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InnoHEALTH/VOLUME-1/ISSUE-2/Oct-Dec2016/New Delhi

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InnoHEALTH/VOLUME-1/ISSUE-2/Oct-Dec2016/New Delhi

Editor-In-Chief:

Dr V K Singh

Executive Editor:

Sachin Gaur

Editors:

M Neelam Kachhap Alok Chaudhary Dr Avantika Batish Shikha Bassi Nimisha Singh Verma

Advisors Konda Vishweshwar Reddy, Member of Parliament, India Amir Dan Rubin, Executive Vice President, United Health Group, USA Thumbay Moideen, Founder President, THUMBAY Group, UAE Prof Prabhat Ranjan, Executive Director, Technology Information Forecasting and Assessment Council, India

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 Dr Ogan Gurel, Chief Innovation Officer, Campus D, South Korea Dr Chandy Abraham, CEO and Head of Medical Services, the Health City, Cayman Islands 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 Major General (Retd) A K Singh, Advisor, Telemedicine and Health Informatics, Rajasthan, India Printed and Published by Sachin Gaur on behalf of InnovatioCuris Private Limited. Printed at Poonam Printers, C-145, Back side Naraina Ind. Area, Phase I, New Delhi. Published at E-29, First Floor, Malviya Nagar New Delhi 110017. Editor: Sachin Gaur. DCP Licensing number: F.2.(I-10) Press/2016

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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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Way Forward…………. Healthcare is a complex industry and innovation can find solution. There are four major healthcare systems (1) out of pocket (2) tax financed Beveridge model (3) insurance based Bismark and (4) national health insurance system. It is interesting to know that none of these models satisfy stakeholders and there is a need to find hybrid system which takes good of every healthcare delivery model. The dissatisfaction in poor and emerging economies is due to affordability, while rich and developed keep spending and demand more like in USA annual per capita expenditure on health was $8602 (17.2% of GDP) in year 2011 but people were not happy. Cost containment is possible by evidence based system, use of quality tool like lean, judicious use of technology, frugal innovation and indovation. The aim is to deliver healthcare at optimum cost keeping quality in mind and find innovative method to make it affordable by insurance, government support or any other system developed, for adoption in future. Information technology has played a vital role in the innovation of healthcare systems. It is normal corollary to innovate and use technology to reduce disease burden by improving health outcome by use of IT, m-health, e-health through effective hospital information system (HIS), telemedicine & electronic health record (EHR). Frugal innovations in Indian healthcare have attracted global attention. IT has been used innovatively on real-time basis to reduce operating cost by Iris Hospital Kolkata, India. Use of various devices like tablet, palm held computing have been integrated at all levels to improve hospital operations to control nosocomial infection, medication management, inventory management and decentralized billing system to reduce cost and improve efficiency.

of world health innovation network. We would keep you updated through our monthly newsletters about all our initiatives and events from time to time. We are open to all suggestions to improve further and add any new activities. We have received very positive feedback which we would publish in our magazine. We soon would be launching virtual training programs on various aspects of healthcare innovations.

We launched InnovatioCuris (IC) a year back with the aim of creating a knowledge platform to share best practices from rich and emerging economies to learn from each other to reach the objective of qualitative healthcare at optimum cost. IC organises International conference InnoHEALTH, which include Thought Leaders’ Forum and Young Innovators’ Award. It also organises webinars, Innovators’ club and InnoHEALTH magazine. This is the second issue of magazine, which would be sent complementary to 25000 professionals.The first issue can be downloaded from our website www.innovatiocuris.com, it is a global magazine and we share experiences, case studies and latest happenings to emulate. We need active support and participation from every one to make it happen and develop ecosystem

We request everyone who has interest in healthcare innovations to connect with various initiatives launched by us to benefit everyone. It is team work and various stakeholders should come together to deliver qualitative healthcare at optimum cost.

We would scout technology from abroad which is simple to use and can impact have-nots for better health outcome at least cost. The present government of India has created many initiatives including funding opportunity to incubate any idea, which can benefit people.

Editor in Chief and MD, InnovatioCuris vksingh@innovatiocuris.com

InnoHEALTH/VOLUME-1/ISSUE-2/Oct-Dec2016/New Delhi

Contents Connecting the Dots ........................................................................................................................................... 01 Sachin Gaur .................................................................................................................................................. 02

Setting the Tone ................................................................................................................................................... 03

Healthcare Reform is Trickier Than You Think ............................................................................................ 04 Paul Lillrank

Indovation ............................................................................................................................................................. 07 Screening for Cervical Precancer in India .................................................................................................... 08 Dr Dinesh Gupta How Tele-Health can Bring Diabetes Care to the Common Man ................................................................ 13 Naveen Gulati Clinical Practice in India- Equivalent to Corporate Sufism .......................................................................... 15 Radhika Shrivastava Business Proposals, Most Favoured by Investor .......................................................................................... 17 Prarthana Gandhi

Global Innovation ............................................................................................................................................... 19

Universal Healthcare: Innovations Needed in Regulations ........................................................................ 20 Dr Shiban Ganju The Swedish Solution to a Global Challenge ............................................................................................... 23 Iris Öhrn Innovating Care: Healthcare to Wellcare .................................................................................................... 26 Steven Yeo

Technology Trends .............................................................................................................................................. 29

Big Data in Healthcare: Mirage or Market Opportunity? ........................................................................... 30 Manishankar Prasad Techno-Management Innovation in Indian Emergency Medical Services .................................................. 34 Sreekanth V K Health 360° – The Big Datalytics Opportunity .............................................................................................. 38 Haritash Tamvada What Is Next for Wearables? ....................................................................................................................... 40 Dr Kate Lazarenko

Pulse ........................................................................................................................................................................ 49

Healthcare Innovations ................................................................................................................................ 50 Dr. Avantika Batish

Interaction with Readers ................................................................................................................................... 56 Guideline to Authors .......................................................................................................................................... 58

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Connecting the Dots

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The North European Connection Sachin Gaur is director operations at InnovatioCuris. He is interested in topics of mHealth and Cyber Security.

n my recent visit to Sweden, Finland and Estonia I gathered that their healthcare concerns are not very different from ours. Although these small European countries are very different from India demographically, financially or even geographically, healthcare concerns like the threat of antimicrobial resistance, concerns of ageing population and IT based healthcare solutions are common thread joining us all.

1. Growing threat of Antimicrobial Resistance A much talked about case in Finland was of a Finnish visitor to New Delhi, who fell ill in Delhi and on his journey back in Helsinki was tested and found to be resistant for 25 antibiotics out of 26 available in Finland for the disease. The scientific community seems to be worried about this travel related spread of resistant bacteria and the preparedness of the country to deal with any epidemic. There were presentations on new kinds of equipment and in general preparedness of the labs to deal with a public health crisis and provide country wide surveillance and monitoring of the various epidemics. The second sets of presentations were on building nano-materials that are antibacterial in nature. However, there was a concern on the impact of building such materials at a large scale. Experts debated that such materials would also kill the good bacteria if erosion of such a coating happens and inhaled by a patient. There were also interesting presentations on new kind of e-services for people to order test kits and send the sample back to the lab for diagnosis.

2. Solutions for Active Ageing I also witnessed many specialized equipment and programs encouraging healthy ageing. Europe, (Northern Europe to

be specific) has realized that the population is ageing fast and this constitutes the maximum concern from a disease burden perspective on the country. Hence, various countries have initiatives to keep the population engaged and healthy. Some approaches are technology focused like that of fitness equipment and some are more social in nature. One of the approaches I liked was a concept of CreAger, where the target group is elderly population, who can contribute in creation of new startups through their vast experience and knowledge.

3. eHealth and other Data Driven Healthcare Services I also witnessed a plethora of eHealth solutions mostly from Estonia, which are bringing huge gains in the efficiency of the health care system and something every country can learn from. The eHealth system in Estonia is definitely a unique experiment at the scale of a nation state which is a case study for any country aiming to adopt eHealth in time to come. ePrescription and its connectivity to the genome bank of 50,000 Estonians offers a possibility for Estonia to pioneer the era of personalized medicine; something we otherwise read in books about future. As an observer from India, I saw that we have many synergies and possibilities to learn from all these countries for future developments. Stay tuned to InnoHealth to learn more about these synergies and opportunities.

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Setting the Tone

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Healthcare Reform is Trickier Than You Think Paul Lillrank has been Professor of Quality and Service Management at Aalto University since 1994. He has served as the Head of the Department of Industrial Engineering and Management and been Academic Dean of the schoolâ&#x20AC;&#x2122;s MBA program. He received a Ph.D. in Social and Political Sciences at Helsinki University in 1988 after spending six years as a post-graduate student in Japan where he researched quality management in Japanese industry. He is a pioneer in introducing industrial management methods to the study of healthcare service production. He has been visiting professor at the University of Tokyo, and teaches regularly at the Indian Institute of Technology, Kharagpur

ealthcare is a troubled industry. There is no known health service system that would work to the satisfaction of all major stakeholders, patients, providers, and payers. No matter the amounts spent, nothing is ever enough. The resource problem looks different in the rich and in the developing world. In affluent countries demand is relentlessly driven by new technologies and cures, ageing populations, life-style â&#x20AC;&#x201C;related problems and the medicalization of trivial ailments. Islands of undercare dot a sea of overcare. In the developing world the situation is the reverse. All responsible governments have noticed that the situation is unsustainable. In Finland, gross health service expenses have doubled since the year 2000 outpacing economic growth by several percentage points. Health and welfare has become the cuckold that kicks other public tasks, such as infrastructure, education and defense out of the nest. The obvious counter-measure is to increase productivity. According to a recent study by Aalto University, there is ample room for that. If all districts in the country, after adjusting for local variations in population and morbidity, would perform at the level of the national average, one billion euro could be saved out of a total expenditure of eighteen billion. If all would perform at the level of the best, no innovations required, the savings could be three billions. Such regional variation is puzzling in a health system that is to ninety percent tax financed and centrally regulated. Neither the government, nor the professionals have been able to implement standardized best practices. There is a strong case for Lean healthcare.

Raw improvement of everything, however, may be a dull weapon. There are several interesting patterns that are not visible to the naked eye. A data â&#x20AC;&#x201C;driven helicopter perspective is needed. There are areas where improvement would be especially welcome, and not only in the shape of smooth processes but better structures and allocations. Curiously, there can be simultaneous overspending and undercare. A common observation is that healthcare expenditure follows the Pareto distribution or the 20/80 rule: one fifth of the population spends four fifths of the resources. In a recent study, The Nordic Healthcare Group (NHG), a consultancy, studied the health expenses in a medium-sized city. The distribution was sharper than the traditional Pareto. Ten percent consumed seventy percent. There was a hard core of high spenders, a few hundred individuals that consumed more than half of the total municipal health and welfare budget. They could be divided into three categories: expensive somatic cases such as premature and massive trauma; elderly multi-morbidity patients in around-the-clock care; and the sad combination of substance abuse and mental disorder. With the possible exception of the first group, these people did not get value for the money. Their quality of life was overall bad. This happens in a welfare society that has for decades mobilized the full force of the state and committed massive resources to universal access and equality of care. Still there some people are simultaneously overserved and undercared. Growth has been fastest in the extremes of the care spectrum. The most technically advanced specialist care spends like there is no tomorrow. The low end of home and community care is not that expensive per unit, but the number of cases increases dramatically. In Finland

