the hacked computer systems. Such system is known as bot. The hacker can remotely misuse a machine (using computing time or other resources) without the actual user being aware of it.

system. One such example is British Airways site hack in 2018, resulting in identity theft of around 3,80,000 users.

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1. Chatbots: There will be an extensive use of machine learning techniques (Artificial intelligence) in near future. A Chatbot can be injected into the important website (for example, a banking site). Chatbot in the form of a man or woman would pop up on the screen and will start interacting with the user (like what we see the google assistant doing). Then it may misdirect the customer to a nefarious link similar to an actual banking site, thereby fetching important information from the customer and compromising his banking information.

Identity platforms offer centralised secure authentication of users, devices and services across IT environment. It could be database of banks, hospitals, social media sites, etc.

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capabilities. More advanced tools will be also be developed in the coming years. Some of the important ones are enumerated below:

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app that monitors depression, etc. • The doctors and patients can connect external storage devices and even mobile phones to the hospital database system. • Third-party software and hardware are deployed which makes it vulnerable to supply chain poisoning. • Most of the services provided by the hospital are connected through the Internet or the cloud services. Clinical data is of immense use for the cybercriminals and cyber terrorists. They can use vulnerabilities in cybersecurity in the following ways: 1. Identity theft: Medical identity record is very useful for the cyber criminals as it can be used to impersonate people in the digital world and gain access to financial systems as well as to commit fraud by claiming treatment or insurance at the cost of insurance agencies and the patients. Therefore, this data is sold at a higher rate in the dark net as compared to identity records of other sectors. 2. The clinical records of the patients may sometimes contain their psychological disorders or conditions, or a person may be suffering from concealed diseases (sexually transmitted disease etc). The hacker may make use of such information by blackmailing or harassing the patients. It would cause hardship to the patients and would put the reputation of the healthcare service provider/hospital at stake which failed to protect the patients’ identity and clinical records. 3. Ransomware attacks on hospitals will be on rise. The information of the patients is mostly time critical. If the cybercriminal denies the access of data to hospital even for a short span of time, it may lead to lack of timely treatment to critical patients and therefore, hospital administration is not in a position

to delay the ransom payment. 4. Prescription change: In India, majority of renowned hospitals in metro cities are computerized. Doctors give online prescriptions which immediately become available to the concerned medical staff, such as a nurse who administers the drug to patient. Cybercriminal scan tamper the prescription which may harm or even cause death of the patient. They can cause obstruction in oxygen supply line or failure of electricity. They would be able to change medical records of the patients, which will lead to wrong diagnosis and treatment. Not only cybercriminals but the terrorists can adopt the above techniques and threaten the nations or can even cause large scale fatalities. Therefore, it becomes extremely important to adequately secure the health sector databases. Q. Health sector has seen major attacks of ransomware; part of the equation is 'money aka cryptocurrency' in organised crime. How do we handle this? Being proactive about cybersecurity is perhaps the best approach to tackle cyber-attacks. Health sector should form cybersecurity forum for cybersecurity policy formulations and mutually evaluate hospitals’ preparedness against the cyberattacksby ensuring adherence to the cybersecurity policies. Additionally, each hospital network should have a dedicated team of IT security professionals to guide the management and proactively check for any cyber invasion. The IT team should ensure that the latest patches for all the devices and software are installed and there is protection from supply chain poisoning. The system should be equipped with features firewalls, Intrusion Detection System, Intrusion Protection system and processes analytical tools among others. The block chain techniques can also be explored for data management and the patient databases should be encrypted so that the are of no use to the hacker.

Further, the hospitals must take data backup with fast recovery plan. Regular penetration testing of the system should be done to eliminate potential vulnerabilities. Hospitals should invest in training IT staff in cybersecurity policies and cybersecurity technologies. Regular analysis should be done of employees’ computer usage pattern so that any compromised user is effectively detected and timely removed from using the system.There should also be a secure access control preferably using biometric features. Q. Today security has become a hot topic and world over we see that regulation is leading change and innovation! What is your vision for India in the regard? What regulations will make health sector more secure? Or we don't need regulation? The cybercriminals attempt to hack the computer resources of the hospitals by exploiting the vulnerabilities in the computer systems. They manipulate the stored information, steal the same or hold it for ransom. The hospital databases work on the trust reposed by patients in the hospital administration that their data will be guarded with privacy. Cybercriminals can be prosecuted under various provisions of the Indian Information Technology Act, 2000(ITA). The IT Act creates civil liabilities for the offences under the Act vide Sections 43 to 45, wherein any amount of compensation can be given to victims; it also creates criminal liabilities vide Sections 65 to 74 of the Act. Cybercriminals are liable to both civil and criminal liabilities. Hospital administration is responsible for protecting the data and failure to protect can result into civil liability under Section 43A of the IT Act. However, this section can be invoked if the breached data results into wrongful loss to victim or wrongful gain to cybercriminal. Victim has to prove that there was wrongful loss to him/her. The offences by the intermediaries are criminalised under Section 67C of the IT Act. However, the same gets diluted by the

PERSONA THEME TRENDS The IP address (internet protocol) and the time of its use, identify uniquely the source of attack. However the cybercriminal may commit cyberattack through Bot or botnet. In that case, the IP address will lead the investigation officer to slave machine, even though user of this machine would have no knowledge of misuse of his computer resources. If the investigating officer doesn’t go into depth of log analysis of such system, then the innocent people might have to face false prosecution. The stakeholders should ensure all logs are maintained and stored by his computer system so that audit trail can lead to actual perpetrator of cyber-attack.

The next hurdle is the global spread of evidences into other jurisdictions. Letter rogatory (letter of request) is sent to each foreign jurisdiction for getting the

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There is also dearth of cyber experts in forensic science laboratories, resulting into delays of months and years in getting reports from them which can compromise the further evidence leading from forensic analysis of seized electronic material. During my tenure in the Enforcement directorate, I found this delay to be of 1 to 3 years, therefore, I initiated six in-house cyber forensic labs. This led to the cyber forensic analysis done at a quicker pace also improving the quality of investigation.

The investigation become further complicated if Tor or onion routing is employed by cyber criminals. Finding the cybercriminal in this scenario becomes more difficult.

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Q. As the cyber incidents keep rising and legal regime catches up, what is your opinion on our abilities in investigating cybercrime? As you know attribution and audit trail are not the easiest in cyber world, any advice for stakeholders, so that they are not wrongly prosecuted or get justice on time? As per the Section 78 of the IT Act, 2000, a police officer of the rank of Inspector and above is authorised to investigate the offences under the IT Act. This is to ensure the quality of investigation. However, all Inspectors in police are

evidences located in that jurisdiction. The process is slow and it may take 3 to 4 years in getting reply. If that reply further requires evidences from another foreign jurisdiction then another 3-4 years are gone. Therefore, the entire investigation is time-consuming.

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The Government of India appointed Justice BN Srikrishna Committee for effective data protection laws in India. The committee submitted the Draft Data Protection Bill, 2018 to the government in July 2018. It will be introduced in parliament after the forthcoming elections in India. The Government of India is also planning to introduce “The Digital Information Security in Healthcare Bill” in the parliament to secure the healthcare data of patients in India.

not trained in cybercrime investigation. Further, complexities of computer technology, tools and methodology used by cyber criminals make it difficult even for a trained person to keep pace with the development in this field. Police organizations don’t employ external cyber experts to aid in investigation. Each police officer investigating the case seeks help from other expert police officers or cyber experts of his/her choice. Therefore, institutional help is lagging.

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provisions contained in Section 79 of the IT Act. Hence, the IT act doesn’t provide absolute data security laws.

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Cybersecurity: Trends, Challenges, and Threats in Healthcare

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Written by DR. URVASHI (RAHEJA) BHATTACHARYYA

ikewise, the global trends, the growth of Internet in India is incredibly fast-paced, with an estimated addition of 10 million active users each month. Along with the increase in number of users, the adoption rate of going digital by various stakeholders in our society is also growing exponentially. Unfortunately, this also increases our vulnerability to potential hacks or security breaches that come from individual hackers to organized groups to even attacks from nation states. Cybersecurity, thus, entails protection of our cyberspace, and all the critical infrastructures like banking and finance, defense, healthcare, manufacturing, nuclear reactors and commercial facilities from being target to any sort of attack,

damage, misuse or act of espionage. The healthcare industry is particularly vulnerable to cyber threats not least because of the minimal amount of investment they put in cybersecurity measures. Hospitals, insurance companies, pharmacies, developers/ owners of healthcare websites, manufacturers of medical devices, or handsets, or third-party vendors to which sensitive patient data gets shared; all represent a leaky pipeline through which hackers can enter a system and cause extensive damage. The types of attacks can include access to patientâ&#x20AC;&#x2122;s medical history, prescriptions, financial and personal details or using the Internet of Medical Things to disrupt implanted medical devices or devices

like drug infusion pumps. Healthy cybersecurity practices have, therefore, never been more important than today when a ransomware attack like WannaCry has the potential to literally shut down a countryâ&#x20AC;&#x2122;s (UK) National Health Service. WHERE INDIA STANDS TODAY? According to the International Telecommunication Union (ITU), a UN telecommunications agency, India ranked 23rd amongst 165 nations on the Global Cybersecurity Index (GCI) in 2017. GCI ranks nations for their commitment towards cybersecurity using various measures legal, technical, organizational, capacity building, and cooperation. With the rapid rise in cyber threats,

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Dr. Urvashi (Raheja) Bhattacharyya is a Senior Research Analyst at StudyMode. She indulges in machine-learning methods during office hours and enjoys writing about healthcare and education in her free time.

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DISHA also specifies the rights of the owner of digital health data, outlines the purposes for which DHD can be collected and explicitly mentions all clinical establishments holding DHD to be duty-bound in maintaining privacy and confidentiality of the patient’s data.

MARCHING AHEAD The breach of data far more often in the healthcare sector compared to other sectors highlights the value of information stored in digital health records. It is, therefore, important that cybersecurity takes precedence for all the healthcare providers. Proactive measures include identifying likely targets, securing and updating systems in a timely manner, constant monitoring for malwares or security breaches and reinforcing good user behavior among the employees. Similarly, the response to data breach incidents needs to be swift to minimize the extent of damage when a cybercrime occurs. Like the adage, ‘prevention is better than cure’, the healthcare providers also have a necessary task ahead of themselves to up their security measures in accordance with the current legal framework, before a patient’s data or trust gets compromised.

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Accordingly, DHD means any electronic record of health-related information • concerning physical or mental health of a person • on any health service provided to an individual • on donation of any body part of any bodily substance • derived from testing or examination of a body part or bodily substance • collected during providing health services • relating to details of the clinical establishment accessed by a person

Importantly, DISHA touches upon what constitutes a breach of digital health data, compensation in the event of one happening and what punishments an individual or a company might face if convicted of a cybercrime.

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HEALTHCARE SPECIFIC PROVISIONS While the above-mentioned regulations provide a general legal cybersecurity framework for all the organizations, no separate provisions are in place viz a viz the healthcare sector. India decided to fill-in this gap last year when the Ministry of Health and Family Affair, the Government of India proposed the Digital Information

Security in Healthcare Act (DISHA) and placed it in public domain on 21 March 2018 for comments by various stakeholders. DISHA aims to ensure reliability, data privacy, confidentiality, and security of digital health data. The act, applicable to entire India except for Jammu and Kashmir, establishes eHealth Authorities and Health Information Exchanges at the state and national levels while also outlining the guidelines on standardizing/ regulating the processes related to collection, storing, transmission and use of digital health data (DHD) in India.

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India established its first cybersecurity policy - the National Cyber Security Policy (NCSP), in 2013, after much mayhem caused by Edward Snowden’s allegations of NSA snooping on India. The policy designated CERT-In (Indian Computer Emergency Response Team), a national nodal agency to respond to and analyze incidents of cybersecurity breaches. CERT-In provides alerts of cybersecurity incidents, conducts emergency measures for handling such incidents, coordinates necessary response activities and issues guidelines, etc., regarding cybersecurity measures. In case of data breach, an organization holding confidential user data must report to CERT-In promptly.

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For instance, it was last in 2000 when the legal provisions related to cybersecurity were formulated in the Information Technology Act (ITA), when the nature of threats revolved only around viral or malware attacks. The ITA was later amended in 2008 and now deals with cybercrimes such as hacking, tampering, data or identity theft, cheating, phishing, etc. Sections 43 and 63–74 provide provisions for civil and criminal prosecution in case of different cyber offences. The ITA requires entities holding private data of users to maintain specified security standards and provides provisions to users for airing grievances in case of data breach.

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India’s growing investment in protecting its data is absolutely a positive development. Nevertheless, a quick look at the current statuson cybersecurity and data protection laws in India highlights the gap we must fill in as we move towards complete digitizing of various infrastructures in the 21st century.

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Cybersecurity Business Evangelist

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Written by KRIS SEEBURN

ealthcare data breaches have risen nearly every year from 2010 through 2019 and the security risks jeopardize hundreds of millions of patients records. Although physical theft used to be the data breach method of choice, now hacking has become the most prevalent method. This partly stems from more information being stored electronically and network servers becoming a more attractive hacking target. However, much like the rest of the world, healthcare organizations are shifting work to cloud services in order to improve accessibility and patient care. The migration of these workloads and moving valuable information such as PHI (personal health information) and PII (personally identifiable information) to the cloud has also led to cybercriminals taking a particular interest in the industry.