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between the years 2000 and 2014 expenditure for specialist care doubled, long-term care for the elderly and handicapped grew 160%, while primary care have had to do with a paltry 60% increase. The trouble is in the middle. Since WHO’s Alma Ata declaration in 1978 every policy maker has paid lip service to the strengthening of primary care. Therapies should be administered at the lowest sufficient level to save the specialized resources to those that truly need them. It is better to treat diseases early than to allow time to turn them into complications. Despite the best of intentions, quite the opposite is happening. A relatively weakened primary care feeds growing numbers of increasingly sick people to hospitals. It is common knowledge that free markets do not work in healthcare. The relative weights of primary and secondary care, however are powerfully market driven. Consider two hypothetical doctors. A is an accomplished neurosurgeon, who successfully saves lives by removing brain tumors. B is a general practitioner, whose working day is an endless stream of small infections, minor trauma, and unspecified pain. As a patient, taxpayer, or regulator, how much would you be willing to pay for a day’s work to A and to B? The answer is obvious. Medical students, investors and decision makers have long since decided to follow the money. In the Nordic countries center-left governments have traditionally been suspicious, if not openly hostile to markets in healthcare. Still, and despite all the Alma Ata –rhetoric, they have been incapable of stemming this particular market mechanism. This points to a broader problem. It appears that even in publicly financed and administered systems, public sector provision is not under public sector control. The government did not call for rampant cost-inflation. No politician has demanded queues and increasing socio-economic health inequality. Still it happens. The Norwegian political scientist Stein Ringen has eloquently described this phenomenon in his book A Nation of Devils. Politicians may think they are in charge. As a matter of fact they don’t do things, they just issue statements, make decisions and allocate money. Before anything real happens on the ground, the issue has to travel through a lengthy

chain of civil servants and administrators, who have every opportunity to turn gold into lead. It is well known that a core issue in health policy is the information asymmetry between patients and doctors. A similar, perhaps even more devastating asymmetry is between politicians and professionals. For this reason planned economies have never worked as planned. If markets don’t work and command-and-control is hopeless, something else needs to be done. The answer is to be sought from the design of quasi-markets. While greed is and has always been pervasive, nothing controls the greed of a seller as efficiently as the greed of a buyer. The current center-right Finnish Government has realized the problem and initiated a sweeping reform. While the initiative sill has to run the gauntlet of entrenched interest groups and parliamentary opposition the basic principles are clear. For a nation to contain health expenditures at a sustainable level without endangering public health, some or all of the following mechanisms must be put at work: - Care should be initiated at the right time; not too early, not too late. - Care should be administered at the lowest sufficient level; primary and secondary care must take joint responsibility of care pathways. - The care of very expensive multi-morbidity cases must be integrated to include somatic, psychiatric and social care. - The overall productivity and quality of care processes and administration must be improved following the principles of Lean healthcare. - Care should, when possible, be evidence –based not to do useless interventions. - Increasing health literacy and the awareness of life-style related diseases should reduce demand. The core issue is how to design a system that can put to work all or some of these mechanisms. There are no simple solutions. Policy makers have two levers at their disposal, information and money. The information should be about value. As Michael Porter and other proponents of the Value –based Healthcare movement have suggested, value is the relation between health outcomes and the money spent, measured at the

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patient level over a full cycle of care. To develop accurate and comparable measures of health outcomes is a formidable task that is currently undertaken by several research and development initiatives around the world. If such information were available, policy makers could design health finance systems that could align the interests of patients, payers and providers. In Finland some of the central policy proposals are, first, a single-payer system. The state collects all money and distributes them to regional authorities. Second, all caregivers should be organized as limited liability companies with standardized accounting and reporting. While most of the money will still flow from the taxpayers, every caregiver would get its income following the same rules and be subject to the same outcome measures. The current public providers who would loose their privileges and be forced to compete, obviously, will furiously resist. Third, to allow patient choice and strengthen primary care, a finance system based on capitation is proposed. Each citizen should register with a health- and welfare center, which would then receive a fixed annual per capita remuneration from the government. The amount of the capitation money, and the corresponding variety of services that it should cover, are hotly debated. At the low end, the amount could be calculated based on the average annual spend of the healthy adult population, which currently is in the range of 250 €. At the high end it could include just everything and be about 3 500 €, which is the total per capita expenditure. In the latter case the primary care centers would get full control of all financial

flows. On the behalf of patients they would purchase clinical interventions from specialist hospitals as needed, essentially taking the role of an insurer. There would be several problems with such drastic measures, so there will probably be a compromise allowing some part of the specialist care to be financed on a fee-for-service –basis by the regions. While capitation –based finance provides strong incentives to primary care; there are some known pitfalls. Since the income comes by registered citizen and the costs come from the resources needed to provide service, there is a temptation to engage in skimming, i.e. lure healthy individuals to register while denying service from those with pre-existing conditions. This can be tackled by legislation that prohibits denying anybody from registering as well as kicking anybody off the list. There would still be the risk of undercare and cost-shifting, i.e. costly patients are referred to specialist care, and to be paid directly by the government. The design of a quasi-market with regulated competition and patient choice requires accurate and publicly available information on value: the relation between outcomes and euros spent at each care organization. Therefore the key task for researchers and policy makers is to develop and experiment with information systems that could do this. For health policy makers in India and other rapidly developing countries this may sound like a rich-man’s problem. Indeed it is. The message, however, should be that money will not solve a nations health problems. The pit has no bottom. Health systems emerge slowly and are difficult to change. Latecomers can always have the privilege to learn from other’s mistakes and make a mighty leap to the front.

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Indovation

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Screening for Cervical Precancer in India Dr. Dinesh Gupta is a technopreneur in healthcare committed to promote advanced cancer diagnostics at affordable costs to many. A molecular biochemist by training Dr Gupta, is engaged in early detection and prevention of cervical, breast cancer and sexually transmittable infections as a national expert. He launched molecular HPV and LBC testing procedures in India. Currently, heading CureHealth Diagnostics, a joint venture cancer diagnostic laboratory with the US partners. He is also an honorary molecular diagnostics expert at CR Wadia Preventive Oncology Center, Thane Municipal Corporation (TMC), Thane and at the helm of a TMC endeavor on cervical and breast cancer screening program covering nearly half a million women in Thane, Maharashtra in next 5 years.

Cervical cancer is totally preventable if women subject to screening once in five to seven years after the age of 30 years or post their sexual debut, whichever is early. It is a leading cause of cancer deaths in women in India, almost parallel to breast cancer. The most significant primary factor for cervical cancer is persistent or long term infection due to the oncogenic types of human papillomavirus (HPV). HPV is the most common sexually transmittable infection that many women would acquire sometimes in their life. Cervical pre-cancer is a clinically detectable stage by advanced mRNA testing followed by colposcopy and that can be treated by simple and inexpensive outpatient procedures that does not require hospitalization too. The national healthcare policy makers need to realize that providing a health insurance cover for screening for cervical precancer would actually save cost on national exchequer thousand folds to treat this cancer, thanks to the people centric governance in the rising India.

Major considerations behind cancer screening With the advent of modern molecular era, for instance, an introduction of HPV testing in cervical screening, a tests

he latest cancer mortality rates in the western world show reduction in cancer-related deaths. A high percentage of cancer patients now show a better 10-year survival rates than the past decade, thanks to their organized healthcare governance, advent and acceptance of newer diagnostic and therapeutic modalities, and consciously aware population at large. On one hand they have some cancers continuing to be chronic and lifelong conditions; cervical cancer is seen providing a greater relief towards overall reduction in cancer-related mortalities. The irrefutable role till lately was being played by a single most important test, the Pap Test (Papanicolaoutest or PapCytologyscreening test). During past 5 to 6 decades of its clinical practice Cytology was the most effective and most economical screening test for cervical cancer. But why this did not do any good for the countries where there is no screening practice in place, is anybody’s guess!

definition of a cancer screening test is getting changed on its qualification criteria. By and large, a cancer screening test must have to be clinically very effective, measured in terms of the “test sensitivity”, and the “test specificity”, that gives rise to better disease predictability for a disease prevalent in a given population, which in turn, is measured by positive and negative predictive values (PPV and NPV resp). Since the screening involves bigger population coverage in order to be effective, the screening test must also be affordable by most if not all, must have a high degree of reproducibility, must have an objectively quantifiable results and finally, that it must not have to be repeated too very often! The Pap Cytology come closer on only half of the criteria. No wonder, why this test did not evoke much response in the resource poor countries. While it has a high specificity of above 98%, it is known to have poor sensitivity to under 50%, or even worse in most resource poor population settings such as in India. A Cytology sensitivity at about 50% means that every other women with cervical lesions will

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stand a chance of being called as (false) negative, apart from missing disease in the otherwise healthy population. An inclusion of liquid based cytology (LBC) in place of Pap Cytology added some advantage, by only marginally improving the sensitivity. Higher the sensitivity for a given test, means higher the chances that a true disease will not be missed at screening, or give a false negative reaction; while higher the specificity, means higher are the chances that a true healthy (for a given disease) individuals will not be overcalled as having a disease, or give a false positive reaction. For any given clinical test, attempts to increase sensitivity would imply commensurate decrease in the specificity, and conversely, improving specificity would necessarily bring down the sensitivity. The improved sensitivity for Pap Cytology was only obtainable by repetitive testing annually, as was the practice in the west to bring some meaning to screening program, but proved a major limitation for less resourceful countries. Given this poor sensitivity, the Pap Cytology therefore had to be repeated annually to attain its sensitivity to correctly pick up precursor lesions in the screening population, identifiable when the dominant changes in cellular morphology have only begun to be observed. Several studies from the organized screening programs showed the LBC did not substantially alter the detection rate of high grade precancer disease (CIN 2/3) than only improving on “unsatisfactory” category of smears that often was a major gray area from the interpretation of conventional Cytology.

Changing gears! A paradigm shift came in the screening for cervical cancer when testing for HPV DNA was added to the Pap Cytology. The poor sensitivity on Pap Cytology that only was marginally bettered by LBC, was greatly supplemented by an excellent clinical sensitivity of HPV DNA to almost 95% or above. The retrospective studies had shown that almost 99.8% of cervical cancers were attributable to the persistent infections due to one or more of 15 high risk HPV types. The mounting evidences during past decade led to the new clinical guidelines in 2012 by way of adding HPV to Cytology to increase sensitivity so as to reduce screening intervals from annual to tri-annual or even once in five years. Thus

the screened negative women did not have to return for rescreening annually. Theoretically, better sensitivity by DNA with Pap cytology co-testing should also have given us with better positive disease predictability or positive predictive value (PPV) when it came to applying such a test for routine clinical use for symptomatic outpatients. Unfortunately it did not happen due to the fact that many women in their 30s and 40s though remained persistently infected with HPV, identifiable by a DNA positive test, but without a clinical disease, only a small percentage of them progressed to aggressive form of precancer or early invasive disease in their 50s or 60s. HPV is largely a sexually transmitted virus and almost 80-90% of sexually active women have a chance to be infected with it sometimes in their life span. Given the fact that almost 80% of these women will clear this virus in 12 to 24 months of first infected, it still leaves a plethora of 20% who persistently may remain infected and thus may have a chance of reporting positive HPV DNA tests in screening set up, despite clinically being asymptomatic. In the clinical setting, this situation necessitates subjecting them to triaging by sequential tests such as HPV genotyping or frequently repeating Pap Cytology, histopathology or even other cancer biomarkers of lesser significance for staging the malignancy when presented to the clinicians with mild symptoms such as pelvic or chronic vulvarpain, abnormal bleeding, discharge, cervicitis, vaginitis or simply inflammatory conditions such as long term oral contraceptive use. In fact chronic vulvar pain is a major health concern for peri- or post-menopausal women1 which, if compounded by persistent HPV infection, becomes challenge to correctly prognose the illness. Often, this tantamount to variety of undue patient anxieties and prognostic inaccuracies for a clinician. The biggest advantage of HPV DNA testing is in its unmatched negative disease prediction or NPV; in that if an HPV DNA test is negative a woman does not need to return to rescreening for at least next five years. This saves a larger burden of screening millions of women annually in the more organized countries and actually saving them millions of dollars for their national health GDP. For resource poor countries, however, this leaves a “clinical gap” between high specificity and very poor sensitivity of Pap Cytology versus high sensitivity and poor specificity of HPV DNA tests, even

Reed BD, Harlow SD, Sen A, et al. Prevalence and demographic characteristics of vulvodynia in a population based sample. Am J Obstet Gynecol. 2012;206:170.1–9 1

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when following a co-testing strategy. Progressively, many western countries have begun to implement “HPV First” strategy, even without Pap Cytology in the first place. Also, efforts were directed towards applying a better molecular test having a superior specificity for detecting high grade precancer lesions withequal sensitivity of a DNA test. HPV E6/E7 mRNA (or HPV mRNA) test was thus evolved, that filled the much needed “clinical gap”. It is a first fully quantitative and objective test that has high specificity of above 90% for detecting high grade precancer lesions with equal sensitivity as that of DNA tests. Studies have proved that HPV mRNA testing has a high concordance with histopathologic findings for high grade precancer too, identified as CIN2/3. It is often said and widely believed that Pap test is by far a cheaper test, and hence better affordable. This has proven to be a myth through a number of cost effectiveness studies in the west. For instance, a cost of running a successful Pap Cytology based screening program in the US costs their healthcare a several billion dollars for its nearly 55 million beneficiaries. Yet, it needed to be performed annually. Triaging by HPV testing actually saved them a huge cost burden by shifting annual screening to once in five years. In fact, it amounted to co-testing with HPV for women above 30 years of age, as stipulated in the latest US-consensus guidelines (NCI/ASCCP/ACOG/ASCP) in 20122. Further attempts are being made to see if the Cytology with HPV co-testing could prolong screening interval to 9 years3. Though rather expensive way of learning, it proves Cytology as a spot-test has a very limited clinical use as a comprehensive screening program towards detecting a true disease in the given population. A woman subjecting herself for a screening by Pap Cytology test in the routine clinical practice must continue to do so at least once in five years between 30 to 60 years even if she continues to report normal findings, in order to bring some utility to Pap Cytology test. The other important criterion of a screening test is in its ability to produce uniform results when performed

repeatedly or even by different set of technical experts. Pap Cytology continues to be very subjective with very poor concordance between any two observer interpretations. Studies show that the liquid cytology only marginally improves its sensitivity though it reports far lesser number of “unsatisfactory” categories of slides. With the Pap Cytology method, cells can be obscured by blood, mucus, and inflammation as against the LBC method preserves the cells and minimizes cell overlap, blood, mucus, and inflammation for better visualization and interpretation. With the introduction of LBC in the UK a decade ago, a clear reduction in the reported rate of inadequate smears was seen from 9% to less than 2%. Changes in reporting of smears lacking evidence of transformation zone sampling also had an effect on the inadequate rate4 .