As organizations seek to protect their patient information from these growing threats, demand for health informatics professionals who are familiar with the current state of cybersecurity in healthcare is on the rise. Having shifted workloads to the cloud, healthcare organizations have highly connected systems that run the risk of being deeply affected even if the attack takes place on smaller, partial systems. In other words, a cyberattack in one place could bring down the entire system. In May 2017, the WannaCry ransomware attack forced multiple hospitals across the United Kingdom to turn away ambulances transporting patients and cancel surgeries that were within minutes of starting. Even basic processes like admitting

patients and printing wrist bands were compromised. The number of ransomware and other malware attacks is rising incredibly fast in the healthcare industry, putting human lives as well as critical data at risk.One of the key aspects making healthcare organizations a top target is the value of their data. Commonly, a single stolen credit card number yields an average $2,000 profit and quickly becomes worthless. Healthcare data, however, such as

PHI or PII, is extremely valuable on the black market.

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• Malware and ransomware: Cyber criminals use malware and ransomware to shut down

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The Challenges The newest cyber vulnerabilities are not necessarily an organization’s biggest cyber threat. Consequently, many common threats continue to be problematic in healthcare, including:

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The continued underinvestment in cybersecurity has left many so exposed that they are unable to even detect cyberattacks when they occur. While attackers may compromise an organization within a matter of seconds or minutes, it

“So, What is Wrong With the Picture?” The base question to ask is “Who would be interested in hacking patient data?” It is precisely this attitude together with the rate at which healthcare refreshes its technology that exposes healthcare organizations to a high risk of cyber-attack. The fact that makes the industry appealing to hackers: ransom for money; denial of service for malice and money; stealing confidential data; compromising data; identity theft and compromising devices. The scale of disruption and impact to busy healthcare settings already operating at capacity caused by a cyber-attack needs

• Leadership: Ownership of the issue • Culture/Staff responsibility/ awareness: Training and awareness of cybersecurity and its related implications • Policies and procedures: Understanding of business continuity processes and incident response procedures • General cybersecurity knowledge: Use of fundamental security processes that are currently followed within the organization to mitigate security breaches, e.g., use of USB, on- and off-boarding processes, password policies, organizational asset register, and so on.

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Data breaches cost the healthcare industry approximately $5.6 billion every year, according to Becker’s Hospital Review. The Breach Barometer Report: Year in Review additionally found that there was an average of at least one health data breach per day in 2016, attacks that affected more than 27 million patient records.

no explanation. The reality covers the four main domains: PERSONA

A single PHI file, for example, can yield a profit of up to $20,000. This is mainly because it can take weeks or months for a healthcare data breach to be discovered, enabling cybercriminals to extract much more valuable data. Moreover, because healthcare data can contain dates of birth and Social Security numbers, it is much more difficult or even impossible to change, so thieves can take advantage of it for a longer period of time.

often takes many more weeks – if not months – before the breach is detected, damage is contained and defensive resources are deployed to prevent the same attack from happening again.

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individual devices, servers or even entire networks. In some cases, a ransom is then demanded to rectify the encryption. • Cloud threats: An increasing amount of protected health information is being stored on the cloud. Without proper encryption, this can be a weak spot for the security of health care organizations. • Misleading websites: Clever cyber criminals have created websites with addresses that are similar to reputable sites. Some simply substitute .com for .gov, giving the unwary user the illusion that the websites are the same. • Phishing attacks: This strategy sends out mass amounts of emails from seemingly reputable sources to obtain sensitive

Another growing threat in healthcare security is found in medical devices. As pacemakers and other equipment become connected to the internet, they face the same vulnerabilities as other computer systems. information from the users. • Encryption blind spots: While encryption is critical for protecting the health data, it can also create blind spots where hackers can hide from the tools meant to detect breaches. • Employee error: Employees can leave healthcare organizations susceptible to attack through

weak passwords, unencrypted devices and other failures of compliance. Another growing threat in healthcare security is found in medical devices. As pacemakers and other equipment become connected to the internet, they face the same vulnerabilities as other computer systems. How are Hackers Achieving this, You Would Ask? Hackers usually access information in one of two ways. They can try ‘social hacking’, which means tricking a human being into giving over sensitive information or security credentials which in turn allows access to sensitive information. This could happen by tricking either someone who works directly for the provider, or an outside contractor. An unsophisticated example could be, ‘Hi, I am an IT provider for your company, and I need to carry out some maintenance, could you please provide these sensitive details for me?’. The second way is brute force: directly attacking a security system. Once Hackers Get Access to The Data, What Do They Do with It? In some cases, hackers access sensitive data, extract it, and lock it off. They can then sell it back to the company. If the company does not have backups, buying it back is probably the only viable option. The alternative is for them to lose all records of their patients which they will never be able to replace. Another possibility, is hackers stealing data and selling it to the

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In Simple Terms: How Do We Improve Cybersecurity? Due to the significant financial impact of data breaches in health care, health informatics and other professionals need to play an important role in ensuring that medical organizations remain secure. Individual healthcare organizations can improve their cybersecurity by implementing the following practices: • Establish a security culture: Ongoing cybersecurity training

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Healthcare security professionals need to understand the threats they face and the regulations they must comply with, and they must be provided with best practices for strengthening cybersecurity defenses. This means implementing comprehensive security awareness

Furthermore, implementing the right cybersecurity measures, such data loss prevention, user behavior analytics, and endpoint security technologies, will further protect an organization's infrastructure and patient data from ransomware attacks. By creating a system that guards the human point — where people interact with critical business data and intellectual property — and

takes into account the intersection of users, data, and networks, the healthcare industry can improve its cyber threat protection.

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Additionally, the industry should be aware that cybersecurity isn't just the responsibility of the IT department: everyone should be aware of the risks, from management down to brand-new contract staff.

training that educates all people on current threats, red flags to look for in an email message or web link, how to avoid infection, and what to do in case of an active exploit. And since the threat landscape is constantly changing, training should be repeated and updated regularly.

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What Can the Healthcare Industry Do to Mitigate Cyber Threats? The industry must realize that cybersecurity is human-centric. Gaining insight into the users' behavior, for example, or the flow of data in and out of the organization improves risk response.

Another possibility, is hackers stealing data and selling it to the public. The information may be sold to criminal groups on the dark web who wish to use sensitive information for blackmail or fraud purposes.

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public. The information may be sold to criminal groups on the dark web who wish to use sensitive information for blackmail or fraud purposes.

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and education emphasize that every member of the organization is responsible for protecting patient data, creating a culture of security. Protect mobile devices: An increasing number of health care providers are using mobile devices at work. Encryption and other protective measures are critical to ensure that any information on these devices is secure. Maintain good computer habits: New employee onboarding should include training on best practices for computer use, including software and operating system maintenance. Use a firewall: Anything connected to the internet should have a firewall. Install and maintain anti-virus software: Simply installing anti-virus software is not enough. Continuous updates are essential for ensuring health care systems receive the best possible protection at any given time. Plan for the unexpected:

Alerts or alarms should be designed to detect event sequences with potentially negative consequences. Statistical and anomaly detection methods are particularly good for these purposes, as are rule-based detection mechanisms. Files should be backed up regularly for quick and easy data restoration. Organizations must consider storing this backed-up information away from the main system if possible. • Control access to protected health information: Access to protected information should be granted to only those who need to view or use the data. • Use strong passwords and change them regularly: The Verizon report found that 63 percent of confirmed data breaches involved taking advantage of passwords that were the default, weak or stolen.

Healthcare employees should not only use strong passwords, but ensure they are changed regularly. • Limit network access: Any software, applications and other additions to existing systems should not be installed by staff without prior consent from the proper organizational authorities. • Control physical access: Data can also be breached when physical devices are stolen. Computers and other electronics that contain protected information should be kept in locked rooms in secure areas.

Prevention is preferable to detection and reaction. But without data collection, an organization cannot successfully detect or react to anything.

In Conclusion To improve cybersecurity in health care, organizations need to hire informatics professionals who not only collect, manage and leverage data, but protect it as well. In addition, health data professionals

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Kris Seeburn is an enterprise trainer and a member of Advisory Board of The New Security Foundation, Member of The American College of Forensic Examiners & Institute of Forensics Science

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In addition to deploying technology tools to help defend against and detect intrusions, it's important to formally define roles and responsibilities for incident response. Organizations need to document procedures that specify what the response team should do if there's an incident and test those procedures periodically. It's not just one technology, it is

The Internet is increasingly a swamp. It's no longer sufficient to just look at standard security logs. You need integrated security information event management that brings together network logs, users log, application logs and server logs, and looks for nonobvious associations.

need to on a continuous basis develop new strategies and best practices to ensure the safety of sensitive health data, protecting both the patient and organization from financial loss and other forms of harm.We know that reaching 100% security against cyberattacks is not realistic but, with a few steps, healthcare organizations can make sure that it's too complex or unprofitable for threat actors to attack them, which will result in them moving on to another target.

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Security information and event management or log management tools can augment data collection efforts.

multiple technologies in order to repel these highly sophisticated and organized attacks. That includes deploying SIEM, as well as multifactor authentication to enter critical systems.

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It's not just one technology, it is multiple technologies in order to repel these highly sophisticated and organized attacks. That includes deploying SIEM, as well as multifactor authentication to enter critical systems.

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How to Defend Against the Growing Threat? Deterrence, prevention, detection and response all have their place.

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Cybersecurity: The Vulnerability of Medical Institutions to CyberAttacks

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Written by MANAS INGLE AND SHARDA BALAJI

cAfeeâ&#x20AC;&#x2122;s researchers were able to modify the vital sign data in real-time providing false information to medical personnel by switching the heartbeat records from 80 beats a second to zero within five seconds. You would have woken up to news that Medstar patient recordsâ&#x20AC;&#x2122; database was subject to ransom ware cyberattack and was asked to pay bitcoins. Unfortunately, the hospital did not have backup of medical records and in some cases, they had to turn away the patients. These incidents, unfortunately, are not stray incidents. There are various technologies converging and a rapid increase in

machine-to-machine communications. It is predicted that by 2025, most hospitals will have the ability to network connect more than 90% of their devices. However, many hospitals are yet to make their data security systems extremely robust. Data privacy and data security are the two important pillars that need urgent consideration. Just as financial data is loved by the cyber criminals, so is health data becoming a gold-mine with the cyber offenders. Specially so when the hospitals are run on legacy systems and there is no dedicated framework or surveillance on their own data. Personally, identifiable data is an

indicator of an individual, such as name, an identification number, location data, an online identifier or to one or more factors specific to the physical, physiological, genetic, mental, economic, cultural or social identity of that natural person. Several cyberattacks on medical institutions are initiated to extract the electronic health records (EHRs) of patients. These EHRs may contain their personal health information, medical history, diagnosis codes, billing information, etc., which can be exploited by the cyber offenders in various manners, for instance to get ransom from the medical institutions or to create fake IDs to buy medical

(a) National Capabilities: The NIS Directive mandates every member state of the EU to have certain cybersecurity capabilities, e.g., it is a mandate for every member state to have a national Computer Security Incident Response Team (“CSIRT”).

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cybersecurity processes and controls which help the medical institutions to mitigate cyber risks and vulnerabilities. In this article, we will be primarily focusing on various safeguards and standards put in place by the European Union and India to deal with such cyberattacks. SCENARIO IN EUROPE As a part of the EU cybersecurity strategy, the European Commission

(b) Cross Border Collaborations: The NIS Directive encourages collaborations between EU member states like the EU CSIRT network, the NIS cooperation group, ENISA etc. (c) National Supervision of Critical Sectors: As per the NIS Directive, every member state shall supervise the cybersecurity of critical market sectors in their respective country including health sector.

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In India, as reported by multiple news agencies, last year in the month of June, the Mahatma Gandhi Memorial (a trust-run hospital) hospital, Mumbai (MGM Hospital) was affected by a similar cyber-attack where the hospital administrators found their systems locked and noticed an encrypted message by the attackers demanding ransom in Bitcoins to unlock it. It was reported that the MGM Hospital had lost 15 days’ data related to billing and patients’ history, though the hospital didn’t face any financial loss.

Regulatory bodies across the world have suggested / adopted guidelines and standards to ensure necessary

The NIS Directive has three major parts to it (a) national capabilities, (b) crossborder collaborations and (c) national supervision of the critical sectors including health.

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As reported in the investigation report on the WannaCry ransomware attack on NHS, published by the National Audit Office (“NAO”, an independent parliamentary body in the United Kingdom), all NHS organisations infected with the WannaCry virus had unpatched or unsupported Windows operating systems. NHS Digital (a national provider of information, data and IT systems for commissioners, analysts and clinicians in health and social care in England) informed the NAO that the ransomware spread via the internet, including through the N3 network (the broadband network connecting all NHS sites in England), though there were no instances of the ransomware spreading via NHSmail (the NHS email system).

adopted the EU Network and Information Security Directive (“NIS Directive”) on 6 July 2016 and it came into force in August 2016. As the NIS Directive is an EU directive, every member state had to adopt a national legislation which would transpose the NIS Directive by 9 May 2018 and identify operators of essential services under the transposed law by 9 November 2018.

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Take this example. On 12 May 2017, a global ransomware attack, known as WannaCry affected more than 200,000 computers in at least 100 countries. The ransomware attack also affected 80 out of 236 trusts (medical institutions under NHS) and further 603 primary care and other National Health Service (“NHS”) organisations were infected with the ransomware virus including 595 general practitioners. The trusts which were affected with WannaCry ransomware faced issues like patient appointments being cancelled, computers being locked out, diversion of patients from accidents and emergency departments, etc.

Once these cyber offenders have access to the EHRs, they hold the systems of the medical institutions hostage for ransom, by encrypting all the systems completely inaccessible and unusable for the victimised medical institutions. The vulnerability to such cyberattacks may account to various reasons, such as outdated digital infrastructure, medical personnel unaware or untrained about cyberattacks. Cyber offenders may gain access to medical institutions’ systems through various ways and sometimes as simple as (a) using a USB drive; (b) exploiting vulnerable or expired software, (c) stealing medical personnel’s mobile devices, (d) hacking email or (e) phishing, etc. It is time that our healthcare providers upgrade their technologies, networks, and understanding on this subject.