Cervical screening made easy Inclusion of HPV testing has offered a big opportunity to cover a vast majority of population under a screening program at a relative ease, to be able to appreciate valuable gains such as quantitative reduction in mortality and morbidity rates. All that is needed for an HPV test is a tissue scraping from cervical opening in to vaginal vault with a brush like device having a long stalk. A cervical region harbors exfoliative cells those that are shed periodically with each menstrual cycle otherwise. The area between the cervical canal and cervical opening is a primary site of HPV infections and collecting exfoliative cells using a cervi-brush by a trained nursing staff is easy and simple, that does not cause any discomfiture to a woman. Alternatively, a woman may collect her own sample herself in the privacy of her home by following three simple steps to insert a cervi-brush till it finds a resistance in the vaginal vault, rotating the brush 4 to 5 turns over the cervical opening and taking the brush out with little care to collect the specimen in to the bottle that contains specimen preservative fluid. A brush and a fluid kit can be supplied by the nearest pathology lab where a properly labeled bottle with a woman’s name or ID could be simply sent. This selfcollection of specimen is actually seen as a very powerful and effective means to bring a far large population under screening coverage. It is hoped that

Pollock S, Dunfield L, Shane A, et al. the Canadian Task Force on Preventive Health Care. Recommendations on screening for cervical cancer.CMAJ 2013;185:35–45. 3 J Dillner et al., Cost-effectiveness of primary and HPV DNA cervical screening. Int. J. Cancer: 122, 372–376 (2008). 4 Moss S.M., Gray A., Marteau T., Legood R., Henstock E., Maissi E. Evaluation of HPV/LBC Cervical Screening Pilot Studies Report to the Department of Health, UK Oct 2004. 2

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a self-sampling kit for HPV testing and a HPV test strip much like a routine pregnancy test strip may be available at the pharmacy outlets in the near future.

India marching towards cervical cancer prevention Therefore where does India go from here in terms of seeing a successful cervical screening program? We perhaps need to normalize cervical cancer scenario in India sooner. According to WHO 2012 statistics, India sees 122,844 new cases of cervical cancer annually and is likely to increase to 148,624 by 2020, showing 21% rise in the incidence. A corresponding mortality rate is likely to increase by 29% from the present number of 71,400 annual deaths. What is more concerning is nearly 35% increase in the incidence among women of 65 years or older by 2020! It is therefore very heartening to note that some of the state healthcare departments in India, such as in Tamil Nadu and Sikkim have taken up to the visual inspection (VIA) based screening programs, and parts of Maharashtra (Thane Municipal Corporation) have lately initiated a holistic VIA/Colposcopy/ HPV mRNA/ HPV DNA based community screening program with an aim to provide complete treatment to women detected with high grade precursor lesions at screening. The focus of the Thane program is to screen nearly half a million women population falling in the desired age group over a span of next 5 years. Thane is fast emerging as the best smart-city for the state of Maharashtra and Thane Municipal Corporation’s endeavor to cover the entire metropolitan population by five mobile camp vans laced with visual examination aid, colposcopy machine, and fully trained clinical and nursing staff will cover every single adult woman in the next five years. This is a very bold step to set an example for rest of the country. The earlier studies in Tamil Nadu had established nearly a 25% and 35% decline in cervical cancer incidence and mortality rates5,6 and results of other ongoing programs are going to set up a cultural trend in the entire country in the years to follow, to see India wins over cervical cancer

with thumping applaud by 2040; thanks to the newer molecular diagnostic approaches with superior specificity e.g. HPV E6/E7 mRNA, p16 IHC or ki67 markers, therapeutic interventional methodologies, vastly talented clinical excellence and conscious healthcare governance conceding to screening success to gain the huge mandate for women of India.

Concurrent mission! Along the side lines of population based screening programs what India needs is a supportive and stronger advocacy program. The awareness about breast cancer early detection and prevention has been seen to be far better than cervical cancer, primarily owing to social taboo associated with lower genital tract diseases. This perspective needs to change. Cervical cancer is now fully preventable cancer, if detected correctly in its precancer stage and every single woman of this country need to know and be able to freely talk about it. The social and news media have lately been playing a significant role in mobilizing a mass mindset. A celebrity endorsement will certainly step up acceptance for screening. Australia became the first country to have introduced HPV vaccination in the national immunization plan in 2006 when the then prime minister John Howard’s wife was detected with cervical cancer and thus became a champion of the awareness cause. The Australian first lady, Janette Howard was treated for cervical cancer in 1996 and took up to immunizing adolescent girls no sooner the HPV vaccination became available in 20067. The next step would be the role of healthcare insurance sector to consider providing reimbursement on at least 5-yearly screening using HPV and Pap Cytology co-testing through their products aimed at women’s health. A onetime reimbursement on HPV and Pap Cytology co-testing may cost under Rs 3000 once in 5 to 7 years but would fetch at least five times annual subscription and considering 100% compliance insurance sector stands to benefit out of such a product, still save few 100 thosands of INR of treatment cost reimbursements on patients progressing to invasive

Sankaranarayanan R, www.thelancet.com/oncology Vol 15 May 2014 555, Krishnan S, Madsen E, Porterfield D, et al. Advancing cervical cancer prevention in India: implementation science priorities. Oncologist 2013;18: 1285–97) 7 Janette Howard Reveals Cervical Cancer Details. News.com.au. AAP. 16 October 2006. 5 6

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stages of cancer. On the other hand, what a boon it may be for the larger section of unorganized private sector women of modern India! Our healthcare insurance sector is largely curative and hospitalization oriented for any reimbursement. For the first time for any cancer, we have a strong evidence of long term prognostic value resulting in to quantifiable economic benefits to insurance providers as well. Not only the cost of treatment for cervical precancer is far lower than confirmed cancer, but largely reduced number of cases still progressing to the invasive cancer stages would mean greater saving on insurance incomes. In addition, the insurance sector gains enormously by reaching out to our women folks who have remained a low family priority when it comes to the better family health. A market survey report suggests if only 10% of the 150 million target women (other than otherwise insured through their government or private sector employment) between the age group of 30 to 60 are reimbursed for cervical screening once in five years, it would fetch additional annual revenue of 5,500 million rupees at only a rupee-a-day subscription, while reimbursing the costs of screening only once in five years, considering 100%

compliance of insurance claimants! While few states are pushing forward the cervical screening in their earnest endeavor to its women, can our union governance push for this dormant aspect of our healthcare system?

Take-home message Cervical cancer is fully preventable cancer if detected early and correctly. Hence screening is very important and each woman should subject herself for clinical pelvic examination at least once in five years, just as clinical breast examination to prevent breast cancer. Testing for HPV has a better long-term predictive value and the specificity for HPV test improves with the age of a woman. Women are encouraged to discuss their lower genital health more freely with their doctors, among friends or even with family members. Awareness is a boon and ignorance is a bane for many cancers. A socially and economically empowered woman of modern India must be â&#x20AC;&#x2DC;awareâ&#x20AC;&#x2122; and share her knowledge to those who may be less privileged.

magazine being released by Sh J P Nadda, Minister of Health & Family Welfare, India

(L to R) Alok Chaudhary, Editor, Dr Avantika Batish, Editor, Sh J P Nadda, Minister of Health & Family Welfare, Dr V K Singh, MD, InnovatioCuris (IC), Sachin Gaur, Director Operations, IC

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How Tele-Health can bring Diabetes Care to the Common Man Naveen Gulati is the co-founder of Open Mind Services Limited, an outsourcing company that is invested heavily in bringing perceptible changes in the state of affairs of Health Services in India.

Diabetes, the plague of this generation, needs qualified support for patients to eliminate fear and preventable sufferings. Tele Health Help Desk offers precisely that solution- Patient relationship management that acts as a single point of contact for patients and their caretakers and provides a dedicated helpline to diabetes patients, ensuring that a hospital or Pharma Company’s brand value augments its reputation in the process. Innovation is the cornerstone of competitive advantage, and we are excited to change the old approach. Will you be a forerunner?

iabetes is a modern day dragon that is threatening to affect a big section of the masses of the present century. The numbers are stunning beyond belief: Nearly 50 million suffer from the deadly lifestyle disease. Average cost of treatment of each diabetic patient is approximately Rs. 6000 a year, as per International Diabetic Federation (IDF) Atlas, 2014. And this cost does not include any cost associated with more serious complications like diabetes foot, kidney and eye disease due to diabetes. With the huge number of diabetes patients- 50 million or 5 crores- the combined colossal amount makes a big dent in any country’s economy, fragile as it is due to continuous recession around the globe. Besides expenditure, there is a big shortage of trained workforce at all levels, especially the lowest and middle rung of the society. According to recent studies, underprivileged sections of society in urban ghettos are particularly vulnerable, if not more than as much as the rising classes. The lack of specialized human resources is proving a major deterrent in fighting the monster and preventing major losses like diabetic nephropathy, cardiac complications and diabetic retinopathy. Picture the scenario outside a health facility, endocrinologists are struggling to muddle through the thronging flock of patients. The benches outside the room are all crammed

to capacity, the cacophony increasing with each passing minute. Waiting is never supposed to give any kind of pleasure; it is always a compromise of the poor. Challenge is defined thus. Even a willing and able doctor will be exasperated with so much to do in so little time. So, how can the healthcare system meet this need? First and foremost, technology should be used to offer prevention as well as treatment of diabetes. The age old adage of cure being an after-thought should be the primary motive for preferring prevention as its go-to strategy. Experienced and well equipped tele-health companies can play a critical role by collaborating with medical institutions and the government for proactive tele health solutions that would minimize hospital visits as well as create an empathetic environment for patients to come back to, via the telephone of course! There are a few organizations that specialize in the sphere of empathy calls and history tracking. Their tele health division is well respected for employing state of the art software that helps in tracking every single detail of all the patients and in the same time helps in issuing alerts and emergencies regarding patients. The positive message of the services—helping patients adapt to daily life without too many restraints —is the

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key to success. If we have a senior citizen diabetic whose blood sugar shot up to 300, because she couldn’t resist her grandson’s birthday cake, empathy urges us to accept what has occurred, and respond, “What’s life without celebrations and a little piece of cake!” Bringing patients within your desired goalposts by teaching them to build their diet around a family event is more realistic than preaching the more stern and unwelcoming, “Never eat dessert.” The challenge before hospitals is to develop a centralized function to act as the single point of contact for the endusers (patients) who require assistance for resolution of problems, concerns, question and requests. The need of the hour is a Dedicated Empathetic Helpdesk for Hospitals that would help your facility build a strong bond and a stronger brand with your customers - Patients and Prospectsbefore and after they are in your premises. Such improved communications, based on a predictive marketing model, result in building and sustaining trust in your facility, a crucial task in the healthcare business. Our tele health help desk has made significant positive changes by improving customer satisfaction and exceeding

performance targets. One of our clients has authorized us to disclose their figures: 1. Operational Savings of INR 2.2 million annually. 2. Patient retention has increased by a sizeable 8%. 3. Higher level of customer satisfaction. It’s going to be increasingly important for you to know what’s happening when patients leave your facility. A handful of futuristic companies, led by charismatic pioneers are engaged in providing helpdesk services to medical institutions that act as the preferred medium of interaction between them and their patients. An explainer video presentation that describes tele health services and benefits thereof can open your mind to exciting new possibilities of retaining patients and providing care for them better than ever before. You can also watch the video directly on YouTube at the URL: https://www.youtube.com/ watch?v=2c57rTr-l64 The process of proactive patient relationship management is still in a nascent stage in India. Change is beckoning you, the risk-taker and innovator. Today is a good day to do that, no?

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Clinical Practice in India- Equivalent to Corporate Sufism Dr. Radhika Shrivastava is a practicing physician specialized in Public Health since past 20 years and contributed immensely in the field of maternal & child health. She has been associated with different national & international NGOs as a Technical consultant for past 16 years. She is a recipient of Senior Research Fellowship of ICMR and International fellowship of Health technology assessment (HTA) & done six sigma Green belt. She has published many papers and articles in different National & International journals.