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equipment(s) or medication which can be resold or exclusively sold on prescription.

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Further, as a part of the NIS Directive the NIS cooperation group through ENISA has developed guidelines regarding (a) identification criteria of cyberattacks, (b) incident notification, (c) security requirements for Digital Signal Processors (DSPs), (d) mapping of operators of essential services (OES) security requirements for specific sectors including health and (e) audit and self-assessment frameworks for OESs and DSPs. With a view to prescribe certain standards of safety and quality, three recognised EU standards organisations namely (a) the European Committee for Standardisation (CEN), (b) the European Committee for Electro-technical Standardization (CENELEC) and, (c) the European Telecommunications Standards Institute (ETSI) were set up. By setting common standards across EU, CEN, ETSI and CENELEC ensure protection of consumers, facilitate cross-border trade, ensure interoperability of goods/ products, encourage innovation and technological development, and

include environmental protection and enable businesses to grow. The General Data Protection Regulations (“GDPR”) specifically define ‘data concerning health’, ‘genetic data’ and ‘biometric data’ and regards them as ‘special category of data’. This means that parties who are processing special category of data shall comply with additional higher safeguards and process it legitimately. Recital 53 of the GDPR states that special categories of personal data which merit higher protection should be processed for health-related purposes only. THE INDIAN SCENARIO Personal medical/health information in India is regarded as sensitive personal information as per the Information Technology (Reasonable Security Practices and Procedures and Sensitive Personal data or Information) Rules, 2011 (“Rules”). The Indian legislature took an important step for addressing issues relating to cybersecurity when it amended the Information Technology Act, 2000 in

The General Data Protection Regulations (“GDPR”) specifically define ‘data concerning health’, ‘genetic data’ and ‘biometric data’ and regards them as ‘special category of data’.

2008, through which they established an Indian Computer Emergency Response Team (CERT), a national agency for incident response. CERT is primarily responsible for handling cybersecurity incidents occurring in India and analysing information related to cybercrimes, but among other things CERT is also indulged in issuing guidelines, advisories, vulnerability notes and white papers relating to information security practices, procedures, prevention, response and reporting of cyber incident. CERT-India has been entrusted with performing the following main functions (a) collecting, analysing and disseminating of information on cyber incidents, (b) forecasting and giving alerts on cybersecurity incidents, (c) laying down emergency measures for handling cyber security incidents, (d) coordinating cyber incident response activities, (e) issuing guidelines, advisories, vulnerability notes and white papers relating to information security practices, procedures, prevention, response and reporting of cyber incidents, and (f) performing any other functions relating to cybersecurity as may be prescribed. CERT-India in the last five years or so has focused on making various institutions who are highly dependent on cyber/digital networks, i.e. are ‘cyber resilient’. Being cyber resilient allows these institutions to effectively anticipate the various threats and figure out the mechanisms of dealing with the cyberattacks. Anticipate, withstand, contain and recover are the 4 main contours of being cyber resilient . • Anticipate: Maintain a state of informed preparedness to forestall compromises of mission/ business functions from adversary attacks • Withstand: Continue essential mission/business functions despite successful execution of an attack by an adversary • Contain: Localize containment of crisis and isolate trusted systems from untrusted systems to continue essential business operations in the event of cyberattacks • Recover: Restore mission/business functions to the maximum extent possible subsequent to successful

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considered as the custodian of data, thereby making such holder responsible to protect privacy, confidentiality and security of data.

Law is just one part to solve the issue. The real question is who is responsible for safety of our personal data, commercial data, data assets, etc.? We

Sharda Balaji is the founding partner of NovoJuris Legal, and along with being a qualified lawyer is also a company secretary and has been at the core of evolution of technology and IT laws in India.

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The EU, through GDPR has made data security an integral part of law and India is taking strong steps to set up a robust data protection and data security law. Various regulations, programmes, codes, standards, etc., discussed in this article are some key indicate steps that can be implemented.

Manas Ingle is a legal associate at NovoJuris Legal and works as a technology lawyer, where he deals with various legal projects relating to data protection, AI, IoT, healthtech, med-tech etc.

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To bring it all together: Majority of the cyberattacks reported worldwide are caused due to reasons which sometimes are trivial and perhaps ignored more often, such as outdated Windows operating system patch, lack of proper antivirus or reasons such as phishing, lack of awareness among the people about cybersecurity, etc.

secure our houses with a lock, burglar alarms, video cams because the house owner wants to protect it. Similarly, individuals, organizations, healthcare personnel, hospitals and other institutions who collect health data for multiple reasons should be aware of various cyber-threats and must take steps to safeguard their networks and systems from such threats.

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Taking a step further, the Ministry of Health and Welfare has introduced a draft bill for Digital Information Security in Healthcare Act (“DISHA”). One of the key purposes of DISHA is to ensure reliability, data privacy, confidentiality and security of digital health data. DISHA prescribes that the storage of digital health data so collected would be held in trust for the owner and the holder of such data would be

CERT is also indulged in issuing guidelines, advisories, vulnerability notes and white papers relating to information security practices, procedures, prevention, response and reporting of cyber incident.

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To strengthen the framework and ensure that reasonable security practices and procedures are followed, the Department of Information Technology introduced certain rules. The rules require each and every corporate body including medical institutions who collect sensitive personal information to have security measures as documented in their security policy/programme which is considered to be a reasonable security practice, keeping in mind the nature of their business and considering the fact that they are collecting sensitive personal information. One such international standard as recommended under the Rules is the IS/ISO/IEC 27001.

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execution of an attack by an adversary • Evolve: To change missions/business functions and/or the supporting cyber capabilities, to minimize adverse impacts from actual or predicted adversary attacks

LATEST INNOVATIONS!

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NOVIOSENSE....THE DEVICE THAT CAN BE KEPT IN THE EYES TO MONITOR SUGAR LEVELS

EEE spectrum has discovered a recent study that seems promising for the Dutch startup Noviosense’s own wearable glucose monitor that measures tears by sitting in one’s lower eyelid. The result was close to 95% accuracy to the levels of glucose as recorded in blood.Therefore, the newly developed glucose monitor

can be placed in the lower eyelid to measure glucose level in tears. It works by tapping into basal tears or a continuous stream of tears that do not require stimulation. The spring coil can rest in the eyelid for long periods and will not be displaced even if users’ rub their eyes. Though the innovation seems to be

another milestone in the management of diabetes which presently is painful, inconvenient or sometimes tedious but the study had a drawback. The sample size consisted of only six people. Noviosense will need to conduct more tests to further prove the device’s validity and reliability. SOURCE: timesofindia. indiatimes.com

APPLE WATCH CAN SOON PREVENT SKIN CANCER, PREMATURE SKIN AGEING AND SUNBURNS

he US Patent and Trademark office has recently granted a patent to the Cupertino, California-based technology company that would help the Apple watch to monitor the ultraviolet light exposure or in other words use a UV light sensor to detect if a user is outdoors and how much he/she has been exposed to the harmful ultraviolet radiation. The system provides the information regarding the total exposure to UV light either via a text message or an alert including guidance on preventive measures if the levels are excessively high. The data from the sensors is first fed into an analyser. The analyser compiles the total exposure time and amount of UV light the user has been exposed to and then alert

the user. Furthermore, the patent suggests that the UV index value and the total amount of exposure to the UV rays would be combined to determine if the user stands at a risk of skin damage and guiding the users for appropriate preventive measures to minimise the damage. Additionally, the smartwatch would also feature an ambient light sensor and an infrared light sensor that would be used to determine the amount and state of light the user is getting exposed to. The new feature would add various health benefits associated with the new Apple watch series 4 which can help prevent sunburns, premature skin ageing and even skin cancer by keeping a track on the UV rays exposure time.

The new Apple watch also has a feature named ‘Fall Detection’ that will alert emergency contact numbers in one’s mobile phone in case the user meets with a hard fall. The new watch also has an electric heart sensor to send across low heart rate notifications and faster heart rate reading. The watch will also immediately notify the user about the user’s abrupt heart rate for when one’s temper is going haywire requiring the user to cool down the mind. The electric heart sensor is capable of taking an electrocardiogram using the ECG app which by now should be available in the US as it was already approved by the FDA in 2018. SOURCE: www.sciencenews.org

BRAIN IMPLANTS LET PARALYZED PEOPLE USE TABLETS TO SEND TEXTS AND STREAM MUSIC

recent study conducted on three people, two men and a woman with paralysis below the neck reveals how they were able to use unmodified computer tablets to text friends, stream music and browse the internet using an electrode array system called BrainGate2. This is a type of device that eavesdrop on neural activity of those who are paralysed and helps them to perform the above said activities. The results of this study show that neural signals can be harnessed to directly allow movement and were published in the November 2018 issue of PLOS One. The three people involved in the study had electrode grids implanted over part of their motor cortex, an area of the brain that helps control movement which picked up neural activity indicating that the participants wanted to move the cursor. Those patterns were then sent to a virtual mouse that was wirelessly paired to the tablet. These three people used nothing more than their intentions to move the cursor to perform seven common digital tasks including web browsing,

sending e-mails. One participant looked up orchid care, ordered groceries online and even played a digital piano. The system even allowed two participants to chat with each other in real-time. The USP of this study is that the researchers used tablets with standard settings and no modifications, shortcuts, or alterations of features to make typing or navigation easier although a few basic tweaks could make the system even more accessible to the users.

The findings could have a major impact on the lives of those who are affected by some neurologic disease, injury or limb loss. The results of this study demonstrate how communication, mobility and independence can be partially restored to those with otherwise limited control over their environment. There is also no dire need to use expensive or specialised equipment for such cases making it readily available to more such candidates. SOURCE: www.dailymail.co.uk

SENSORS TO DETECT MILK ADULTERATION......

ccording to a recent research published in the Food Analytical Methods Journal, IIT Hyderabad has developed a sensor-chip based detector system to detect adulteration in milk. This helps to measure the pH levels of milk through an indicator paper that changes colour due to acidity of the milk. Currently, methods like chromatography and spectroscopy are used to detect milk adulteration, which are quite expensive, so the researchers at IIT used a relatively cost-effective process

called â&#x20AC;&#x2DC;electrospinningâ&#x20AC;&#x2122; to produce halochromic paper-like material made of nano- sized nylon fibres and loaded it with a combination of three dyes. They have also developed algorithms that can be incorporated on the mobile phones to accurately detect the colour change. The algorithm captured the colours of the sensor strips after dipping in milk using the mobile phone camera and the data was then transformed into pH ranges. On testing with milk spiked with various combinations of contaminants, they

found near-perfect classification with accuracy of 99.71%. In order to get comprehensive milk quality check systems that can be incorporated in mobile phones or any other hand aids the team now aims to study the effects of mobile phone cameras and lighting on detection efficiency and hopes to develop sensors for other physical properties like conductivity and refractive index and integrate them with the pH detection unit. SOURCE: www.timesnownews.com

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FITLOO: MIT’S SMART TOILET DETECTS CANCER, DIABETES THROUGH URINE

esearchers at MIT and the European Space Agency have developed a smart toilet called “ FITLOO “ which screens human waste such as urine to detect diseases like cancer and diabetes. This is a high-technology toilet that has sensors to track changes in one’s glucose levels to detect signs of diseases along with the warning signs of cancer. On detection, it sends the data gathered directly to the users’ smartphones to monitor health. It is also based on automated sample testing technology used by astronauts aboard the International Space Station to monitor their health. Experts at the European Space Agency and MIT have teamed up with sanitation specialists to create the FitLoo. The high-tech lavatory will screen urine for the presence of extra proteins and glucose, gathering data through sensors located inside the bowl. These will detect fluctuations in levels of these substances and presence of other markers that might be an early warning sign of cancer or diabetes. The data gathered could then be beamed on the users’ smartphone or even directly to general practitioners so that they can keep a close eye on their patients.

Smart toilets are already present in countries like Japan with a focus on greater comfort and hygiene with additional features like warm-water washing, air drying and heated seats. Companies like Toto and Matsushita have released Wi-Ficonnected toilets that measure body mass index, biochemical makeup (sugar, protein), flow rate and temperature of urine. In a similar direction of work, the scientists at Stanford University have also developed a colourchanging paper test that can detect diseases or spot signs of a urinary tract infection with the

help of a smartphone camera. All these works are the space of preventive healthcare and the idea is that people will connect their phone to the toilet and get information about their health. If anything is of concern, they would seek their doctor’s help for more detailed tests and retain their good health in time. Researchers also state that by putting these sensors in public toilets would allow health officials to track and gather data on prediction of spread of diseases in communities, giving an important early warning of outbreaks. SOURCE: www.inshorts.com

TESTCARD: A CARD-SIZED URINE TEST AT HOME

he UK-based Med Tech Startup Test Card has created a postcard- sized urine test that can be done at home and is very much similar to a pregnancy test, which is analysed by an accompanying app to provide immediate results. The postcard has an embedded, pull-out urine test. The urine test has no electronic component involved in its usage. The postcard test is likely to be launched in the UK in April 2019. In the near future, TestCard also plans to screen diabetes products in India. SOURCE: wwwnewsshorts.in

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Compiled by: Dr. Avantika Batish, working as the Director Strategy and Healthcare at International Health Emergency Learning and Preparedness. She is also a guest faculty for MBA (HR) and MBA Healthcare Management at various B-Schools and is a soft skills trainer.