Clinical Practice is an amalgam of leadership, managerial skills, decision making, innovation along with empathetic attitude, which is what we call “Sufism”in ancient literature. Considering the demand of time, a practicing clinician, who is now called “Health care Provider”, dealing with so called “ Clients or Consumers” instead of patients. Evidence based medication has taken over experience and bed side knowledge, which is again directing amateur medical professional for didactic knowledge more than practicum. This article is all about dynamics of present day clinical practice and its challenges with shift in the scenario from Indian traditional system to western corporate & market based approach. The purpose is to make budding Clinician aware and bring understanding with respect to Indian value systems, resource settings and present health indicators Infant Mortality Rate (IMR), Maternal Mortality Rate (MMR) of India.

Introduction

linical practice is the process by which a clinician is treating a client (patient) independently or in group, with their best of knowledge and experiences considering clinical guidelines, ethics and evidence based treatment. It has been existing in Indian context since beginning of medical sciences as vaid, hakeem or allopathic doctor (angrazi davakhana) . During earlier days even Govt hospital used to allow private practice by their doctors after hospital hours, legally (still existing in few states of India). Doctors were healers and their patient used to treat them equal to God. Faith and trust were the binding forces for doctor patient relationship. Until, the law brought the awareness about the doctor as providers and patient as consumer. Health care services are market driven so as to survive in this competitive world. Data reveals that 70% of health care services are provided by private health care providers, in India. And these private health care providers are actually sharing the burden of Government, who is falling short in providing these quality services, timely to their people. Vis a Vis, clinical practice is actually the strong pillar support, to the health care system

of India where there is poor doctor patient ratio. Keeping in view of present status of medical education with lack of campus placement and limitation of seats for Post- graduation, by default many medical professionals start their own clinical practice. A medical student who comes out fresh after graduation has no road map for their future usage. It all begins with a thought or compulsion or by choice or lack of alternative. As the processes of clinical practice are yet to develop, this article attempts to ensure the vision and mission.

Discussion There is not much work done with respect to guiding a clinician for understanding the dynamics of establishing clinical practice. Many laws are made to keep check on wrong practices but there is not much support given to how to provide quality services to the people through the upcoming project. These knowledge gaps and its repercussions are upsetting to not only clinicians but their patients also. An ill equipped doctor cannot manage the demands of today’s consumer hence; clinical practice needs a facelift, from Sufism to corporate culture.

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Steps of Clinical Practice STEP 1 : ◊ Inception of Project or Idea ◊ Bringing existence of Clinic/ Hospital ◊ Staffing ◊ Reaching out to People/ Clients STEP 2 : ◊ Treatment modalities (clinical decision making & quality treatment) ◊ Stakeholders like Pharmacy, Lab, counsellors,

dieticians, paramedical staff ◊ Human resource management STEP 3 : ◊ Data management ◊ Training & capacity building STEP 4 : ◊ Monitoring & evaluation ◊ Feedback & further progress STEP 5 ◊ Sustainability of project

STEP1 STEP5

STEP4 Challenges of clinical practices • Lack of clear cut guidelines & road map • Lack of support system • Lack of knowledge of management of clinical practice • Lack of knowledge of processes of managing a project • Lack of knowledge of other departments (interdepartmental) like legal, financial & development sector • Lack of goal, mission, vision and sustainability component

Way forward ◊ Practice management classes (evening / weekend) ◊ Capacity building of support staff

STEP2

STEP3 ◊ Interlinking with Government goals ◊ Data collection and pooling in national data repository ◊ Join hands with government and non government sector ◊ Rebuilding faith through patients participation in decision making something like patient doctor association (PDA)

Conclusion A medical student, who is interested in providing services through private practice, should be provided hand holding support after MBBS, as they can be the readily available human resource for the country where we are still struggling with TB, MMR and IMR. So, there is a need of management program for budding practicing clinician for serving their clients in a professional competent manner.

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Business proposals, most favoured by Investor Prarthana Gandhi is a Designated Partner in an Amaya Capital LLP, which is a provider of indispensable capital to the entrepreneurs focused on health care sectors having viable business model. She had worked with Guy’s and St Thomas’ Hospital, London run by National Health Services,UKfor 3 Years, before joining the family office.

This article provides insight to the entrepreneur, starting their new venture, about thinking process of the investor so that entrepreneur can select the venture accordingly. The business proposal having the traits discussed in the article will be favoured by the investor. The two examples from real life makes this concept explicit. Even though the investor has invested in the venture considering all the aspects, the venture can be made successful only with passion and focused approach of the entrepreneur.

Introduction

ver since the corporate entities have come into existence, raising capital for apparently viable business proposal has been possible. The entrepreneur can raise the capital from the investor initially and later on with proven track record can go for IPO (Initial Public Offer) to raise the capital from public for further growth. In this article the basic traits of the business proposal are discussed which attract the investor. The investor favours the businesses, which are ○ ○ ○

Sustainable Scalable And having corporate governance in place

Sustainable Bussiness Sustainability of business depends upon the product or the services creating value for the customers, ability to achieve breakeven within the reasonable time, competition, and efficient operations and last but not the least customers’ satisfaction.

• Value proposition

Any product or the services, provided by the businesses should be the part of value chain. The customers must feel

that by using the product or services they are getting the values worth for their spending. Any business proposal which fit this criterion will have lasting future. The customer and the company should be in a win-win position.

• Breakeven

When business achieves a stage where it neither gets profit nor loss, technically it is known as breakeven point. From here with increase in volume the business starts getting profit. At breakeven point business stops burning cash. Different business takes different times to achieve the breakeven point, but for the investor sooner is better. Sometimes investor do not mind longer period to achieve breakeven, burning the cash, in anticipation of large scale volume compensating with higher profit at the later stage.

• Competition

Business should be capable of withstanding the competition. Either the business with very difficult entry barrier or business with complex operation requiring specialize skill will face less competition. Business with unique selling proposition will race ahead in competitive scenario. If promoters are agile they can beat the competition.

• Efficient operations

For long term sustainable business operations, efficiency in operation is inevitable. Inefficient operation increases the cost of goods and services and ultimately it reflects in end prices. Higher prices may be a big deterrent in competition. Efficiency leaves sufficient profit in the business to survive.

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• Customers’ Satisfaction

In any business customer is king. Without customers’ satisfaction, customers can not be retained affecting business adversely. A satisfied customer brings more business through words of mouth, which is very important for sustainable business. The real test of customer satisfaction is a gain to a customer by using goods or services and not the lower price only.

Calable Business The business model which is scalable brings lot of opportunity for all the stake holders. In a business life cycle, growth phase create the maximum wealth. The businesses which are profitable but not scalable do not attract investor as there is less room for creation of wealth. The investor is even ready to burn the cash initially, if business model is highly scalable Walmart, Flipkart, Snapdeal & Amazon are some of the examples of highly scalable models. Only time tells when highly scalable model are successful in creating wealth.

Corporate Governance From the day when corporate entity came into existence, the corporate governance became very relevant as the ownership and management of the business rest in different hands. The transparency between all the stake holders is very important when business grows under corporate entity. The management should take various decisions in the business balancing the interest of all the stake holders. Since investors are not involved in day to day management of the business they like the companies where corporate governance is at place.

Live Example Of Scalability Attracting The Investor In healthcare sector Practo has set a live example of attracting high profile investors like Russian billionaire Yuri Milner, when business model is scalable. Seven years ago, twenty-year-old engineering graduates, Shashank ND & Abhinav Lal from National Institute of

Technology, Suratkal, Karnataka, founded an online health service platform, which assist patients to fix appointment with doctors. They built a software platform to digitize their health records and have online consultations as well. Practo today scaled up to an impressive level of clientele comprising of 200,000 doctors, 10,000 hospitals and 5,000 diagnostic centers based in 35 cities in four countries and still counting. The online service has made rapid strides, raising $124 million so far, the biggest by any healthcare start-up.

Lack Of Scalability Rendering Business Unviable TalentPad was founded by IIT and IIM alumni Mayank Jain, Nikhil Vij and Raghav Jain. They were into hiring space where a clear opportunity lies because of requirement by new businesses as well as existing businesses. It is not easy to offer a clear value proposition for long term sustainability and hence many players struggle to survive. TalentPad was in the same category and hence it has to shut down less than a year after it raised funding from Helion Ventures. They used efficient marketplace model based on analytics to serve their customers by providing suitable candidates. In pursuit of increasing their delivery capacity it had acquired Optimized Bits, a Bangalore-based rival company. But months after that it abruptly shut shop with the remark: “We helped a lot of companies hire from some of the best tech talent in India and played a crucial role in their growth, while delivering the best customer experience. But, we failed to figure out a scalable business for a big enough market.”

Conclusion Business models which are sustainable, scalable and having corporate governance definitely attracts investors but it does not mean that they will always be successful as success depends upon so many other factors as well, mainly the execution of business plan. The focused approach and promoter’s passion are the ingredients without which success cannot be spelled out.

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Global Innovation

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Universal Healthcare: Innovations Needed in Regulations Dr Shiban Ganju is the founder chairman of Atrimed Pharmaceuticals, a company modernizing Ayurveda. He is the founder of ‘Save a Mother’, a healthcare NGO, which works in over 1200 villages. During his career, he has participated in over a hundred non-profit projects.In, the past, he was the CEO of Reliance Health and Technology, executive director of America India Foundation, chairman of Action for India and adviser to Rajiv Gandhi Charitable Trust. He also served in the Indian army. He graduated from the All India Institute of Medical Sciences, Delhi and specializes in gastroenterology and hepatology. In most other countries, the constitution requires the government to provide some form of healthcare. The implementation, however, suffers from deficit of policy, governance or resources even in the countries that consider healthcare as a part of social justice. The Author talks about how India can lead with innovations in legislation, policy, governance and finance to provide health for all.

dequate healthcare is both, a prerequisite and a consequence, of the growth of a country. A health system can deliver public health and medical services, if its solid foundation includes skilled workforce, information systems, medical products, technology, adequate financing and governance. While technology can provide innovative tools to improve health, it is the regulatory framework which can provide the enabling ecosystem. It is important that Innovations not be limited to drugs and devices but also include regulations.Ultimately, it is laws that determine financing and structure of healthcare.

India extrapolates health rights from other parts of the constitution. The right to health in India is outlined the Directive Principles of State Policy- Articles 42 and 47 and the fundamental right to life as stated in article 21.

The nations of the world have included healthcare in their legal framework in some form. Almost all countries are signatories to one or more international human rights or health rights declarations.

Article 42 states that the State shall make provision for securing just and humane conditions of work and for maternity relief. Article 47 states that the State shall regard the raising of level of nutrition and the standard of living of its people and the improvement of public health as among its primary duties and, in particular, the State shall endeavor to bring about prohibition of the consumption, except for medicinal purposes, of intoxicating drinks and of drugs which are injurious to health. Article 21,“The Fundamental Right to Life” guaranties individual life.

One third of the countries include healthcare as a constitutional right for individual citizens. Russia and former countries of the Soviet bloc Italy, Spain, Brazil, Philippines and South Africa have maintained health as human right in their constitution. On the other end of the spectrum are countries like the USA, which have no individual constitutional right to healthcare.

The Indian judiciary has interpreted the “Right to Life" in many ways. It has held that humane working conditions, health services and medical care are an essential part of Article 21. Public interest litigation, as well as litigation arising out of claims made by individuals, has generated substantial case law showing right to health is an integral part of the Right to Life.

In most other countries, the constitution requires the government to provide some form of healthcare. The implementation, however, suffers from deficit of policy, governance or resources even in the countries that consider healthcare as a part of social justice.

For technological innovations to flourish in its current stage of development, India needs more proactive regulations to progress towards universal healthcare.

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Currently the Indian government spends about 1 percent of GDP on healthcare. Compare that to 3 percent in China and 8.3 percent in the USA. Private expenditure on healthcare is in addition to public expenditure; approximately 70% of health expenditure in India is from private sources.

of health services with cost-eﬀective interventions that include health promotion and disease prevention. • All health practitioners and facilities in the public and private sectors have to be registered with the Integrated National Health System.

A study done by PGI Chandigarh, suggests that universal health care services for entire 1.2 billion population, the annual cost of providing preventive and curative services will be INR 2415 billion (USD 54 billion). This would amount to increasing the allocation to health sector from current nearly 1% to 3.8% of GDP. Indian business association, Federation of Indian Chambers of Commerce and Industry (FICCI) and consultants Ernst and Young (EY) estimated in 2012 that universal health cover would require government health spending to increase to 3.7-4.5 percent of GDP. The current government, under the National Health Assurance Mission, would provide all citizens free drugs and diagnostic treatment and insurance cover to treat serious ailments. It would cost an estimated $11.4 billion annually.

Health Financing

In 2010, a High Level Expert Group on Universal Health Coverage recommended increasing public financing from 1% of the gross domestic product to at least 2.5% to provide essential health care package through tax funding and employer-provided insurance. The Lancet published an India focused issue on health in Jan 2011. The lead authors (K SrinathReddy, Vikram Patel, Prabhat Jha, Vinod K Paul, A K Shiva Kumar, Lalit Dandona), summarized the recommendations of various working groups as ‘call to action’ as follows. They propose the following targets to be achieved by 2020 through the creation of the Integrated National Health System with three overarching goals: ensure the reach and quality of health services to all in India; reduce the ﬁnancial burden of health care on individuals; and empower people to take care of their health and hold the health-care system accountable.

Service delivery • The entire population should be covered by an entitlement package of health care with ﬁnancing from a combination of public, employer, and private sources. Full range of relevant diseases need to be included in the entitlement package

• Public spending on health should be increased from 1% to 6% of the gross domestic product, and 15% of tax revenues— including new taxes on tobacco products, alcohol, and food with little nutritional value—should be earmarked for this purpose. • Reduce the proportion of out-of-pocket spending from 80% to 20% of the total health expenditure. • Increase spending on health research to 8% of the health budget.

Human resources for health • Establish the Indian Health Service with guidelines developed through an autonomous National Council for Human Resources in Health. • An updated training curriculum should be fully in place for medical and allied professions that is relevant to the situation in India. • Establish suitable incentive structures to retain health providers in underserved areas.

Health information system • Have in place comprehensive health information and surveillance system that covers all major diseases, healthsystem issues, and key social determinants, which also facilitates assessment of public health interventions. • Establish adequate research capacity in India to investigate and report key issues that aﬀect the health system and policy for further improvements. • Have in place a fully functional autonomous council that compiles and synthesizes relevant information to develop guidelines for evidence-based health care and its assessment.

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Drugs and technology • Implement a national network of pharmacies for generic low-cost drugs for the entire population. • Establish mechanisms for bulk purchase of patented drugs at low cost. • Have in place mechanisms to check and control the use of perverse incentives by pharmaceutical and biotechnology companies for health-care providers.

Governance • Have in place mechanisms to make functional the components of the National Health Bill. • Have a system in place that requires all middle and senior functionaries in public health to have relevant training in public health. • Ensure devolution of responsibility for health care to district management systems along with accountability mechanisms and explicit community participation(The Lancet, Jan 2011). India, at current stage of development needs more healthcare in every form and not less. Multiple studies

have confirmed the fiscal feasibility and for technological innovations to flourish we needs a progressive enabling ecosystem. Opposition to right to health emphasizes that it could increase the fiscal deficit; it could create shortage and increase the wait time for medical services, which would lead to rationing and lower the quality. It could also cause people to overuse health care resources. While appreciating valid opposing view, human development is not possible without guaranteed healthcare. Financial burden of a single episode of disease pushes millions of Indians into poverty, which stifles the market for technological progress Health and longevity have improved as never before in human history. And with explosive growth in the knowledge of human biology and genetics, it is likely that the life span will increase exponentially. It may even change the very definition of health to include happiness, intelligence and aesthetics as components of a new paradigm. It is imperative that innovations in legislation, policy, governance and finance will have to stay ahead of the burgeoning technologic innovations and not fall behind to irrelevance. It is important to have innovative strategic thinkers in the leadership positions that understand biology, healthcare, governance and finance.

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The Swedish Solution to a Global Challenge Iris Öhrn is Investment advisor for life science & healthcare at Business Region Goteborg. With a combined scientific and business background, she has over 15 years of international experience of working with governmental organizations, entrepreneurs, SMEs and multinational companies in matters going from intellectual property, regulation, sales and foreign direct investments.

When companies, governments, universities and healthcare institutions work in tandem to push the frontiers of knowledge, they become a powerful engine to find innovative solutions to major social problems including health.The article talks about the healthcare scenario in Sweden and how the country is reforming its healthcare system to benefit its people.

cross Europe the rising cost of healthcare, caused among other things by the ageing of the population and the parallel rise in chronic illness; has made policymakers support the development of more effective preventive measures and early diagnosis products. At the same time, patients have started to take more responsibility for their own health, treatment and care, thus becoming a major cost driver of the healthcare system. Innovation within material sciences, genetics, biotechnology

and computational information has escalated in recent years, bringing significantly improved chances of surviving disease. In Europe and especially in Sweden, patientcentered care, evidence-based care, and early detection are dictating the path to follow for designing the healthcare of the future. Sweden spends about 11% of its GDP on health care and nearly 80% of it is publicly financed. Healthcare expenditure as percentage of GDP is higher in Sweden compared to many countries of similar or larger size.

Sweden Demographics

Average life expectancy: 81 years for men and 85 years for women About 10% of the Swedish population will be aged 80 years and over in 2050 5% of the population is 80 years or older The number of long-term care beds in institutions (82 per 1000 population aged over 65) is still one of the highest in the OECD The main causes of death are cancer and cardiovascular conditions including strokes

The following are some of the major innovations care at hospitals and primary care facilities and reforms introduced during the last years for • More choice of provider, competition and privatization to support the development of primary care containing costs. • A shift from hospital inpatient care towards outpatient

• Regionalization of health care services including mergers between county councils • Privatization of the pharmacy sector

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• Continued specialization and concentration of services within the hospital sector • National reforms for shortening waiting times for services • Cost-effectiveness and social perspective are becoming key indicators for reimbursement.

Health economics is a priority for the 21 county councils and 290 municipalities in charge of health provision in Sweden. Some of the latest initiatives include: • New mechanisms to support evidence-based and cost– effective vertical priorities • Health outcomes and benefits from the patient perspective • Process orientation • New valid performance indicators • Increase abilities to monitor performance on a regular basis by investments in health quality registers and new information technology

Cost-Effective Methods For Early Diagnosis And Treatment Can Anticipate Future Societal Costs The Swedish Cardiopulmonary Bioimage Study (Scapis) The Swedish CardioPulmonary BioImage Study, one of the largest studies of its kind in Sweden, is a major joint national effort to reduce mortality and morbidity from cardiovascular disease (CVD), chronic obstructive pulmonary disease (COPD) and related metabolic disorders, all of which are important issues for public health. A Swedish cohort of 30,000 men and women aged 50-64 years are characterized with help of advance imaging techniques (Ultrasounds, MRI, Computer tomography, 3D ECG, etc.) together with information obtained by proteomics, metabolomics and genomics. A comprehensive pilot study with over 1000 patients were completed at the Sahlgrenska University Hospital in West Sweden in 2012 and recruitment to the nationwide multicenter study is ongoing.

Centre For Imaging And Intervention Sahlgrenska University Hospital

In 2015, a new centre for imaging and intervention opened at the Sahlgrenska University Hospital, one of the largest hospitals in Northern Europe. The center is unique among the Nordic imaging centres in that it was initiated by a hospital, rather than by academia. The regional health authorities have recognized that advanced imaging and intervention are critical not only to the provision of the best healthcare possible but also to making the care cost-effective. The newly built 21 000sqmcenter houses Hi-tech operating rooms with advanced imaging equipment such as gamma and PET cameras, X-rays, computed tomography, ultrasound and magnetic resonance. Academy, healthcare, county council and industry are already collaborating in a model in which technology development and transfer can evolve from the traditional ‘pull’ and ‘push’ model to an integrated process in which problems and solutions are addressed on a day-to-day basis. The use of microwave techniques for the treatment of hyperthermia of deep seated cancer tumours; breast cancer detection with microwave tomography or stroke diagnostics are some of the cross-disciplinary collaborations that have resulted of this long-term strategic triple helix collaboration.

Smart Textiles With Medical Applications Companies, universities and research centers in western Sweden have been collaborating for almost a decade now around the design, development and production of the next generation of textile products. With Smart textiles, a large part of the health monitoring can be done from home in the future. One example is a regular shirt with integrated sensors that can be used to measure breathing and heart activity and thereby reducing the number of visits to the hospital. Textile based sensors made of conductive fibres incorporated in clothing to record electrical activity from the heart (ECG), brain (EEG), or muscles (EMG), might become part of the future health care of patients suffering from sleep apnea, breathing difficulties or stress-related

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conditions. When companies, governments, universities and healthcare institutions work in tandem to push the frontiers of knowledge, they become a powerful engine to find innovative solutions to major social problems including health. However, product innovation, value networks and

ecosystems alone will not be enough. How we innovate and connect with customers and patients is crucial. We need to involve patients and patient organizations in the innovation process and decision-making. We need to take the time to see the patient in all aspects of his life. It might be the best alternative for both providing more quality care and at the same reducing the spiralling healthcare costs.

Buy from the publisher: http://bit.ly/2eALdMA Buy from Amazon India: http://bit.ly/IIHCM The review was Published by ICT Post, read here: http://bit.ly/2fUQP1V

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Innovating Care: Healthcare to Wellcare Steven Yeo, Founder & CEO, TalentGrid Ventures Pte Ltd has more than 25 years of international business and management experience working with government, multi-national corporations and non-profit organisations. He specialises in healthcare, advanced technology and life sciences practice group for both multinationals and local companies. Prior to starting up TalentGrid Ventures Pte Ltd, Steven was the Executive Vice President for DHR International a global-retained search firm covering Asia Pacific. He was also the Vice President and Executive Director for HIMSS (Healthcare Information and Management Systems Society – the largest Healthcare IT society in the world). Steven was also the Director of Intel Corporation managing its e-Business Group and Digital Health Group from 19992008 in the Asia Pacific region.

Healthcare today is in a truly interesting state of transition from traditional to wellcare models, powered by technology and disruptive innovation. To address the prevailing healthcare challenges and also leverage on the opportunities, there needs to be a coordinated effort across multiple stakeholders in order to deliver innovation that can improve outcomes, expand access and increase affordability of healthcare in Asia Pacific and beyond.

e are at the turning point of a new generation of healthcare: The transition from healthcare to wellcare, facilitated by technology and innovation that can help improve individual patient outcomes and elevate the standard of care. The transition is, however, not always a smooth one. In Asia, which is considered to be the fastestgrowing and most dynamic region in the world today, there still exists a huge disparity in access to high quality and costeffective healthcare for millions of people. In fact, the need in some Asian countries is particularly acute, especially with the rapid growth of the ageing population. Lack of patient awareness, infrastructure, proper training for healthcare professionals, and in some cases, lack of healthcare manpower itself, are just some of the barriers to effective healthcare and recovery. On the other hand, there are also empowered and engaged healthcare consumers who may have a different set of needs to satisfy. In order to address these barriers while at the same time pushing down costs, healthcare experts collectively agree on one thing – innovation. Disruptive innovation, according to some, because current healthcare systems in place are ailing and they need help. By definition, disruptive innovation is one that creates a new market and value network by disrupting an existing market either through a brand new solution or a perhaps a creative

spin on something that already exists in order to deliver better results. Healthcare today is in a truly disruptive state, opening up doors for opportunities for different healthcare stakeholders. Innovating Care Asia Pacific (ICAP) 2016 conference is an event platform that aims to build a community of highly influential, knowledgeable, and very well connected healthcare professionals, decision makers, thought leaders and influencers who are passionate about transforming healthcare, for the greater good of the patients and other healthcare consumers. There is a great need to address prevailing challenges and leverage on the opportunities – and these require a coordinated effort across multiple stakeholders in order to deliver innovation that can improve outcomes, expand access and increase affordability of healthcare in Asia Pacific.

The Silver Tsunami Considering that most of the countries in Asia Pacific are rapidly ageing, with a vast majority of those above 60 yrs requiring treatments and assisted care, governments and concerned institutions are therefore hard-pressed to establish and implement measures that would help the seniors age-in-place and continue living fulfilled lives. Singapore is one of the fastest ageing countries in the world.