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implants. Since they are smaller and can be implanted deeper into the human body than traditional ones available, neural dust can interfere directly with specific nerve clusters allowing more precise diagnostics and treatments. Iota’s devices can concurrently record information and stimulate nerves giving near instantaneous closed-loop therapies that could better treat diseases from the inside out. SOURCE: TimesNow

cientists at University of California have created a wireless device called ‘WAND’ which works like a pacemaker for the brain and may aid in the treatment of disorders like epilepsy and Parkinson’s disease. Wand is a neurostimulator that can monitor and stimulate the brain with electric current. This device is autonomous and can simultaneously stimulate and record electrical signals in the brain.

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n American biotechnology Startup, Iota Biosciences founded in 2017 by Carmena and Michel Maharbiz has recently raised 15 million dollars for its inbody sensor which is smaller than sand grain. The University of California in a microelectrode research developed the sensors called ‘neural dust’ which then transfers the data wirelessly from inside the body. The Co-CEOs hold exclusive rights to neural dust technology which offers revolutionary therapeutic applications for various chronic health conditions from inflammation to motor disorders and eventually cognitive impairment. The advantage of this small-sized sensor is that it uses ultrasound avoiding any danger that is associated with wire and battery-provided

WAND... PACEMAKER FOR THE BRAIN

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IOTA BIOSCIENCE CREATES BODY SENSOR SMALLER THAN SAND GRAIN

savvy clinicians. The software has important modules like automatic segmentation of lung boundary, retrieval of similar segments from the database with their report and assess the probability of the pathological segment to be a particular ILD category based on the data retrieved. The mapping of disease is performed by doctors based on the ILD pattern and clinical inputs. At present, the lung nodule detection rate and classification rate is 86% and 87%, respectively. The success rate for ILD classification is 84%. The researchers are working to further improve to conduct clinical trials on bigger sample sizes. The report has been published in more than 13 International Journals and 19 International Conferences in various stages of its development. SOURCE: www.inshorts.com

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can also identify interstitial disease patterns in HRCT images showing the lung tissue texture. Another added benefit is that the reference point is Indiacentric, i.e. the medical image scan database used for reference is taken from the Indian patient population. Data has been taken from PGIMER Chandigarh; mainly biopsy cases and foreign database such as LIDC-IDRI and MedGIFT ILD have been used. The malignancy detecting tool detects a lung nodule, segment the nodule and provides a way to modify segmentation, retrieve similar nodules from the database with their report assess the chances of malignancy of the nodule in question based on the retrieval results. The ILD tool is developed by incorporating feedback from expert radiologists to make it easy to use for non-tech

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esearchers at the Department of Electronics and Electrical Communications, IIT Kharagpur have recently developed a decision support system to diagnose cancerous tumours and other diseased tissues in human lungs. While one system can refer to CT scan images to detect lung nodules and test them for the possibility of malignancy, the second software can detect interstitial lung disease patterns in chest HRCT images. The team has successfully tested both software systems at AIIMS, New Delhi with a success rate higher than 80%. The advantages of these newly developed systems include their use of non-invasive and comparatively affordable methods of image analysis that would aid the radiologists to identify malignancies by reading growth in the lung nodules. The system

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IIT KHARAGPUR DEVELOPS DIAGNOSTIC TOOLS FOR INTERSTITIAL LUNG DISEASES AND LUNG CANCER

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Is “Smart” Technology a Saviour of Healthcare?

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Written by VICTOR MUKHERJEE

he healthcare industry is continuously sprouting with the exponential evolution of technology such as artificial intelligence (AI), virtual reality (VR), and robotics, etc. These new areas of smart technology are expected to pose unswerving influence on the healthcare industry during the next couple of years. Smart Health Technology is equipped to automatically obtain, store and compute health information from technically advanced sensors and offer personalized advice or automated actions from the collected data. This technology can interact and engage with data via Virtual or Augmented Reality to provide even more realtime experience for both, physicians and patients. With the dissatisfaction among junior doctors reaching unprecedented levels (a staggering 80% feel excessively stressed) and the number of doctors progressing to specialty

training dwindling to its lowest rate in the history of the National Health Service (NHS); these changes have never been more needed. In the event of NHS staff struggling to cope up with the growing demand for patient care, owing to the UK’s rising aging population, technology is seen as an enabler which will further propel healthcare professionals to work smarter, and not harder. There are numerous opportunities for healthcare stakeholders/ manufacturers to innovate Smart Health Technology solutions, which are expected to streamline the precise medical care approach, e.g., telemedicine. However, there are also certain restraints in the regular healthcare system pertaining to infrastructure and adequate competencies to integrate Smart Health Technologies. Moreover, manufacturers and service providers need to ensurethe data security and adhere to global standards. Few of the latest applications of Smart Health

Technology are Smart Apps, Smart Pills, Smart Syringes, Intelligent Fabrics, and Smart Wearable Devices. SMART APPS The global smartphone users’ count is expected to surpass 2.5 billion by 2019. This exponential base of users is expected to influence the fate of health and fitness apps, which have already increased by more than 30% since 2016 (as on current date). It is estimated that almost 75% of current active mobile users run their health and fitness apps at least twice a week. With increased awareness among the mass population, people are leveraging technology to take better control of their health conditions such as asthma, infertility, obesity, and diabetes, etc. Moreover, the plethora of user data churned out from these apps is helping the market researchers access unparalleled volume of data forfurther in-depth and precise insights. SMART PILLS The smart pill technology includes a wireless capsule, a receiver, and the

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Victor Mukherjee is currently working as an Assistant Manager – Healthcare Practice, Infoholic Research

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Precisely, the Apple Watch Series 4 is embedded with an ability to automatically inform hospital service providers, if a user becomes immobile for a stipulated period of time. This deviceassists people to become healthier, simultaneously storing real-time data which can be analysed by healthcare professionals via remote patient monitoring,

CONCLUSION Upcoming healthcare technologies such as Smart Healthcare and AI are gradually renovating healthcare practices and areset to experience further innovations in the recent future. A significant number of healthcare experts are unquestionably banking on smart healthcare as a growing number of patients are keen to use these technologies and apps to improve their lifestyles. However, it is impossible to contemplate every research aspect of smart healthcare, considering its broad facets. Hence, as a result of the emergence of Smart Technology, healthcare stakeholders now should focus on imperative subjects such as security and privacy, ethics, training, biomarkers, genetics and personalized medicines, roboticenhanced environments, humancomputer interaction, and so on. The future is endless and exponential!

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SMART WEARABLES Smart wearable medical devices are small electronic products

Few of the latest smart health monitoring wearables in the global market include: • Apple Watch Series 4 (healthcare app) • Pebble Health (health monitoring app) • Zephyr BioPatch (wireless monitoring device) • Muse headband (brain-sensing monitoring headband) • AliveCor Heart Monitor (smartphone-based ECG device) • Garmin Forerunner 935 (GPSenabled heart rate monitoring device)

ensuring more precise and perceptive data for better healthcare practices. Moreover, AI can continuously monitor healthcare data and transfer the same to hospitals when necessary.

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For instance, the first digital pill -Abilify MyCite (approved in November 2017 by the US Food and Drug Administration) is used to track patients’ medication data. This is a venture between Tokyo-based Otsuka and California-based Proteus Digital Health (digital medicine service provider).The other key players operating in the smart pill technologies market include Novartis AG, Given Imaging Ltd., Philips Healthcare, Smartpill Inc., Olympus Medical Technology, Medtronic, Pentax Medical Co., Siemens Healthineers, Stryker Corp., GE Healthcare, and Boston Scientific Corp.

(consisting of sensors) which have computational competence. These devices are entrenched into items, which are attached to different body parts of the user. They can resemble watches, eyeglasses, clothing, contact lenses, shoes, or even jewellery.

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software, which investigates and categorizes the gathered information from the patient who consumes the pill. It is an emerging technology, which is witnessing an upsurge in demand and is expected to show significant potential in the diagnostics domain in the future. The technology is used to detect gastrointestinal (GI) conditions and offers the physicians with information relating to several parameters such as pH, temperature and GI tract pressure.

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Data Analytics Will Increase the Quality of Care! How?

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Written by DR. THAMARAISELVI

SUNDARARAJAN

ccording to the MerriamWebster dictionary, an analysis is "a detailed examination of anything complex in order to understand its nature or to determine its essential features: a thorough study." Data analytics is a method of analyzing, manipulating, and processing of complex data in a more defined and logical way. In brief, it can be defined as "a method of logical analysis." In data analytics method,complex data are drilled down at various levels in order toarrive orconclude ina meaningfulway. It is mostly used to make organizational decisions, implement any new processes, changing the existing processes, etc. The healthcare industry generates and collects a huge amount of complex data daily. Using data analytics technique, these large set of data can be broken down in a meaningful way to know the trends and make more accurate decisions for many major quality outcome projects. Through analyzing trends and forecasting the data, the healthcare providers will know whether implementing or changing any project would have a positive or negative impact on an organization. For example, if an organization wants to increase the overall mental health of their patient population, the provider should first know what percentage of patients are not undergoing their depression screening during annual health checkup, says Thamarai. To identify the percentage of patients who did not have their depression screening done, the data analyst will collect data from the organization’s database for a year. Once the organization identifies the base population, the experts look at the data and analyze the gap by

drilling down the data to find why a depression screening was not done. Finally, using the same data analytics method, an organization can decide whether this quality projectneeded to be implemented after performing management level decision such resource needed and financial status. According to Thamarai, however, though data analytics aids and helps the

leaders to decide, it is utmost important to include clinical folk’s knowledge as there might be something beyond this analysis. In the above example, the patients who did not have depression screening may voluntary avoid (needed to be excluded from the base population) or there is no such information captured in the medical record altogether. In these scenarios, the doctors will come with ideas to close the gaps such as using a phrase or a flag in the medical record for the patients who voluntarily declined the screening. Hence, a combination of Small and medium enterprises (SMEs) and data analytics team is required to obtain a positive outcome for any healthcare quality project.

“Can this data analytics method be feasible in the Indian Healthcare System?”. Major Indian healthcare organizations still use surveys and administrative medical records data to analyze the quality of care. These resources of data are less reliable and collecting this type of data is always a challenge for the healthcare organizations because

of lack of Electronic Health Records (EHR), says Thamarai. Though EHR implementation is slow in India, it is predicted to grow in years to come because of many government-initiated policies such as ‘The Digital India Healthcare Policy’, increase in EHR implementation in Major hospitals like AIIMS, etc.

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Medical IoT: Future of Connected Health, Are We Ready?

nnovatioCuris Foundation of Healthcare & Excellence (ICFHE) and IIT-Delhi jointly hosted a panel discussion on Medical IoT: Future of connected health, as an emerging development area. Below is a journalistic account of discussions and decisions made during the Innovators’ club meeting held on Saturday, 2 March 2019.

Our inaugural speaker Dr Partha Dey of IBM emphasized the importance of rapidly growing medical space in next 5 to 7 years (million to billion to trillion) and that the numbers are promising. The question “Is there anything we can do to get our pie of the share from that increasing number?” Connecting internally (institution/hospitals) and with the outer world, there are two aspects. He went on to highlight a concern that connected health should be targeting illness rather than wellness. Illness market would have a better opportunity and that's a fact of life. Integration of many devices also causes a problem in the implementation of IoT in healthcare. The reasons can be many.One of them is that the medical stakeholders do not have any consensus regarding the consent, generation, storage and transmission of data. But IoT changes the way!

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DrV K Singh, InnovatioCuris is working towards healthcare disruptions in India to help reducethe healthcare delivery cost. Since the medical space is growing rapidly from 20 million market to 70 million by 2025, describing a business opportunity for the younger ones and existing players of Internet of Medical Things (IoMT), insisted on mastering the technology instead of technology mastering us!

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Written by SHIVANK KHANDELWAL

The need to change the way of delivering care/service should be our priority. A paradigm shift in the way of offering

The reasons can be many. One of them is that the medical stakeholders do not have any consensus regarding the consent, generation, storage and transmission of data. But IoT changes the way! services through connected health services and emphasizing that privacy and security concerns are of utmost importance when it comes to connected health. Responsibility and accountability after acquiring data is very important. The question is how to analyze the data and get actionable insight. Analytics and IoT should be considered together for actionable insight. The challenge of interoperability has turned up with increase in number of devices being used.

there has been an ongoing conversation about how it might change healthcare, improve patient safety, affordability and accessibility for patients.

Trends and Opportunities of Medical IoT IoT or Internet of Things is not new, but it has been gaining traction at a very high pace. Since the inception of the word IoT,

One of the key challenges is developing the algorithm for medical devices such as CT scans and X-rays. Application of artificial intelligence and machine learning in healthcare should be

Healthcare in India has a huge potential in terms of IoMT or medical IoT solutions. There will always be challenges and opportunities in this sector. Connected health is contributing towards the growth in space of IoT, but is lagging behind many other connected sectors.

cautiously done because in case of a CT scan, if we miss a module it has life risk and hence should be used carefully and should be a well validated clinical algorithm.

Things change very rapidly and in very small time, and IoT is taking shape with it. But who will fund the cost of development/ Can government help the industry in making such policies?

Since the infant mortality rate in India is twice the rest of the world, and that is certainly alarming as the bottom of the pyramid is affected; there is a company which focuses on the mortality rate of low weight birth babies. They have come up with developing a bracelet which diagnoses hypothermia in low birth weight babies. This was a very simple and innovative device, but then they analyzed the intermissions they can work on and came up with baby cradle. The main challenges to develop and design such a product is to cope with the cost factor and the startups definitely need funds to develop such a technology.

Business Models of Successful IOMT in India and Challenges The IoT healthcare business strategy is not yet robust because it involves a set of elements with new requirements such as new operational processes and policies, new infrastructure systems, distributed target customers and transformed organizational structures. Therefore, there is a need for a new business model. The IoT technology opens a new dimension of business opportunities for healthcare companies and the IoT platform becomes a key artifact in this transformation. Early movers who are taking a proactive approach to establish their IoT healthcare ecosystem will tap into new business models. In this part of the business model, the panel discussed the basis of pricing and the way of charging for a product or service. Beside this, the panel also discussed the ways of revenue generation.

The goal of connected health is not just early identification of health issues, but also effective patient care and safety. Today IoT platforms support integration of medical devices and wearables. The need for security is as important as when it comes to IoT and accessing healthcare data and strengthening advocacy for connected health.

While there are many benefits of the Internet of things in healthcare, it isn't

without its challenges. As with any new technology in healthcare, hospital and IT executives are concerned about data security and IoT device management. What are the potential barriers to IoT adoption and how healthcare IT can overcome those obstacles? AI and IoT change the way healthcare is delivered and we obviously are on the cusp of a revolution. This definitely poses a fair amount of concerns but also huge possibilities. The panel also discussed how Modicare is 100th the cost per person when compared to Obama care. So clearly, there must be more innovations coming from IoT and AI; they are going to help us reduce the cost. In the past, how people tried to use the data for the benefit of both patients and providers, starting from patient side faced huge failures, as nobody was willing to pay. And that's where the thinking came from that; how do we really make this work? How do we really turn this data into a business model? And that's where they pivoted the model, working with providers and using their data sets. But then the question comes up, â&#x20AC;&#x153;Why the providers would share their data?â&#x20AC;?. Thus, the first pitching that

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started was to use the provider’s data for their patient care. And it didn't work well. The whole narrative was, “What's in it for providers?”.Therefore, the business model turned out to be, as we kept on talking to people, we realized that the data is going to be useful for provider’s revenue success, and then the same datasets will help the patients. A solution that they projected is to help retain the provider with patients’ data, grow their revenues and help in patient care. The MedTech certainly seems more complex. Where they are trying to come out with a dermatology solution and oral health solution for serious diseases where a cell phone image taken from an off the shelf mobile phone camera is sent to an AI backend and it gives a diagnosis and possible treatment options for a variety of skin diseases, particularly oral cancer. Such cases are very prevalent. What the panelist found is a landscape extremely complex in terms of the business model because when someone comes out with something like this, then figuring out who would it be paying is difficult. And suddenly the AI and IoT thing comes up and say that it can perform this diagnosis at par the level and in certain cases better

than certain trained specialists. This does not support their case. One of the panelists shared her thoughts on important factors to concentrate and realize why health care has not moved digitally as compared to other industries like banking, insurance and how a lot of digital interventions can happen in healthcare. There are a whole lot of opportunities. The main thing to focus on is What is the problem? What is the solution? And who's going to pay you? Because that's where the panelists believe that lots of startups have a scope. Customer is one, the doctor being another and hospital, the other spectrum. So how to manage this change and address the change management. If you give a thought on what to overcome, it gives you a kind of value that you try and achieve success and how do we overcome the quality assurance issues, change issues, challenges that one sees in terms of adoption. Let's say for the doctors, it took a hundred years to the doctor to adopt stethoscope. Today, it's widely accepted. IoMT is something

that is obviously very innovative, very useful. But then not every doctor will accept it right away. How does one plan to overcome that barrier? So, they might just want one to focus on change management issues. There are three components of the IT embedment in a hospital. One is the business side of it, which gets adopted immediately. There's just no resistance to it. The second side is the paramedical side of it; it has pathology, radiology and other such things. They take a little time but they come on board. Learning curve is much shorter over there. The third one is the clinical side, which is the most difficult, as in a hospital system there are doctors who are most resistant to changes and the reason being their upbringing and learning of clinical practices in a certain way. The question arises “How does one change their practices?” The changed management is already happening at the college level. The medical students who are coming out now are more hands-on and are accepting the new technological changes. We will have to wait a little while, but they will accept it. When we talk about a change in the managements,

the problem that arises is not specific to India only. In the USA, George Bush had said that he wanted EMR to be adopted by everyone within next ten years. Surprisingly, he didn't even get 15% conversion in those ten years. As many of the players in the Medical IoT ecosystem are coming out with innovations. The academic institutions can be helpful in their independent evaluation. There is a gap in case of independent evaluations; sometimes the system works and sometimes it doesn't. One can observe the lifecycle of the product and the support system together. If one wants to make a difference, collaboration is the key. Another issue which keeps boggling is that the tech industries feel they have oversimplified the solutions. While the business of medicine is not that simple

and it's an ever-evolving dynamic subject. There's a need to understand the system. Each hospital has its own dynamics. The clinician has to be on-board in every case, otherwise the products will not succeed. The doctors come across the instruments, which fail to get them the right values, same thing as also shared by our methodological counterparts. The need of the hour is to standardize these results. Only then can we really come in terms with IoT. Otherwise they will tend to have a short life cycle and attain failures at the end effect. It is important to secure the data and look over the cost implications of data security issues in connected health work moving forward. There is a need for appropriate interventions at the transition level of doctors and patients, as well as the importance of advocacy and awarenessâ&#x20AC;?raising at community

level about connected health. There is also a need for financial support for encouraging the tech enthusiasts of the country to address health issues in India with connected health solutions. One needs to understand customer value as well. How do we speak the right language in terms of what would appeal to that particular user or customer or doctor or hospital for that matter only then we will see more IoMT adoption happening. Yes, there is a need to understand the regulatory framework. Startups needs to adopt a lean structure in collaboration with the medical partners and come up with innovative solutions. India has a fantastic opportunity, but clearly it does need elements to come together and work together. Shivank Khandelwal is currently heading Digital marketing team of MixOrg

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ASHAs Set Up a Role Model in the Eradication Programme Against Malaria in Odisha

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Malaria control efforts in the state were intensified from 2008 onwards as Odisha is one of the worst-hit states due to malaria. In 2010, malaria services were expanded with the involvement of ASHAs. With scaling up coverage of interventions together with active programme management and better administration, the introduction of ASHAs led to a dramatic reduction in malaria burden in the state.

Written by JYOTI SINGH

nvolving ASHAs (Accredited Social Health Activists) in the malaria eradication programme has proved to be fruitful in bringing down the number of malaria cases in Odisha.

â&#x20AC;&#x153;Various countries have followed this module though with variation in the approach and the outcomes. In India too, we have strengthened malaria case management system through communitybased interventions,â&#x20AC;? said Prof Balram Bhargava, Director General, Indian Council of Medical Research. The utilization of malaria services in the intervention areas improved as the

ASHAs and other service providers had the required commodities and

ASHAs WERE PROGRESSIVELY INVOLVED IN MALARIA CONTROL ACTIVITIES IN ODISHA. “THEY ARE THE BACKBONE OF THE PROGRAMME. WE TRAINED THEM AND THEN THEY TRAINED MORE VOLUNTEERS,” POINTED OUT DR. N. DHINGRA. skills to diagnose and treat patients at the village level. The death toll reported in Odisha in 2014 was 89. In contrast to this high number, the 2018 data shows a reduction in number up to 4. Consequently, the state registered 85% decline in the malaria burden in the intervention blocks. “Various countries have followed this module though with variation in the approach and the outcomes. In India too, we have strengthened malaria case management system through community-based interventions,” said Prof Balram Bhargava, Director General, Indian Council of Medical Research. ASHAs were progressively involved in malaria control activities in Odisha. “They are the backbone of the programme. We

trained them and then they trained more volunteers,” pointed out Dr. N. Dhingra, Head of Malaria Division in the National Vector Borne Diseases Control Programme (NVBDCP). Additional to the training with standardized modules designed by NVBDCP, ASHAs were equipped with rapid diagnostic kits and anti-malaria drugs. “In the control areas, malaria services were provided within the constraints of the routine programme. In the intervention areas, various measures were undertaken to improve the coverage and quality of malaria services” said Dr. Anup Anvikar, Scientist, National Institute of Malaria Research. The supply chain management system was strengthened up to the village level to

ensure uninterrupted supply of drugs and diagnostics. Buffer stocks were maintained at the block level in the Comprehensive Case Management Program (CCMP) areas, rather than at the district level in the routine system. It was ensured that there should be adequate stocks in remote areas before the arrival of the rainy season since it is the time when the transmission is at peak and it becomes difficult to access remote villages. Along with the drug and diagnostic kit supplies, several steps were taken for smooth working of the programme, such as additional microscopy centers were opened at the primary center level to complement the ones at the block level. This helped in providing supportive supervision to ASHAs and other providers and also aided in confirming diagnosis and posttreatment parasitological clearance. Credits: India Science Wire

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Health and Wellness Coach Platform for Industrial Workers

Written by FERNANDA VARGAS AMARAL

nappropriate diet, relationship problems, stress and lack of physical activity lead to chronic diseases and other health issues, such as obesity, diabetes, heart conditions, depression, and even some types of cancer. An unhealthy lifestyle and its consequences have a direct impact on acompanyâ&#x20AC;&#x2122;s productivity and on the life of the employees and their families. keeping this in mind, the SESI Innovation Center for Health Technologies, Brazil, has created a health platform aiming to bring health and wellbeing for the industry workers. According to a recent study published in the scientific journal Lancet shows that about 9.15% of the world population was considered obese in 2016, which implies around more than 700 million people on the planet. The World Health Organization (WHO) declared that obesity is one of the biggest public health problems in the world. According to a projection by the same study, for 2025 about 32% of the world adult population will be considered overweight and more than 10% obese.

According to the WHO, chronic diseases are one of the leading causes of death in the world, whereas more than 40% of these deaths (16 million) were premature and could have been avoided by simple interventions. Besides that, the chronic diseases account for 65% of all health expenditures in the world. In Brazil, it is estimated that chronic, and noncommunicable diseases will cause a total loss of 8.7% in GDP by 2030, which is equivalent to approximately the US $ 184 billion. According to the WHO, chronic diseases are one of the leading causes of death in the world, whereas more than 40% of these deaths (16 million) were premature and could have been avoided by simple interventions. By reducing the risk factors for chronic diseases, the number of premature deaths could be reduced by half. For this reason, it is crucial to stimulate behavioral changes related to health habits.

On the other hand, in view of the increasing use of smartphones, including by healthcare professionals, the development of computational solutions in the form of mobile applications represents a compelling means of making effective health interventions available for a larger number of people. Additionally, digital health technologies have the potential to transform the health management system by enabling consumers to play an active role in their self-care and to define what services are important to them. In this sense, technology is being developed to reach a greater number of people who understand and manage

their own health, thus preventing more invasive interventions and generating less costs for the health system in the future. With that in mind, the SESI Innovation Center for Health Technologies, has developed a virtual platform that aims to encourage the industry workers to adopt a healthier lifestyle. Our differential is the wellness coach functionality, which consists of a video conference channel for coaching sessions and a gamification system with customized challenges. Nevertheless, this solution contributes to an increase in productivity and indirect reduction of health costs by the combination of health information and customized strategies for habit change. Applying artificial intelligence to make precise decisions about collective health promotion programs within formative dashboards of user groups, our platform is intended to facilitate the decisionmaking of companies regarding the best course of action to improve their employeeâ&#x20AC;&#x2122;s health and wellbeing. The platformâ&#x20AC;&#x2122;s prototype was tested in 194 Brazilian industry workers and it is now available in several

companies of Brazil. After two years of development, it has undergone one year of tests and project pilots in two different states, four cities, and seven different companies, reaching a total of more than 400 employees. The platform has been tested for its usability, engagement and health and wellness benefits. The proposed technology is expected to bring benefits for a larger number of industry employees by keeping them healthier, as well as, in the

medium term, cut company costs with disease treatment and removals. This platform also strengthens the companyâ&#x20AC;&#x2122;s image regarding social responsibility to suppliers, customers, and competitors. Fernanda Vargas Amaral is a Ph.D. in Sports Medicine and works at SESI Innovation Center for Health Technologies, in Brazil.

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Cognitive Development: Before and After Birth-Myths and the Realities

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Written by KUSUMIKA KRORI DUTTA

ognition simply means the process of thinking and learning with knowledge and experience. In todayâ&#x20AC;&#x2122;s rapidly developing era, cognitive skills render the power to live a happy and healthy life. But despite so many myth-busting articles available, the existence of cognition is often associated with certain myths. Cognitive skills 8 Are God-gifted; i.e., they exist from the birth 8 Can be developed over time; irrespective of their prenatal development 8 Can only be developed until a certain age, as 60

And the list continuesâ&#x20AC;Ś.. Here in the following article, we intend to explore the answers to many such rational queries. WHAT IS COGNITIVE DEVELOPMENT? To begin with, one must understand, what is cognitive skill and how does it affect the individuals? Among the variety of available literature on cognitive skills, it is most simply defined as how an individual perceives the world and acts accordingly. It is the set of mental abilities or processes which are connected to nearly each human action.

Cognitive abilities are brain-based skills thaten able an individual to execute any task from the simplest to the most complex ones. They involve the mechanisms of how one learns, remembers, solves problems, and pay attention, rather than with any actual prior knowledge. For instance, memory skills rely mainly on parts of the temporal lobes and parts of the frontal lobes (behind the forehead). The given figure shows the different parts of the human brain responsible for different cognitive skills.