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According to the Long-Term Care in Singapore Challenges and Learning Points presentation by the Ministry of Health (Singapore), the estimated number of Singaporeans aged 65 and above who may require assistance with mobility and other activities of daily living is expected to nearly triple between 2010 and 2030. Which means that by 2030, one in five Singaporeans will be aged 65 and older and there will be nearly a million elderly, most of whom will be afflicted with at least one chronic disease, resulting in reduced autonomy and lower quality of life. To ensure good quality of life for the seniors even as they grow frail, the Singapore government is now looking into a more patient-centric view of long-term care focusing on accessibility, quality and affordability. Meanwhile, innovators from the private sector continuously churn out innovative solutions and re-engineering care models to help the elderly cope with ageing, whether in the confines of their own home or in nursing homes. These innovations may come in the form of health kiosks, Intermediate and Long Term Care (ILTC) subsidies, augmentation of manpower with the use of technology and more. In other developed countries like Japan, said to be the worldâ&#x20AC;&#x2122;s most ageing society, more radical solutions have been devised to meet this challenge. In less developed countries in the region, you might be surprised to see unexpected forms of innovation that deliver tremendous results as what the Indian hospitals

that became the subjects of Vijay Govindarajan and Ravi Ramamurtiâ&#x20AC;&#x2122;s Harvard Business Review-published study called Delivering World-Class Healthcare, Affodably, have shown. Taking off from the discussion and knowledge exchange that had transpired during the ICAP 2016 Conference, Innovating Care Asia Pacific is launching a vertical spin-off forum focusing mainly on Elderly and Home Care where decision makers, practitioners, researchers, service providers, and community members can share their experiences to support and empower rapidly ageing populations worldwide through the integration of healthcare, social participation and community. As the healthcare sector slowly but steadily moves away from physician-centred to patient-centric health, patients are now encouraged and empowered to take charge of their health and treatment. And with the help of technology and innovation, patients are now also redefining the very borders of healthcare. As someone who has spent many years entrenched in the healthcare and healthcare IT sectors, I am happy to take part in this new revolution that will see more and more patients owning their health, as we slowly transit from traditional healthcare models to wellcare.

Want to write for InnoHEALTH ? Please share your article with us on magazine@innovatiocuris.com. Our editing team will go through it and come back to you. If you want to know more about the publication and guidelines to the authors. Please refer our website: http://innovatiocuris.com/magazine/ .

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Glimpse of "Technological Trends in Health Care Delivery" at Army Medical Corps Center & College

Dr V K Singh, MD, IC, Keynote Speaker Sachin Gaur, Director Operation IC, Speaker

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Technology Trends

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Technology Trends Big Data in Healthcare: Mirage or Market Opportunity? Manishankar Prasad is the principal of the healthcare practice at BIS Research. A National University of Singapore Alumni; he is a prolific contributor to knowledge platforms in the area of public health, sustainability and social change. Shiv Sharma is a project manager with the healthcare practice at BIS Research. A BITS Pilani Dubai Campus Alumni; he is passionate about mainstreaming data science. Esha Bhatia is a research analyst with the healthcare practice at BIS Research. A SRCC Alumni; she has lead research projects in the knowledge domain of Big Data and IoT Security.

This article enumerates the structural and cultural challenges of Big Data implementation in Healthcare organizations in the hierarchy of numbers, juxtaposed along the binary of the developed and developing world, which depicts the inherent digital divide which reflects in the adoption of emerging technologies.

Introduction

ig Data is the currency of the digital era, as oil was for the twentieth century. This article maps two major concepts; Big Data and Healthcare. Defining these two terms will help in informing the reader to comprehend the epistemic origins of the application, which in turn will help in unpacking the technological black box. Big Data is defined as; “An evolving term that describes any voluminous amount of structured, semi-structured and unstructured data that has the potential to be mined for information.”1 And, Healthcare is defined as; “The act of taking preventative or necessary medical procedures to improve a person’s well-being. This may be done with surgery, the administering of medicine, or other alterations in a person’s lifestyle. These services are typically offered through a health care system made up of hospitals and physicians.”2 Healthcare is a public good, as it is a social justice issue inter twined with our fundamental human rights. Big Data

is a byproduct of twin drivers, Information Communication Technology (ICT) revolution and globalization. Data in the healthcare space is generated furiously at every node of the value chain: Payer, Provider and Global Health. The Internet of Things paradigm generates multitude of data points per second as well with numerous tracking health indicators on their smart phones. Hence, from electronic Emergency Health Records to Insurance, Data in the Healthcare space is notionally ‘Big’.

The Opportunities Medical Practitioners decide upon the course of treatment on the basis of data which is gathered from monitoring instruments to gauge various parameters and the outcomes of diagnostic tests. Doctors leverage data to extrapolate health trends to recommend treatments to their patients particularly while treating oncological ailment. Electronic Health Records are the basic unit of medical information which needs to be stored. There are hundreds of millions of such records in federal health system architectures in the developed world.

http://searchcloudcomputing.techtarget.com/definition/big-data-Big-Data, 8th August 2016 http://www.businessdictionary.com/definition/health-care.html, 8th August 2016

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Technology Trends In contrast there is unstructured, fragmented data in the medical services market in the developing world due to the standard practice which is mostly handwritten prescriptions and hard copy filing of medical reports. These data points often get lost in the complex web of files and a comparative cannot be drawn at ease between two longitudinal data points which is the basis of medical decision making. Digitization brings benefits of on boarding this enormous data set on the mainstream decision making grid such as on the enterprise architecture or on the cloud.

This treasure trove of data is an incredible opportunity to mine consumer insights for healthcare service providers. According to a research study released by BIS Research in 20153, the growth rates are in double digits for the big data analytics market across its financial, clinical and operational segments. The clinical analytics pie of the healthcare analytics market is growing at 22.54% CAGR from 2015 to 2020 while the financial slice is more than half the overall market space as depicted in figure below.

BIS Research Analysis Figure: Big Data Analytics in the Healthcare Sector Market, by Applications, 2015-2020 (%)

Challenges Big Data in Healthcare as argued in the previous section is a huge opportunity to improve decision making capabilities through enhanced data storage and enabling sophisticated enablers to make sense of the data. In this section, it is our endeavor to cut through the market rhetoric and ask some

hard questions regarding the actual acceptance rate of Big Data as a critical lever to leverage value in the healthcare space. The major structural barrier in the implementation of Big Data platforms in the developing world are the following three factors:

BIS Research Industry Report on â&#x20AC;&#x2DC;Big Data in Healthcareâ&#x20AC;&#x2122;, August 2015

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Technology Trends Capital: The initial deployment of capital in order to digitize paper records and have systems which can present the data in a format which is conversant with the end user; the medical practitioner is prohibitory for small players. The consumer in the global south is cost sensitive and the back end enablers to improving decision making is not a priority for the patient. If the infrastructure up gradation costs is passed on to the patient, then it is a discomforting factor. Skills Barrier: Medical school education pedagogy has not evolved for decades in the global south and seems to have frozen in bureaucratic and intellectual stasis. The data analytics paradigm has not seeped in to the medical school curriculum in the developing world, and there is an evident skills chasm between the potential of the market as seen from the technology industry perspective and its adoption on the ground by the healthcare service actors. Service Providers are ‘Tech Laggards’: Doctors consider additional data entry work into electronic database systems for medical records as a ‘burden’ on top of their existing medical duties. The recent changes in the regulatory landscape in the United States compulsorily mandated electronic medical records as per The Health Information Technology for Economic and Clinical Health (HITECH) Act and Obamacare, the landmark legislation expanding medical coverage in the United States has made electronic medical records a part of the health services conversation. The quest for documentation from a cultural perspective is an effort to leave a paper trail in lieu of any legal action.

The big data intervention here does not create greater efficiencies; rather it adds a new layer of bureaucracy, which has a negative externality. Big Data in the Healthcare space is an opportunity from a techno-deterministic standpoint as it is a data rich environment, but in order for Big Data to become a tool for performance improvement; structural and cultural barriers need to be resolved.

The Market Scenario There are numerous small, medium and large healthcare providers which are utilizing big data depending on the availability of skills and infrastructure. Pharmaceutical research organizations with well-equipped infrastructure and domain expertise are leveraging on big data in oncology and other clinical trials for the toxicity and safety analysis of the medicinal products[4,5]. Big data analytics is enabling value based future for the healthcare organizations which helps them prioritize healthcare outcomes for patients through precise data. Healthcare payers are implementing predictive analytics to detect fraudulent claims. Medium scale healthcare providers are not able to benefit from big data analytics despite of established infrastructure because of technical expertise scarcity and lack of cultural perspective as explained above. Small healthcare organizations still rely on decentralized data for decision making, making big data analytics implementation strenuous due to the paucity of spare capital.

Bertsimas D, O’Hair A, Reylia S, Silberholz J (2013) An Analytics Approach to Designing Clinical Trials for Cancer. MIT Working Paper. https://www.hpcwire.com/2016/05/18/machine-learning-fighting-cancer , 16th August 2016)

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Technology Trends

Figure: The Conceptual Map juxtaposing healthcare service providers with the challenges of Big Data Implementation (Source: Authors) The Big Data phenomenon is well underway in developed economies. Increasing healthcare expenses and focus on value based care are driving the demand of big data analytics in the healthcare domain. Healthcare providers are moving towards evidence based medicine for systematic clinical data analysis. Meanwhile from 2010, many new innovative health-care applications and smart devices have been developed with 40% of the loT rendering predictive capabilities. In low and middle income countries, presence of advance IT systems is limited or non-existent which end up health data on paper records. The growing and ageing population is acting as a key driver for this market which demands value based metrics for enhanced healthcare outcomes. As the healthcare infrastructural spine gets digitized, the

opportunities for big data in healthcare are manifold, but this will take time as the digital inequities are symmetrically mapped in the healthcare space as in the financial inclusion sphere.

Conclusions: Healthcare operates at the intersection of socioeconomic variables, public service delivery, demography and technology. Big Data if the correct questions are asked, this paradigm has the potential to better create decision making tools for medical professionals across the board. The attempt of the authors in this article has been to identify the gaps in the wide scale implementation of Big Data visĂ -vis the ticket size of the players in the healthcare arena which in turn is the intellectual anchor of the article.

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Technology Trends Techno-Management Innovation in Indian Emergency Medical Services Sreekanth V K is pursuing his PhD at Rajendra Mishra School of Engineering Entrepreneurship, Indian Institute of Technology Kharagpur, India. He is working on decision modeling in emergency medical services as a part of his doctoral thesis. He is an active member of a research group working in healthcare operations and analytics under the supervision of Dr. Ram Babu Roy.

Author shares his views on how techno-management innovation could help in dealing with the challenges in Emergency Medical Services in India.

mergency Medical Services (EMS), across the globe, play a crucial role in saving lives of the patients who require urgent medical assistance1,2. The concept of Star of Life3 conceptualized by National Highway Traffic Safety Administration, United States of America (1995) drives the operations of EMS which include the out-of-hospital care to the emergency patients and transport the patients to the definitive care at hospitals within predefined time standards4. The Star of Life was adapted from the personal Medical Identification Symbol of the American Medical Association. Each bar on the “Star of Life” represents one of six EMS functions. The functions include: 1. Detection 2. Reporting 3. Response 4. On-Scene Care 5. Care in Transit 6. Transfer to Definitive Care

Figure 1: Star of Life (source: http://www.ems.gov)

The story of Indian EMS started with the inception of Emergency Management and Research Institute in April 2005 that provided services across the state of Andhra Pradesh (currently Andhra Pradesh and Telangana). Earlier, people were mostly dependent on the ad-hoc emergency provider networks in which hospitals and taxis provided the services to meet the emergency needs. Later in 2005, the concept was conceived by National Health Mission (NHM) (then National Rural Health Mission) and initiated

Aboueljinane, L., Sahin, E., &Jemai, Z. (2013). A review on simulation models applied to emergency medical service operations. Computers & Industrial Engineering, 66(4), 734–750. http://doi.org/10.1016/j.cie.2013.09.017 2 Al-Shaqsi, S. Z. K. (2010). Response time as a sole performance indicator in EMS: Pitfalls and solutions. Open Access Emergency Medicine, 2, 1–6. 3 National Highway Traffic Safety Administration. (1995). “Star of Life”, Emergency Medical Care Symbol: Background, Specifications, and Criteria. U.S. Department of Transportation, National Highway Traffic Safety Administration, Office of Enforcement and Emergency Services. Retrieved from http://www.ems.gov/vgn-ext-templating/ems/sol/index.htm 4 Rajagopalan, H. K., Saydam, C., Setzler, H., & Sharer, E. (2011). Ambulance Deployment and Shift Scheduling: An Integrated Approach. Journal of Service Science and Management, 4(1), 66–78. http://doi.org/10.4236/jssm.2011.41010 1

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Technology Trends Emergency Response Services (ERS), popularly known as “108 Ambulance Service Project” to ensure emergency care for rural India along with urban India6. The number ‘108’ corresponds to the toll free number which allows the patients to report the emergency cases to Emergency Response Centres in each state. ERS is a part of National Ambulance Service (NAS) in which NHM guides and supports the states of India to operate various ambulance services directly or in Public Private Partnership (PPP). In most of the states of India, the 108 Ambulance Services are being run in PPP mode with various private service providers such as GVK EMRI7, Ziqitza Health Care Limited (ZHL)8 and BVG India Ltd9. Apart from the 108 ambulance services, there are various other services such as 102, 1298, 1033, Centralized Accident and Trauma Service (CATS) and different localized ambulance services run by private bodies5. Figure 2 shows the distribution of various types of emergency ambulance services such as 108, 102, 1033, 1298 and CATS in India.