EFFECTS OF COGNITIVE IMPAIRMENT Neuroscientists have discovered that people with cognitive impairment have noticeable and measurable decline in cognitive abilities, which include memory and thinking skills. The deterioration further increases the risk of developing Alzheimer's or dementia. The visible manifestations may include social avoidance of family and friends, annoyance for no reasons, lack of confidence and energy levels, etc. COGNITION: INHERITED OR ADAPTED Now that’s a brain explanation and it gives us a fair idea about how important is cognition for a healthy life. But let us resolve the million dollars question: Is it God gifted orcanbe improved even after birth?If the answer is Yes! then what is the age until which it can be worked upon? Answers to these intriguing questions can probably be improvised logically as follows: God is everywhere and controls all our activities (those who believe) as Super Power (as may be connotated). But in true sense, cognitive skill of a child is a gift from the mother to her child which continuously flows as per biological terms along with anothernatural and genetically complex phenomenon. A baby’s brain development begins even when the baby is in its mother’s womb. As documented in the Hindu epic Mahabharata, Abhimanyu, Arjuna’s son learnt the technique to enter the Chakravyuha while in his mother Subhadra’s womb when Arjun narrated. It is said that before Arjuna would tell her the way to get out she fell asleep and the child could not listen to it. It is not claimed to be 100% true, but, corroborates with the fact that achild’s cognitive skillsare developed much before birth. The good news is to help your baby develop a healthy brain, it is advisable to stay happy, have positive attitude, stay in positive environment, read good books, do little permissible exercises, and stay active during pregnancy. Here, the question arises what is the relation between happiness and cognitive skills? Human brain has two memories a) hippocampus (erasable memory),

b) amygdala (non-erasable memory which stores all negative data), when we are happy amygdala can’t secret juice which effects cognitive skills. For children, in their early years of development, we ought to choose the right kind of games, and activities which help in skill development. One of the severe impacts, the busy parents today can have on their children is that they are often overlooked and left out in the company of electronic gadgets like smartphones, Tabs, videogames, etc. But,let us take a pause and think, are these gadgets helpful or harmful, which can destroya child’s future completely.Research says that theradiations of smartphones, Tabs, laptops,etc.,can be the main cause of various diseases/disorders in their tender age, and have huge negative impact on their cognitive skills. Here, food also plays a vital role on a child’s brain development. Adding severity to the grave situation, the easily available junk food which mostly contains taste enhancers that most of the kids like today are tough to digest and do more harm than help to the kids. Children are blessings of nature, but what if a child is not healthy physically and mentally, will it not be a problem to himself/herself and others? So, for better future, it’s extremely important to take care our child and help them in right direction to develop a healthy active brain. It is actually very easily achievable. We must encourage our children to get involved in different types of indoor, outdoor and innovative games, and tasks that involve thinking, etc. People at large have this misconception that only studies and good score cardsshould be the only focus in life and pressurise our kids butin reality pressure never gives pleasure and if pleasure is missing then nothing stores as knowledge. Another very common myth is, in higher classes kids should concentrate only on studies, no cocurricular or extracurricular activities. But the fact is co-curricular (projectbased learning, etc.), extracurricular (like music, dance, art, exercise,

martial art, swimming, etc.) are the booster of our brain. These helps increase the cognitive skills which help the child to grab the curricular concept very quickly. Music and mathematics is a magical combination;music makes patterns in our brain which help to understand any tricky problem very quickly even it can help to learn new things during sleep as well. Improvement of cognitive skills is not time bound. One can easily improve it throughout life, even in the age of 90—100 years.. The URLs mentioned below shall guide the readers, “How to improve cognitive skills?”. The easiest way to improvise cognitive skills, is to do some changes weekly in your daily routine, try out new recipes (all genders), do regular exercise, eat right, sleep on time, etc. Interestingly, the retirement age assigned by the government for most organisations is sixty years, which might also be based on the myth that post-sixty years, new neurons do not generate and people start losing their cognitive skills. For certain jobs, this is true to a certain extent but for research oriented or non-monotonous jobs, this doesn’t hold true.In organisations, where an individual is posed to same kind of work, it is thought that few brain parts stop getting pulse stimulations and start forgetting their activities. But in some jobs, where each day there are new tasks, new challenges to face daily,individuals stay active throughout. Afore-mentioned explanation doesn’t intend to discriminate between any kind of job. It is an deliberate attempt to exemplify that whatever may be the job demands, we need to pledge for our good physical and mental. For both, dependency on others is unmanageable and makes the life miserable. We all must hope, pray and seek a happy and healthy life. Kusumika Krori Dutta is an Assistant Professor, Department of Electrical and Electronics Engineering, Ramaiah Instittute of Technology, Bangalore

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The Fertility Diet: Zero Stress Recipe Written by DR. RITA BAKSHI

tress is one major thing which has been clouding and shadowing the lives of most of the young generation globally. It is one constant thing that keeps hollowing our minds and lives. Many issues such as work pressure, social issues, personal problems may contribute to stress. Straining and persistent pressure often stresses the lives of the people and often leaves them with unbelievable problems including infertility. Studies reveal that infertility is not only caused by mentalstress, but physical stress is also a major contributor tothe problem. Infertility is the inability to reproduce even after having unprotected sex for a prolonged period. It is very important in today’s times that people start focussing on improving their lifestyles. Extended working hours with fluctuating shift timings really obstruct the lifestyle of the intending parents which is strenuous for their fertility health. Stress and anxiety often indulge people in activities such as smoking, drinking alcohol and drugs which significantly and temporarily reduce the stress levels but severely affect the fertility levels. These habits may have a direct impact on the health of the sperms and thereby reduce both theirquality and quantity in men. This consequently may hamper the process of conceiving. The shape and motility of the sperms is also compromised which can reduce a men’s libido and hence cause impotence. People, who at large are exposed to such activities are likely to have greater risks of miscarriages and still births. Increased stress levels and apprehensions may also drive few people towards unhealthy eating habits leading them to mostly consume junk food. This stress eating eventually leads to unwanted weight gain and obesity in people. Obesity can further result in Polycystic ovary syndrome (PCOS).

It is a condition that affects a woman's hormone levels and makes it harder for them to get pregnant.Therefore, it is always advisable to check and control your stress and anxiety levels before planning to go for any kind of fertility treatment. WAYS TO CUT-OFF STRESS LEVELS AND BOOST YOUR FERTILITY • Take time off from your strenuous routine and involve in activities that you enjoy. Indulge yourself in watching movies, fun games, travelling, meditation, reading, spend time with your loved ones and make time for recreational activities. This will make

you feel better and elevate your life condition. • Try to keep your personal and professional lives separate. This will help you maintain a better life at both places and substantially reduce the stress too. • If you think that your job is stressful and hampering your fertility levels, try and look for an alternative but do not leave it. That’s because any extreme changes in daily life usually increase stress levels. Also, accustomed routines are usually more stress-reducing than

extra free-time. People with a habit of a regular and routine work culture, often find it difficult to sit home or idle. • Indulge yourself in workout and exercising as they help in relieving stress and calm your mind. Zumba and exercises are fun activities to involve yourself in as they help you shed unwanted weight and keep you energetic throughout the day. Yoga and swimming are the best medicines for those dealing with infertility issues. • Be optimistic and do not fret or worry often if you are undergoing fertility treatments. Look at life with a bigger perspective and lookfor little things that make you happy.

• If needed, take professional help. There is a lot of stigma attached with this but go for everything and anything that helps you in reducing stress and boosting fertility. Dr. Rita Bakshi, Senior infertility specialist & gynaecologist is the chairperson of International Fertility Centre. She sees herself as a catalyst, which has helped illuminate the lives of many by her passion of treating infertile couples while quenching their search for a bundle of joy in their lives.

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Gallstones:

The Truth Underneath

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Written by DR. JAYADATTA PAWAR

he gallbladder is a small pear-shaped pouch situated at the under surface of liver which secretes a greenish fluid called “bile” which aids in digestion.. Gallstones are the most common disease of the gallbladder. Technically, we call this disease as “cholelithiasis". About 80% gallstones patients are asymptomatic, i.e., show no visible symptoms. Gallstones are usually discovered incidentally during abdominal ultrasound scans done for another cause. The most direct and effective course of treatment is surgery which provides excellent results. Gallstones can be divided into three main types: cholesterol, pigment or mixed stones.In the Asian populations, the majority of them are pigment stones. CAUSES The process of gallstones formation is quite complex and many areas

remain unclear. Obesity, highcalorie diets and certain medications (e.g. oral contraceptives) can increase secretion of cholesterol and can saturate the bile and added incomplete emptying of the gallbladder can cause these stones. Hence, to avoid inevitable recurrence of gallstones, the whole gallbladder must be removed surgically and not just the stones. SYMPTOMS Patients usually have pain in the upper abdomen, feel nausea and vomiting. A few patients may even have this for months with intermittent relief periods without any symptoms. Patients can come with acute symptoms which may warrant surgery. The treating surgeon diagnoses it with an ultrasound scan and visible symptoms. Earlier, the gallstones were worrisome causing jaundice

due to lack of awareness among the patients and delayed approach to the doctor as they believed that these stones can be melted. Unfortunately, these stones, unlike the urinary stones, cannot be melted or crushed into pieces and removed. With the advent of new surgical laparoscopic (camera) approaches, patients can be easily discharged on the next day of surgery with a completely normal diet with minimal pain and small scars. A person can function very well without a gallbladder. So, do not hesitate to approach your nearest surgeon if you suffer from gallstones and get yourself treated as it’s a completely curable disease. Dr. Jayadatta Pawar is a general surgeon. She is currently involved in doing private practice and shares a keen interest in creating awareness about public health.

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Snakebite: A Public HealthProblemYou Don’t Hear Of ! Written by DINESH C SHARMA

The antivenom manufactured in

The call to end the neglected tropical diseases (NTDs) under the Sustainable Development Goals framework has brought the problem of snakebite into focus, and this could be an opportunity to take up research in this neglected public health problem, the study has said.

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The special issue of the medical journal has focused on neglected diseases such as lymphatic filariasis, kala-azar, neonatal sepsis, and multidrug-resistant enteric fever. It was supported by the Drugs for Neglected Diseases initiative (DNDi). “This collection highlights the notable successes of public health programs in neglected diseases in South Asia and identifies areas where research and supportive policy are needed to sustain plans for control or elimination,” said Dr. Suman Rijal, Head of DNDi, India. Credits: India Science Wire

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“Most snakebite victims die before they reach a health facility because they first approach a traditional healer for treatment. The quality of available antivenom in health facilities is another problem,” pointed out Dr. Ravikar Ralph, a member of the research team from Christian Medical College Vellore, while presenting his findings at a meeting here.

India is exclusively against venoms of four major snake species and is not effective against other species prevalent in different regions. It has also been seen that there is an intra-species variation of venom of the four major species. In addition, the antivenom products available vary in their neutralization efficacy and clinical effectiveness, the study pointed out. The quality of liquid antivenom is also compromised due to problems in maintenance of cold chain during transportation as it must be stored between 2 to 8 degrees.

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Poor health facilities in rural areas are a major reason due to which snakebite victims do not get adequate care. First, people don’t reach health facilities in time due to lack of transport and even

if they do so, healthcare personnel have inadequate knowledge of snakebite management and lack effective antivenom, according to a new study published last month in the medical journal, The BMJ.

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Many of the deaths and disabilities due to snake bites can be averted if health authorities take steps to prevent snake bites as well as improve facilities for treating those bitten by venomous snake bites. Snakebite mitigation needs concerted efforts just like other public health problems such as malaria and tuberculosis.

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ndia used to be dubbed as a country of snake charmers in just decades ago, but few would know about the darker side of snakes – snake bites. An estimated 28 lakh cases of snake bites occur in India and about 50,000 Indians die due to snakebites every year. Yet it remains a neglected public health problem.

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Can Millets Be the Answer to India’s Nutritional Problems?

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Written by DR.

GEETIKA A. BATRA

odern India, in spite of technological and industrial progress, is still fighting its battle against “food”, both quantitatively and qualitatively. India is one of the top five countries with respect to adult obesity, childhood obesity, and type-2 diabetes. It is predicted that by 2025, India will rank second in obesity, with the count of obese children over 17 million. The irony of the situation is that India ranks first in under nourishment, constituting 40% of the world’s under weight population. Such extremes of poor health conditions are prevalent because of unhealthy food options in one stratum of society, and scarcity of food in another. Currently wheat and rice constitute the most consumed cereals in India. Wheat cultivation dates back to Indus valley civilization, approximately 5000 years ago. In habitants of the Mohenjo-Daro period used wheat to make bread and porridge. The obsession with wheat was further instigated by the Green Revolution in the 1960s when new higher yielding varieties were introduced to cater to a rapidly growing population. Further more, there have been reports about the origin of rice in India about 35 million years back. In India, rice is mostly consumed in the Southern region and the Northeast, where as Northern-central part is the bread basket of the country. Both these staple cereals are consumed as refined flour and polished rice; and because of their smooth appearance and taste fulness, our traditional grains like Bajra (pearl millet), Jowar (sorghum), Ragi (fingermillet) and Rajgira (amaranth) have taken a back seat. In fact, Dr. M. S. Swaminathan, Father of Green Revolution, himself called millets “orphan crops” as they used to constitute 40% of all the cultivated

grains before the Green Revolution, which dropped to about half immediately after 1965. Although all grains, cereals as well as millets, mostly comprise of starch (~60-65%), however the concentrations of protein, dietary fiber and minerals greatly vary among them. Wheat grains are composed of 70% starch, while rice is 90%. Protein ranges from 13—15% in wheat but is essentially lowest in rice among all available cereals. The fiber content, as well as the minerals composition of both the privileged grains, is also poor. Considering the modern-daysedentary lifestyle, the amount of refined carbohydrates we consume without much physical activity is taking a toll on our health, as is evident by rising malnutrition numbers. Moreover, the sudden release of glucose into the blood stream causes “energy crash” soon after a starchy meal. Thus, we need grains with higherdietary fiber and resistant starch. These slowly digestible nutritional elements provide satiety feeling for a longer period of time, and help prevent constipation by accelerating food movement through the gastrointestinal tract. They also bind to toxins and remove them from the gut, thereby protecting the colon mucosa from cancers. Dietary fibers also reduce serum LDL-cholesterollevels, by binding to cholesterol generated bile salts there by hindering their re-absorption in the colon. Based on all nutritional parameters, millets are far ahead of rice and wheat. Not only are they more resistant to digestion, but also the antioxidants abundantly present in millets scavenge free radicals that cause inflammation in the body. Bajra/Pearl millet is the oldest millet used by our ancestors. It is still a part of regular meals in desert belt of the country like Rajasthan

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India is believed to be the world’s capital of diabetes. It is estimated that the diabetic population in the country will increase with an alarming rate of 26.6%, which will account

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micronutrients present in them compensate for their health implications. High iron content in these alternate grains may help increase hemoglobin; considerable phosphorus concentration is good for bone growth and development; magnesium controls blood pressure as well as helps reduce respiratory problems; also strong antioxidants present improve heart health. Millets possess hypoallergic properties as well; they are alkaline in nature, thus preventing the formation of acidity and ulcers in the stomach.