102 Service, a government supported service, essentially consists of basic patient transport and primarily focuses on maternal and neonatal care. It provides free transfer from home to facility, inter facility transfer in case of referral and drop back for mothers and babies. 1298 and 1033 services are privately owned services which cater to various states of India. The Centralized Accident and Trauma Service (CATS) is one of the early ambulance services in India which was conceptualized and initiated well before EMRI. It focuses on accident and trauma and extends its services only in Delhi. There are various ambulance services run by private bodies which are controlled locally and serve the local people. For example, Accident Care and Transport Services in central Kerala which uses toll free number 1099. As the Figure 2 shows some of the state yet to have an EMS while other states have more than one type of EMS services which follow different implementation models 7,8,9,10.

Challenges in EMS in India Although the implementation of NAS guidelines is mandatory for all the ambulances which are financially supported under NHM, the guidelines for training and operation of EMS are not well defined. Due to the state level PPP and private ownership models, the national level perception is lacking and people of some states do not have access to the services. The recommendation for a single number at national level for all emergency cases is yet to be implemented and there is a high variability in the emergency numbers which create confusion among the people. The lack of standardization in EMS education creates problematic situation as EMS requires highly skilled labor. Figure 2: Distribution of various types of emergency ambulance services in India

Sharma, M., &Brandler, E. S. (2014). Emergency Medical Services in India: The Present and Future. Prehospital and Disaster Medicine, 29(3), 307–310. http://doi.org/10.1017/S1049023X14000296 6 Emergency Response Services /Patient Transport Service, National Ambulance Service(NAS), http://nrhm.gov.in/nrhm-components/ health-systems-strengthening/emri-patient-transport-service.html 7 Emergency Management and Research Institute (EMRI), http://www.emri.in 8 Ziqitza Health Care Limited (ZHL), http://zhl.org.in/ 9 Bharat Vikas Group (BVG) India Ltd, http://bvgindia.com/emergency-medical-service 10 Chandigarh Metro, Chandigarh now has 2 Ambulance Services (102 and 108), http://chandigarhmetro.com/chandigarh-emergencyambulance-services-102-and-108 5

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Technology Trends Even though the 108 ambulances are conceptualized to cater only emergency patients, in some states these ambulances play the role of 102 ambulances to provide maternal and neonatal care including the transfer from facility to home. The dual role play makes the situations complicated as the emergency resources are allocated for elective cases which would require the basic transportation facility only. Furthermore, the challenges become harder as there are budgetary constraints and the cost of operations are ever increasing along with the high capital investments. It is important to notice that the increase in the number of strikes by the emergency health care professionals in various states in the recent past. In addition to that, there are requirements for replacing existing ambulances with new ambulances as most of the ambulances have attained the mandatory cut-off retirement age of five years and covered more than 0.5 million kilometers11. There is a call for more ambulances as the existing number of ambulances is not enough to serve the high density population of India. The services are dependent on technology like Global Positioning Satellites (GPS) / Geo-spatial Information Systems (GIS) and other information and communication technologies (ICT) including internet of things (IoT). The technology development in India needs to go a long way to reduce the preventable manual error in the system. Presently, the data entries in most of the states heavily depend up on the manual effort and there is a possibility of human error in entries which makes the collected data highly unreliable. Moreover, the GPS technology fails miserably in some rural part of India which forces the system to have manual intervention in locating the incidents. The awareness among the general community regarding the emergency service is crucial for success of the service. The people who call to the emergency

response centre for non-emergency cases are not only misusing the resources, but they also prevent the real emergency users from using it. As the service is free, the chances of misuse are very high due to the ignorance about the significance of these services.

Techno-management innovation as solution As the services are constrained with budget, resources and skilled laborers, the innovation in the way it is managed is necessary. Technological innovation could help in reducing the cost and improve the management of system.

Technology Innovation: Technology innovation is necessary to identify and forecast the requirements so that we could plan well and reduce the waste. It would help us to design and develop the ambulances with necessary equipment and remove unnecessary equipment so that cost of ambulances will be reduced, and we could place different types of ambulances depending upon the demand. The big data analytics could help us in processing the data and forecast the need so that we could be in a better position to act. Long term forecast may help us to decide up on the budget and strategic decisions. The reduction of manual intervention in data management and the streamlining of information flow in the system will help us to improve the quality of service and make action quicker. There is a need to develop an ambulance tracking system using indigenous GPS system developed by ISRO which will cover entire country and provide information more accurately. In a nutshell, we need innovation in technology to capture and disseminate the information accurately and in a well-defined fashion, and the information captured should be processed to have better insights.

The Hindu, 108 services in critical stage, http://www.thehindu.com/news/cities/Hyderabad/108-services-in-critical-stage/ article7279007.ece 11

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Technology Trends Management Innovation Management innovation is inevitable as the cost of operations is ever increasing and 70% of the cost is attributed to the labor cost. Developing a national standard for operations and training may improve the services, and it will improve the transparency in the system. The innovation in operations management techniques is necessary as most of the existing techniques use assumptions from other countries

which are not applicable to Indian context. The high population density and low level of health literacy makes Indian EMS context a difficult nut to crack. With the help of appropriate technology interventions, we need to develop new management methods to minimize the labor cost and to improve the service quality. The regionalization of EMS, standard training process, appropriate budgetary provisions, and improving awareness among the general community might improve the performance of EMS.

Getting a vibreacoustic therapy in Estonia through the HealBed

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Technology Trends Health 360° – The Big Datalytics Opportunity Haritash Tamvada brings in 8 years of global Entrepreneurial and Executive experience (across Europe and Asia) with cross functional expertise in Marketing, Business Development, Sales, Strategic Partnerships and Alliances. He is passionate about Digital, Mobile and Data Analytics technologies. He is currently the Chief Marketing Officer of Posidex Technologies, a market leader in India within Master Data Management, Big Data and Analytics solutions. Previously he founded Warrantify.com, an award winning startup based in Helsinki. He is an alumnus of Aalto University (Finland), NTNU (Norway), Stanford GSB (USA) and JNTU (India).

This article throws light on current data related challenges in healthcare sector along with how organisations can benefit from various digital initiatives like getting a unified and 360 degree view of various entities for an efficient and effective data exchange and management. Building a predictive intelligence and data analytics platform aggregating data from all stakeholders with real time reporting capabilities can bring a transformative change in digital healthcare.

raditional Healthcare is experiencing a tectonic shift and is clearly one of the hottest frontiers for digital disruption. The sector is ripe for digital transformation as it could give an opportunity to unlock data related intelligence and analytics to a largely underserved industry, touching millions of lives. Many countries are devising their national eHealth programs1 investing heavily on digital healthcare. With organizations increasingly investing in robust IT infrastructure for an effective and efficient data exchange and management, initiatives such as digitizing medical records2 have made the need for good and clean data at the center of this digital transformation. Incorrect and inconsistent information across organizations due to reasons like information duplication or IT systems not talking to each other often leads to higher operational costs, compliance penalties, sub-optimal resource utilization with consequent impact on key stakeholders. Organizations need a powerful and unified platform for an end to end data management of various stakeholders with a 360° view of entities like practitioners, patients, suppliers, insurers and other players in the ecosystem. Let us face it - data is the new oil,and goes without saying, we need

good data refineries to really make sense of all the available data to get the right insights. Mining the massive amount of data, which most of the healthcare providers have access to can help in building predictive healthcare intelligence. For a largely traditional industry like healthcare, where practitioners depend on independent evaluation and derive own clinical diagnosis and decision making, an ecosystem level collaboration and exchange will be beneficial for the entire industry.

Key Challenges in Data Management

• Data duplication3: Refining and making sense of the deluge of data from different sources. • A 360° view of relations and interdependencies between various entities like providers, patients, suppliers for decision makers to take a holistic view. • Risk categorization of patients for an integrated and holistic medicare. • Data security and privacy. • Data capturing is not taken seriously especially in the context of eHealth monitoring for digital health services. • Right clinical data to get the right insights for effective decision making.

National e-Health Authority, Ministry of Health & Family Welfare, Government of India. http://mohfw.nic.in/showfile.php?lid=3099 Electronic health records https://www.cms.gov/Medicare/E-health/EHealthRecords/index.html 3 Duplicate Medical Records: A Survey of Twin Cities Healthcare Organizations http://www.ncbi.nlm.nih.gov/pmc/articles/PMC2815491/ 1 2

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Technology Trends • High administrative and operational costs. • Fraud in payments and other customer touch points. Data transparency in patient care. • Lack of a good feedback mechanism for healthcare input companies (Pharma, Insurance, Medical instruments, Technology vendors, digital health systems etc) for innovating new and cost effective R&D in medical treatments. • Building an effective outcome and evidence based service approach.

Why is 360° view important? Healthcare providers across the world are sitting on huge amounts of data, often in silos, which when used in the right way, can really help drive better outcomes. The multiple sources of disparate data captured from diverse stakeholders can add to the complexity. Under these circumstances, Data integration and aggregation with robust infrastructure and technology platforms with inherent deduplication capability (which can remove noise from the sound, so to speak) becomes crucial. A unified and 360° view can help in getting a single source of truth with all possible contributing parameters available. Deduplication is an important step as it gives a streamlined, unified, duplicates-free and 360° view of the available data4 – which can mean connecting the right dots where decisions are taken in totality and not in isolation. After all, the analytics you get is only as good as the contributing data which drives it. For example, if a practitioner has a full overview of a patients’ health (current and historical data) in real-time, the diagnosis and prescription could be holistic and data driven which can be very effective.

The Big “Datalytics” moment is here Data analytics5 can play a catalytic role in overall healthcare management for better services and outcomes. Analytics has become a proven phenomenon which has transformed many industries from government to banking, retail to travel verticals and has the potential to transform medicare industry too. While cost savings and overall improvement in medical services are immediate benefits, taking a lead in the data centric initiatives can give competitive advantages to

organizations in many ways apart from giving the industry a new thrust and direction which could have a lasting impact on lives of millions of people around the world. An outcome based approach leveraging operational, clinical, claims and other available data can help improve overall patient care, something which access to right data can enable. Access to the right data can help providers deliver superior quality service with differentiated and personalized value added services. Every aspect of patient care could become a digital data point for a comprehensive outcome based diagnosis in the overall clinical process. Some of the other tangible benefits include creating actionable insights, improving clinical effectiveness and decision making, reduce data related medical errors, and improve patient wellness and overall satisfaction. On the administrative front, it can reduce costs and improve overall operational efficiency, drive revenue growth. While healthcare has been a fertile ground for payment related frauds, a good data engine can help reduce fraud and incorrect payments. Regulatory compliance is another major area where good data analytics can help mitigate the risk and help build robust pro-active and stringent compliance initiatives.

Big Data Mining for Predictive Intelligence & Real time reporting A pertinent question is: How can all the stakeholders in the healthcare sector together with government collaborate to build a risk mitigating and predictive intelligence platform? Essentially, a platform that can give a combined and aggregated view of different sources of data to get insights streamlined into a single view simplifying complex data. Can the organizations re-use and mine the massive data points to connect the dots (in terms of conditions for a particular health trigger to happen, discovering relationship and patterns within these disparate sources of data) and predict if a given place is going to have a health epidemic (like Zika virus)? Can we get reliable intelligence in making sure that does not happen as well as contain its spread further? The individual contributing data pools from each stakeholder when combined and rinsed for data related insights can be a great information clinical repository. Such data mining can throw light on various patterns and help analyze the causeeffect relationships6 with real-time reporting capabilities.

Posidex Technologies http://posidex.com/ State of U.S. Healthcare Provider Analytics, 2016 Gartner. 6 The 'big data' revolution in healthcare - McKinsey & Company 4 5

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Technology Trends What Is Next for Wearables? Dr Kate Lazarenko is a founder and director of Health Industry Matters Pte Ltd, a boutique consulting firm focused on creating customised solutions that address unique needs of clients across the health industry ecosystem. Kate holds a PhD in health information systems from Monash University, Australia and was as an adjunct Research Fellow post her doctorate. Apart from academia, Kate worked for the government-funded authority supporting a national vision for digital health for Australia (National E-Health Transition Authority), management consulting (PricewaterhouseCoopers, Singapore) and health IT industry. Kate is passionate about exploring ways in which companies can foster innovation in order to create better services and products. Aaron Kong is a co-author and managing director of A Life of Active. Wearable technology, also referred to as ‘wearables’, ‘fashionable technology’, ‘wearable devices’, ‘tech togs’ or ‘fashion electronics’, is defined by Wikipedia as “clothing and accessories incorporating computer and advanced electronic technologies”1. We would argue that health technology wearables, with their increasing popularity and growing demand, are the better-known members of the Internet of Things family. In this article we will touch upon the history of wearables, discuss their evolution and adoption, outline five main categories of wearables with a particular emphasis on wristwear as the most popular health technology wearable today, and the potential of such wearables for tracking health measurements. We will also touch upon certain challenges and opportunities associated with wearable devices and discuss what is to come.