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Consumption of millets lowers the Glycemic Index*, thus combating type-2 diabetes and obesity. Glycemic indices of wheat and rice are 65 and 70, respectively; whereas it is 54 for bajra and 62 for jowar. Although these values are higher for ragi (84) and rajgira (107); but the great amounts of

High iron content in these alternate grains may help increase hemoglobin; considerable phosphorus concentration is good for bone growth and development; magnesium controls blood pressure as well ashelps reduce respiratory problems; also strong antioxidants present improve heart health.

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and Gujarat. It is extremely rich in iron (0.8%), zinc (0.3%), calcium (0.4%), phosphorus (0.4%), and most importantly dietary fibers. Jowar/Sorghum is rich in antioxidants, abundant in phytochemicals such astannins, phenolic acids, anthocyanins, polysterols, and policosanols.They are also a good source of vitamin B complex and folate. Ragi/ Finger millet is mostly consumed in Karnataka, followed by Andhra Pradesh, Tamil Nadu, Odisha, Maharashtra, Uttarakhand, and Goa. Ragihas the highest amount of calcium (344mg/100g) and potassium (408mg/100g), and fairly low content of fat (1.3%). Moreover, it contains antioxidants such as phytates (0.48%), polyphenols, tannins (0.61%),trypsin inhibitory factors; and are a substantial source of dietary fibers (15— 20%). They are also rich in amino acids like tryptophan, threonine, valine, isoleucine and methionine. Rajgira/ Amaranthisconsidered a pseudo-cereal because of its starchy seeds. Its 13—15% proteinaceous grain comprises of almost all the essential amino acids required by the human body, especially high content of lysine, which is basically absent in wheat and rice. It is an excellent source offolates, niacin, thiamin, pantothenic acid, vitamin B-complex, vitaminE as well as essential fatty acids. All of these alternate grains area rich source of soluble and insoluble dietary fibers, providing 7—17% of daily requirement of fibers. Moreover, these grains are gluten-free, which are a greatfood substitute for people with celiac disease.

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for 69.9 million affected individuals by 2025 and 80 million by 2030! In fact, the prevalence of diabetes mellitus in the urban areas is 28%, whereas in the rural population it is 5%. New scientific approaches of developing genetic markers for estimation of the incidence of obesity and diabetes are being developed worldwide, with ironically a simple solution residing in our backyards, Millets! India has 5,97,464 villages and 2,50,000 Gram Panchayats. We need to take initiatives to promote millet farming and consumption starting at the very basic level of villages. Since millets have evolved surviving drought, floods, harsh hot and cold climates, they have adapted with time and are easy to grow under varying environmental conditions. Because of such varied exposures, millets have become resistant to pests and diseases. For this reason, they are easy to grow, without pesticides and insecticides and with little caution; making the end-product “organic”. More so, adding to the food problem is another crisis, “global climate change”, which will cause severe water scarcity inournear future. The additional advantage of millets is their less irrigation demand in agriculture. To sum up, more production of these grains would mean limited water requirement; more consumption would mean decrease in health issues thus resulting in lower expense on medical bills and more availability of funds for other purposes, and extensive availability of the alternate grains for end-use would mean cost-effectiveness. The reasons why these grains are not market-ready are very evident. Most important being the color and tastefulness. Millets contain polyphenols which cause the grains to become rancid faster than wheat and rice. Also, their nutritional utilization demands more effort in terms of processing/ cooking times. Further, to increase the rate of iron absorption

in the body as influenced by phytates present in these grains, processes like roasting or other alternate methods are required. In a quick-fix world of peoplewith changed mindsets seeking instant gratification, it becomes challenging for people at large to take out time and makeefforts towards their better health. The age-old adage, prevention is better than cure, holds true here when we consider the consumption of millets. Considering the overall nutritional status of our country and the environmental issues globally, it is time we approach these matters comprehensively, and expand our food baskets and minds to include more nature-friendly elements. *Glycemic Index (GI) – It is a figure representing the relative ability of a carbohydrate to get hydrolyzed in the body, causing an increase in the level of blood glucose. Dr. Geetika A. Batra is a cereal carbohydrate specialist with R&D experience in genetic and biochemical alterations in cereal grain digestibility and its nutritional implications. She is an active member of scientific societies, American Association of Cereal Chemistry and K. K. Nanda Foundation for the advancement of Plant Sciences. She has been awarded several prestigious international awards and scholarships (Herb R. & Marian H. Cark Scholarship, Paulden & Dorathea I. Knowles Postgraduate Scholarship, two times winner of Life & Health Sciences Conference at University of Saskatchewan, Canada); and has various international publications to her credit. She is currently working as Research Associate in Biothreat Mitigation project at CBRN Defense, DRDO.

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Non-Obese and Lean Indians Also Prone to Type 2 Diabetes: A Study

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Written by DR. P K MUKHERJEE

ontrary to popular belief, not only obese and overweight but also nonobese and lean persons may be prone to type 2 diabetes. A recent study has found that while most diabetics in the West are also overweight and obese, in India nearly 20 to 30 percent suffering from diabetes are non-obese and even some are lean. The incidence of type 2 diabetes has been showing an upward trend in India and elsewhere in the world. This basically arises due to insulin resistance. Increasing obesity and sedentary lifestyle are considered to be main pivotal factors for insulin

resistance and consequent diabetes. However, the new study has busted the myth that increasing obesity alone is the main causative factor. Insulin resistance occurs when the cells in muscles, body fat and liver start resisting the signal that the insulin hormone is trying to send out to get glucose (also known as body sugar, which is the main source of bodyâ&#x20AC;&#x2122;s fuel) out of the bloodstream and put it into the cells. Insulin resistance leads to diabetes, which in medical parlance is known as type 2 diabetes mellitus or T2DM. Researchers measured insulin and C-peptide levels of 87 diabetics

(67 men and 20 women). Actually, beta cells in the pancreas that make insulin also release the C-peptide-a polypeptide composing of 31 amino acids. Although C-peptide does not actually affect the blood sugar of a person, the doctors can measure its level to figure out how much insulin the personâ&#x20AC;&#x2122;s body is making. What made researchers measure the C-peptide levels along with insulin levels in the diabetics under study? This is because C-peptide gets secreted at a more constant rate across time durations as compared to the insulin secretion. Also, C-peptide levels are more stable compared to the insulin levels (its half-life is nearly six

increasing,” “Indian physicians should urge patients to lose weight even when they are in normal body mass index (BMI) category to maintain body habitus at leaner side. This could prevent diabetes in those who do not have it yet, and blood sugar levels are better managed in patients with diabetes,” he added. Credits: India Science Wire

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Summarising the outcome of the study, Dr. Anoop Misra, chairman Fortis C-DOC who led the study, told India Science Wire: “Indians have normal weight-high body fat and low muscle mass. They are not overtly obese but have not only high body fat but fat which is located in the crucial organs of metabolism, i.e., liver and pancreas. Once this occurs, the action of the insulin hormone becomes jeopardized, and blood sugar starts

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Along with high body fat and visceral fat, researchers also found elevated levels of insulin and C-peptide in the 87 diabetic patients studied by them. Such patients would benefit better from pharmacotherapy using insulin sensitizers or weight loss therapy, the study noted.

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The study has concluded that nonobese (BMI below 25) and even lean (BMI below 19) Indians have high body fat, excess fat in the liver and skeletal muscles and lesser skeletal muscle mass. In particular, they have ectopic fat in the liver (non-alcoholic fatty liver disease) and pancreas (nonalcoholic pancreas disease), which may contribute to insulin resistance leading to diabetes even in young age.

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times that of insulin)which facilitates testing of beta cells’ response, the study has pointed out. The results revealed that the persons included in the study had largely the features of adiposity characterised by high body fat, abdominal fat and fatty liver condition, which may not be visible from outside.

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DigitalDiabetesManagementMarket Written by KEVIN

STEWART

iabetes is one of the worst nightmares that is spreading like a wildfire in all the regions of the world. According to the International Diabetes Federation, almost one in every ten people suffer from diabetes and the number is expected to increase further, if proper measures are not taken. The hectic lifestyles and changing food habits of people across the globe make them more vulnerable to this epidemic. For a long period of time, oral drugs, blood glucose monitoring devices, insulin pumps, and others are supporting diabetic people to control their blood sugar levels. However, the advent of new technologies has

taken this to an all new level. The rapid adoption of technology in healthcare also touched the area of diabetes care management; digitizing the available methods to provide more comfort and simplicity to the affected people. The sudden wave of smartphones had a great impact on the digital diabetes care as it brings forth several smart apps that help the consumers to track their blood glucose levels, diet and physical activities, sleep pattern, and so on at their fingertips. More innovations are being carried out to provide more compact and efficient solutions to diabetic people, especially the geriatric population in remote areas of the world.

The Global Digital Diabetes Management Marketis is expected to cross around USD 20 billion by the end of 2024, registering a CAGR value of 24% during 2019 to 2025; as per the research report published by Research Cosmos. The growing adoption of technology and increasing acceptance of smart applications by consumers along with the extensive spread of diabetes in all the demographics, people are expected to drive the demand for digital diabetic solutions. The major benefit of these solutions is that they can be availed within the comfort of home, without any hospital visits or medical professional support. The portability offered by these

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world, who prefer home healthcare will become the lucrative segment of end-users for these devices; pulling the market players to focus more on this section.

Kevin Stewart is currently working with Research Cosmos as Market Research Manager; a firm that does Global Market Intelligence.

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Globally, North America has been the demanding region with the significant market share in digital diabetes management market. The contribution from the developed nations of this region like the USA, Canada and Mexico has been tremendous in the recent years. The

Ascensia Diabetes Care, and others. All these players are investing in their R&D activities to implement and introduce more innovative solutions in the world digital diabetes management market.

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The major challenge these digital solutions face is to reach the rural population in many developing regions of the world. The lack of awareness about the availability of these features due to the improper publicity and initiatives from the government can be a stronghold for this market. Additionally, the high costs of smart devices and unstructured regularization of the products, which can lead to the availability of counterfeit products that

Some of the prominent names in the global digital diabetes management market are Abbott Laboratories, Merck KGaA, Roche Diagnostics, AgaMatrix, Glooko Inc, Tandem Diabetes Care, Medtronic, Dexcom, Lifescan, DarioHealth, Tidepool, Insulet Corporation, B. Braun,

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The increasing acceptance for digital diabetes management has pushed many manufacturers in healthcare to concentrate more on the development of innovative solutions to grab the major chunk of the world profits. Several acquisitions, mergers, collaborations and new product launches have become the important strategy of many leading players to improve their market holdings. One such popular event in the recent years is the partnership of digital diabetes platform provider GlucoMe with the leading German pharmaceutical company Merck KGaA to offer the digital diabetes platform services to various hospitals in Vietnam, which has one of the fastest growing diabetic cases in the Asia-Pacific.

However, the future looks more promising for the digital care in diabetes with the augmenting innovations in the technology such as data analytics and artificial intelligence (AI). These technologies will further intensify the services offered currently at more affordable prices. In particular, AI will play a prominent role in the increasing efficiency and care of these solutions. Similarly, the added style factor in wearable devices by several manufactures around the world will further create huge demand for digital diabetic solutions. Furthermore, the growing elderly population of the

increasing cases of diabetes, rapid adoption of advanced technologies in medical care, sophisticated healthcare infrastructure, mounting number of geriatric populations, awareness about the benefits of these devices among the population and the favourable government reimbursements have been the driving factors for the growing demand of digital diabetes management in the North American nations.

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One of the most noteworthy trends in digital diabetes management is the introduction of wearable devices. These devices can be worn on the body with much ease and are capable to provide round the clock assistance to the consumer, along with the maintenance of style quotient. The advantage of these wearables could be continuous monitoring of the blood glucose levels of the person, providing required amounts of insulin to body without any external assistance, sharing patient condition to respective healthcare provider or doctor, providing regular alerts about health status, offering suggestions to improve health and so on and so forth.

are harmful to the body could act as limiting factors for the rapid adoption of the digital diabetes solutions among the global population.

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digital solutions allows the patients to carry them anywhere without any hassle.

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Diabetes and Digital: Discussion on Unmet Needs and How Digital Tools Can Help? Title: Panel discussion by ExperimentsWithSugar team for FTR4H in Medical Fair India 2019

Gaur and was graced by panelists Surgeon Rear Admiral (Retd.) Dr V K Singh, Mukul Bagga and Dr Vibha Jain.

ExperimentsWithSugar, a non-profit initiative under InnovatioCuris Foundation of Healthcare & Excellence (ICFHE), participated in a panel discussion on "Diabetes and Digital: Discussion on unmet needs and how digital tools can help?" which was a part of FTR4H (Future for Health) under the MEDICAL FAIR INDIA 2019 banner.

The panel discussion strikingly discussed about the challenges in behaviour change and lack of right information and actionable insights for a patient and clinicians alike.

The panel was moderated by Sachin

The panel discussed about • The wildfire growth of Type 2 diabetes in India; its knowns and unknowns • Proposals to fix the oncoming

diabetic epidemic situation • Unmet needs of stakeholders in terms of diabetics, care givers, clinicians, diagnostics, etc. • Prediction of digital tools in the Indian healthcare diabetes landscape Some moments from the panel discussion can be found at experimentswithsugar.in/ participation-gallery

Full video of the panel discussion can be watched at http://bit.ly/ewsftr4h-panel

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Healthy Lives:

Everyone, Everywhere DRIVE TOWARDS GLOBAL HEALTH

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Written by DR.

JASMEET KAUR

Good health is the most precious thing anyone can have,” says Dr TedrosAdhanom Ghebreyesus, WHO Director-General. “When people are healthy, they can learn, work, and support themselves and their families. When they are sick, nothing else matters. Families and communities fall behind. That’s why WHO is so committed to ensuring good health for all.” WORLD HEALTH DAY April 7th marks the birth anniversary of World Health Organisation (WHO) and along with drives a worldwide attention by spreading the message of importance of global health each year. Ranging from imperative issues such as food safety, diabetes, depressions, etc., this year the World Health Day embarks the mission of people-centred care irrespective of their financial hardships. The 2019 theme envisions the Universal Health Coverage (UHC), i.e., health for all. There are millions of people who have no access at all to healthcare. Majority of the populations are forced to choose between healthcare and other daily needs such as food, clothing and shelter. In India, lot of efforts need to be put in to ensure adequate medicines, affordable health policies, and financing strategies to enable everyone to get access to equal healthcare. “Universal” in UHC means “for all”, without discrimination, leaving no one behind, i.e. providing healthcare facilities which are • Accessible • Affordable • Available • Appropriate • Adequate

ADDRESSING THE FINANCIAL CRISIS “Universal health coverage is also about ensuring access to essential quality care and financial protection,” says Dr Mahjour. It aids in enhancing people’s health at large and increasing their life expectancy. Under this, many countries are protected from epidemics and the risk of hunger. This paves a way for new jobs, enhanced economic growth and gender equality. To make the phenomenon of Universal health coverage achievable globally, there should be concrete roadmaps which highlight the gaps and obstacles patients face in accessing proper

healthcare. This can be done only when there are identified challenges, key actions and sustainable goals to be taken care of. • There must be a holistic range of health and related services • Quality care is a must • There must be an end to discrimination and stigma • The healthcare products and services should be affordable • Sustainable investment in health is another prerequisite

Prime Minister Narendra Modi has initiated a new programme called Ayushman Bharat, which along with focusing on preventive health, emphasizes on affordable health.

Through its ambitious National Health Protection Scheme (NHPS), the Government of India provides

Dr Jasmeet Kaur is a Doctorate in Immunology and whenever she gets free time from her full-time job she loves to read and write about imperative issues in healthcare.

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The scant funding from the Central and state governments seems the root cause and the major hindrance in achieving UHC. The Central Government has recently announced a massive expansion of healthcare facilities.

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WAY FORWARD FOR A HEALTHY NATION Does Universal health Coverage still seem a distant goal in India!

a framework for universal health coverage in which it prioritises healthcare delivery and its easy access. By reducing out-of-pocket payments, expanding service coverage, improving quality of services, and ultimately advancing UHC, countries and in particular India with schemes like NHPS in place can transform health of their people and bring drastic changes in society. As stated by WHO Director-General: “No one should have to choose between death and financial hardship. No one should have to choose between buying medicine and buying food.” UHC indeed is a way to go ahead.

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Modi is the first Indian Prime Minister who has grasped the importance of health for Indian citizens and has prioritised universal health coverage as part of his political platform. “Modicare” as it is sometimes addressed to, can become a decisive issue in the upcoming general elections.

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Ayushman Bharat majorly comprises two new flagship programmes. First, the creation of 1.5 lakh health and wellness centres across the whole country. These centres will primarily be responsible for providing primary healthcare facilities to provide health coverage for all. Second includes the National Health Protection Mission (NHPM)—a system of health insurance that intends to cover 500 million people. It covers secondary and tertiary care for the poorest and most vulnerable strata of society. These twin programmes together must help India improve access to quality health services and reduce out-of-pocket health expenditures.

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It would be unfair if we highlight only the negative side of the picture. After many years of neglect, the Government of India has finally recognised and considered the perils of public discontent relating to health. Prime Minister Narendra Modi has initiated a new programme called Ayushman Bharat, which along with focusing on preventive health, emphasizes on affordable health.

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Recent researches reveal an alarmingly rapid epidemiological transition. The occurrence of diseases such as cardiovascular diseases, diabetes and cancer are rapidly on a rise. For instance, since 1990, the number of Indians with diabetes have increased from 26 million to approximately 65 million till date. The incidence of all cancers has increased by 28% between 1990 and 2016, with new cases of cancer emerging each year.India not only seems terribly engulfed in the swirling epidemic of non-communicable diseases, it is also in the grip of a mental health emergency. The rate of global suicide deaths is speculated to be 1.1 times higher among women and 1.4 times higher among men than global averages in 2016.

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WHERE INDIA STANDS – THE NEW “HEALTH-Y” POLITICS The much-awaited general election will be held in India in April 2019 when the Indian voters will go to the polls. It is anticipated that whichever government comes into play will surely set a course for a newer and better health policy.

Reviewed by Dr Debleena Bhattacharya, Project Co-ordinator (SRISTI-BIRAC PMU), SRISTI

Lean. The examples in this book describe the successful actions taken in patient treatment goals of better healthcare in less patient time. The authors have done a great job of compiling a wealth of knowledge from across the globe to demonstrate how innovation, technology, and Lean principles can transform the delivery of quality healthcare and reduce costs. Healthcare is a troubled industry globally. There are new approaches in this book we can all learn from. At the same time, what is needed in America may not be the same as what can be implemented in India with over 500 million people and incredible levels of poverty. In its essence, the book focuses on a country with lesser developed infrastructure, and therefore, the problems encountered are not unique to India, but also not universal.

A “Shingo Publication Award” Winner 2018, the book “Innovations in Healthcare Management” by Dr V K Singh and Paul Lilrank brings together various aspects of healthcare management innovations and the journey which the organizations have followed to streamline the delivery of healthcare while facing quirky challenges. The following text brings forth the review of the book. CONTENT This thoughtful and engaging book which involves 34 contributors is a resourceful compilation of 22 chapters which cover a wide range of topics. Majority of the chapters provide a snapshot of approaches taken to improve healthcare management but do not delve into the roadmap for implementation. Thus, the book would be a good companion guide to stoke innovative thinking for those involved with a healthcare system. Innovations in Healthcare Management cover a wide range of topics that can be used to create a Lean transformation roadmap. Not only does the book cover the systemic burning platforms shared by various healthcare organizations (i.e. improve quality, reduce cost, improve patient satisfaction), but the book puts a high value on healthcare improvement from the end-user perspective. Additionally, the book identifies opportunities that impact communities, supply chain, and stakeholders. This publication adds to the existing body of knowledge by providing not only tools and techniques for transforming an organization, but also includes real-world examples of Lean transformation within healthcare organizations such as Tan Tock Seng Hospital in Singapore, Stanford Health Care, and the Mayo Clinic. Also, there are examples of Lean tools such as A3, Just in Time, and Quantitative versus Qualitative impact analysis. The book provides a comprehensive approach to Lean transformation within diverse healthcare environments. The insights and real examples provided benefit the reader regardless of lean knowledge or level of experience.

IMPACT The demonstrated impact for Innovations in Healthcare Management on the body of knowledge is difficult to ascertain. The market is flooded with a large number of books with the subjected topic. However, it can be inferred there is a demand and there has been sufficient impact to justify a second printing with a special Indian addition. The book has been prescribed in Indian Institutes of Managements (IIMs); prestigious institutes established by the Government of India. There are 12 endorsements from a very impressive list of healthcare experts from the United Kingdom, United Arab Emirates, India, United States, Tanzania, Brunei, South Africa, Sweden, and the Cayman Islands. This indicates the level of impact the book has made. PREMISE The premise of the book is quite simple: “A lot can be done with a little. It is reducing healthcare delivery cost yet maintaining quality through technology, innovation, and various quality models like Lean and others.” The authors’ statement that “trying to do more with more ends up accomplishing less with more” is the reason for any organization to embrace becoming

PRESENTATION The presentation and style of writing the articles flows together quite well and contribute effectively to the authors’ objectives. The stories and examples provided throughout the book offer compelling ideas for understanding how to positively impact the delivery of healthcare from Britain, United States, Singapore, and India. The book contains many simple illustrations and is grounded with facts and visual examples. All of the articles are well referenced. The summary at the end of each chapter provides a linkage back to the overall premise. The book is an easy read and effective at getting the reader to understand the concepts. KEY TAKEAWAYS Examiners agreed that there are many takeaways in the publication. The authors successfully support the premise that more can be done with less. They prove that people can be very creative and innovative when faced with a meaningful challenge that can be embraced. They also effectively show the importance of relationship management between the patient, medical staff, and ancillary stakeholders and dispel the concept that patient care only occurs between the hospital and the patient. Additionally, not all the important healthcare innovations have come from the USA, as India is becoming a leading innovator in healthcare, and others can learn from them.

Reviewed by Sachin Gaur, Executive Editor InnoHealth At first glance, this book by Kai-Fu Lee is not a very eye-catchy book to open. However, open it up and youâ&#x20AC;&#x2122;ll quickly realize that how comprehensive and timely book it is, and he is probably the best person to share this story. The title of the book sounds political;however, it is much more profound as it not only speculates the new world order but also discusses the age-old dilemmas we have faced as a human race in our quest of taming technology (read AI). What makes this technical topic accessible to readers as Kai-Fu Lee after spending his lifetime in the development and promotion of AI suffers a personal tragedy and is diagnosed with cancer. The situation forces him to question his own lifeâ&#x20AC;&#x2122;s priorities and what matters to the human race when existence to do work is at threat. He suggests a novel approach by which we can coexist with technological changes and maximize what makes us human. The beauty of the book lies in the

intelligence to solve problems across sectors and highlights the importance of (having) data (training datasets) for an edge in the AI-driven world. Given the past decade of developments in Chinese market in regard to consumer Internet applications, it has given an edge to China over the US. Hence, the new world order Kai-Fu Lee foresees has a market share of 70% for the US and China out of the wealth created from the AI revolution.

fact that at one hand it makes you think of the fundamentals of the human existence and life on an abstract level and on the other, it provides a comprehensive history and understanding of development of AI technology starting from western world to being mastered in China as of today. It presents the potential of artificial

Given that Kai-Fu is an AI freak, he is able to better understand the implication of AI on his own diagnosis of cancer. During the preliminary diagnosis, his cancer is diagnosed as stage IV by the radiologist basis a simple classification (considering only few variables). He realizes how AI can consider many more variables when making such a decision. He was lucky to discover that his case was treatable, and he could survive to share this interesting story with us! Hope you also find inspiration to automate your tasks using AI and spend more time being a human than a work machine!

InnoHEALTH magazine volume 4 issue 2 - April to June 2019

Articles inside

Book review of AI Super powers

Book review of Innovations in healthcare management

Healthy Lives: Everyone, Everywhere

Diabetes and Digital: Discussion on Unmet Needs and How Digital Tools Can Help?

Digital Diabetes Management Market

Non-Obese and Lean Indians Also Prone to Type 2 Diabetes: A Study

Can Millets Be the Answer to India\u2019s Nutritional Problems?

Snakebite: A Public Health Problem You Don\u2019t Hear of!

Gallstones: The Truth Underneath

The Fertility Diet: Zero Stress Recipe

Cognitive Development: Before and After Birth-Myths and the Realities

Health and Wellness Coach Platform for Industrial Workers

ASHAs Set Up a Role Model in the Eradication Programme Against Malaria in Odisha

Medical IoT: Future of Connected Health, Are We Ready?

Data Analytics Will Increase the Quality of Care! How?

Is \u201CSmart\u201D Technology a Saviour of Healthcare?

WAND... PACEMAKER FOR THE BRAIN

IOTA BIOSCIENCE CREATES BODY SENSOR SMALLER THAN SAND GRAIN

IIT KHARAGPUR DEVELOPS DIAGNOSTIC TOOLS FOR INTERSTITIAL LUNG DISEASES AND LUNG CANCER

TESTCARD: A CARD-SIZED URINE TEST AT HOME

FITLOO: MIT\u2019S SMART TOILET DETECTS CANCER, DIABETES THROUGH URINE

SENSORS TO DETECT MILK ADULTERATION......

BRAIN IMPLANTS LET PARALYZED PEOPLE USE ATABLETS TO SEND TEXTS AND STREAM MUSIC

APPLE WATCH CAN SOON PREVENT SKIN CANCER, PREMATURE SKIN AGEING AND SUNBURNS

NOVIOSENSE....THE DEVICE THAT CAN BE KEPT IN THE EYES TO MONITOR SUGAR LEVELS

Cybersecurity: The Vulnerability of Medical Institutions to CyberAttacks

Cybersecurity Business Evangelist

Cybersecurity: Trends, Challenges, and Threats in Healthcare

Healthcare: Handle with care - By Shri Karnal Singh

Indo-Danish relationship in healthcare