Health Consumers circa 2016

here is a lot of research dedicated to the new generation of health consumers. The common agreement is that the new generation of consumers extensively uses the Internet to obtain health related information2 . Such consumers feel empowered due to the fact that they are not only able to consult their family doctors, but also get extensive Internet information about their topics of interest, get in touch with the communities and groups of consumers that are interested in the same issues, and even get recommended the best specialists in the area or country to get a second opinion.3 However, a number of health consumers these days do not stop there – they take health matters in their own hands and use various digital tools, also known as health technology wearables, to track and monitor health

measurements, such as heart rate, number of steps, sleep patterns, calories burnt, food consumed, and more. These wearable devices are highly popular amongst the modern connected generation who are impatient, information and data hungry, value convenience above all and expect personalised, on-demand services that enable them to take control over their health.4 The existing usage statistics and forecasts demonstrate that the use of health technology wearables has doubled over the last two years (21% in 2016 vs. 9% in 2014).5 Moreover, 78% of healthcare consumers across the globe wear or are willing to wear gadgets to track their lifestyle habits and/ or vital signs.6 Juniper Research forecasts the wearable market to grow extensively in the next few years with the anticipated global revenue from smart wearable devices reaching $53.2 billion by 2019.7

https://en.wikipedia.org/wiki/Wearable_technology Tabitha Tonsaker, Gillian Bartlett and Cvetan Trpkov (2014) “Health information on the Internet: Gold mine or minefield?”, Canadian Family Physician; 60(5): 407-408. 3 Carmen Wong, Christopher Harrison, Helena Britt and Joan Henderson (2014) “Patient use of the internet for health information”, Australian Family Physician; 43(12): 875-877. 4 https://www.accenture.com/us-en/insight-predictable-disruption-digital-health 5 https://www.accenture.com/us-en/insight-research-shows-patients-united-states-want-heavy 6 https://www.accenture.com/us-en/insight-research-shows-patients-united-states-want-heavy 7 http://www.juniperresearch.com/press/press-releases/smart-wearables-market-to-generate-$53bn-hardware 1 2

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Technology Trends Other findings suggest that the number of wearables produced for the healthcare segment will be growing steadily over the next five years.8 Such predictions are easy to believe given the amount of non-traditional players that are stepping into the healthcare field with their original and competitive offerings, e.g. multiple startups that offer various wearables and devices that capture health measurements, analyse and share them in real time and on demand.9

Health Technology Wearables It is well known that we cannot effectively track something that we do not measure. The fact that health technology wearables allow users to effectively track health measurements in real time is one of the key factors that make them popular with the new generation of health consumers. As a proud owner of a fitness band for the last four years, I can unequivocally state that the ability to get instant access to my data (e.g. heart rate, amount of calories burnt, etc.) when I need it and with minimal effort from my part is the most useful feature of my fitness band.

Moreover, there are a number of other attractions that help health technology wearables gain popularity: - Availability and variety of wearables (different colours, shapes, interfaces, etc.); - Effortless wireless connectivity and integration with smartphones; - The convenience of getting real-time data at any given moment, at a glance and from anywhere; - Different types of information and health measurements that are getting tracked, stored, analysed and presented in a user-friendly manner, and often in a manner conducive for decision-making; - Relatively inexpensive price; - Some of the wearables are highly customisable (e.g. classy designer cases made especially for Fitbit fitness bands); - Plethora of applications that can be easily installed on and removed from smartphones and other smart devices, e.g. tablets, phablets, ipads, etc.; - Provision of ‘extra’ functions, e.g. ability to see the caller or read a message using the wearable, that are similar to the functions of smartwatches that are often more expensive.

Moreover, there are a number of principles related to the design and performance of wearables that make empowered health consumers appreciate their wearable devices even more (see Figure 1).

CONTENT Less is more and the information is presented in a format conducive to decision making CUSTOMISATION The users can personalise the displays, set up silent alarms, opt in for various colourful device cases, etc.

INTERACTION Ability to communicate with the device by setting up and adjusting various goals, provide feedback, etc.

INTENTION Opportunity to set up various alerts (e.g. once the goals are achieved), receive just in time information, etc.

LINKAGE Option to link one’s exercise regime and tracked food preferences to lifestyle habits, e.g. sleep patterns

NETWORKING Ability to communicate with others using the device, motivate each other and share the results

ENHANCEMENT

Constant evolution of the devices, variations in sizes, colours, manufacturers, presentation, etc.

Figure 1. Key Design Principles of Wearables

https://www.strategyanalytics.com/strategy-analytics/news/strategy-analytics-press-releases/strategy-analytics-pressrelease/2016/06/22/strategy-analytics-wearables-revenues-projected-to-grow-31-percent-in-2016-as-smartwatches-lead-valueshare 9 https://www.accenture.com/us-en/insight-predictable-disruption-digital-health 8

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Technology Trends When it comes to the wearable devices currently available on the market, there are various types of wearables that can literally cover us from head to toe. Whilst some of the wearables are very popular (e.g. fitness wristbands), others are not so well known (e.g. sensors that help adjust one’s posture in real time). Overall, all existing wearables can be divided into five distinctive categories as illustrated in Figure 2. It is clear that consumers have plenty of choices when it comes to wearable devices, and each one of the five categories listed above, has a lot of potential when it comes

evolution of wristwear, elaborate on how this technology facilitates taking health measurements globally and talk about ‘A Life of Active’ - a case study from Singapore that demonstrates how wearables are currently being used in the Asian context.

Evolution and Adoption of Wristwear According to Forbes, the wearables industry has been blooming with its market worth $5.1 billion in 2015, and is

Figure 2. Categories of Wearables

to tracking health measurements. However, from our perspective the most interesting and promising wearables from the world of health technology today are the wristwear, namely various fitness bands or activity trackers, along with smartwatches that often offer more extensive functionality. Further in this paper we will discuss the

expected to grow by 25% more by 2020. Wristwear is the most popular category of wearables as it currently accounts for 9 in 10 wearables bought worldwide. The wristwear has gone a long way before becoming the world’s most popular wearable (see Figure 3).

Figure 3. Evolution of Wristwear

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Technology Trends While Jawbone Up was the first wristwear of its kind with the ability to track and store health measurements on the go, some might argue that it was not always connected to the smartphones or laptops, which is partially true. Jawbone did not have a screen and could only display health measurements (such as the number of steps, hours of sleep, calories burnt, etc.) when plugged into a smartphone or connected to a laptop. However, the invention of this wristwear device was revolutionary, and was followed by a number of fitness trackers and smart watches that had displays and could be wirelessly connected to smartphones. Inspired by a resounding success of Jawbone Up, Nike designed and manufactured Nike Fuelband released in 2012. The device had a small graphical display that notified the user of their daily activities, proximity to hitting their goals and provided other feedback. The fitness band came with its own Nike+ connect software that enabled calculation and customisation of personal statistics and achievements once the device was plugged into a laptop or a smartphone. Pebble watch developed by Pebble Technology Corporation, USA in 2012-2013, was the first of its kind smartwatch that could wirelessly via Bluetooth connect to and display messages and notifications from iOS as well as Android smartphones. Pebble watch also had an online application store where users could download applications customised for Pebble watch that were developed by a myriad of third party sellers. In the end of 2013, Nissan, a Japanese automobile manufacturer, created Nissan Nismo Smartwatch, the first smartwatch to communicate with a car and a smartphone via Bluetooth. The watch could connect with Nissan vehicles and monitor drivers’ biometrics, e.g. heart rate, in order to identify when the drivers were becoming tired. That information then would be matched to the car’s performance data, e.g. its current speed, and an appropriate action, e.g. to slow down or take a break, would be suggested to the driver. Starting 2013 every big player in the smartphone market, such as Apple, Samsung, Sony, LG and many others have

been working on their own smartwatches. In parallel, Fitbit, a consumer electronics company based in the USA, released Fitbit Flex in 2013, which was worn on a wrist as opposed to their other trackers that needed to be clipped onto the clothes. Since then, Fitbit released a large number of wristwear devices, and while they do not offer the extensive functionality of smartwatches, they meticulously track health measurements, easily and wirelessly connect to various smartphones and are offered at competitive prices. The wristwear market keeps growing and offering more and more devices of various colours, sizes and functionalities. Nevertheless, it is important to understand whether the variety and availability of wearables drive their adoption, or are there other factors in play when it comes to choosing health technology wearables that empower users to measure progress towards their goals and trigger subsequent behavioural change. According to Dr Mitesh Patel and his colleagues from the Philadelphia VA Medical Center, there are four major challenges pertaining to the use of wearables, including wristwear devices that need to be addressed in order to enable behavioural change: 1. Health consumers should be motivated and interested enough to be willing to invest in the wearable device; 2. Once acquired, the user needs to remember to wear the device and to recharge it; 3. The device has to be customisable enough to enable the user to regularly and accurately track their targeted behaviour; 4. Tracked information has to be presented back to the user in a way that can be easily understood, supports decisionmaking and motivates the user to take action.10 Statistics demonstrates that 27.2% of US adults do not intend to use wristwear or other wearable devices to track their fitness or health measurements.11 Therefore, it’s safe to assume that whilst some, more technologically savvy, health consumers are comfortable to use various wristwear and other wearable devices, others might find such devices not particularly useful, interesting or needed.

Mitesh S. Patel; David A. Asch and Kevin G. Volpp (2015) “Wearable Devices as Facilitators, Not Drivers, of Health Behavior Change”, JAMA; 313 (5): 459-460. 11 Research.technologyadvice.com/wearable-technology-study 10

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Technology Trends However, half of these same respondents state that they would be prepared to reconsider if: 1. The tracking device is provided by their physician, or; 2. Wearing such a device would result in better healthcare advice from their physician, or; 3. There would be a possibility of lowering their health insurance premiums. To conclude, the respondents indicate that they would be willing to use wristwear and other wearables to track and store their health measurements, if that would result in certain tangible benefits for them, whether it’s monetary incentives or better health advice. However, we would argue that simply tracking and storing health measurements using wristwear and other wearable devices might not be enough to trigger behavioural change. Therefore, the increasingly growing popularity of wristwear does not always suggest that just because the health consumers are enabled to track their health measurements, they will readily change their behaviour or adjust their lifestyle habits.

Wristwear to Support Behavioural Change There are a number of books and articles written about behavioural change. Most authors agree that it is a complex phenomenon that does not happen overnight. While it is difficult to persuade people to perform their tasks in a different way to trigger behavioural change, it is even more challenging to maintain such behaviour change in the long run. Therefore, the importance of persuasion and the right motivation in enabling and promoting behavioural change cannot be overstated and emphasised enough.13 Researchers from the Philadelphia VA Medical Centre suggest that whilst wristwear and other wearable devices

have the potential to trigger behavioural change in health consumers, the devices alone cannot trigger such a change. In fact, there is little evidence to suggest that the gap between recording information and changing user behaviour is being effectively bridged by wearable devices. The authors suggest that a combination of various behavioural economics concepts and engagement strategies, such as individual encouragement, social competition and collaboration, effective feedback loops, gamification, could help initiate and achieve behavioural change.14 In Asia, a new Singapore-based startup ‘A Life of Active’ 15 (ALOA) has created an online wellness portal that rewards its members for walking. According to a 2012 survey, seven out of ten Singaporeans do not get enough daily exercise, which contributes to health conditions such as heart disease and diabetes.16 Studies show that regular but short periods of physical activity can help reduce the risk of such health issues.17 ALOA was created to encourage Singaporeans to engage in and maintain a healthy lifestyle. Each consumer subscribed to the ALOA portal, has a wearable device – a wristband - that collects data about the number of steps taken and distance walked. The data is then synced from the wristband to the portal and displayed back to the users. Members are encouraged to take part in various challenges of different intensity to win cash, vouchers or to participate in lucky draws. The ALOA founders wanted to determine whether implementation of various engagement strategies could, in fact, lead to and promote behavioural change, and how such strategies would influence consumers’ motivation. A number of studies talk about the power of intrinsic motivation that can be defined as a desire to act in a specific manner because of the sense of fulfilment gained, and how it can supersede external rewards.18

Garvin, David A., and Michael A. Roberto. “Change Through Persuasion.” Harvard Business Review 83, no. 2 (February 2005): 104–112. Mitesh S. Patel; David A. Asch and Kevin G. Volpp (2015) “Wearable Devices as Facilitators, Not Drivers, of Health Behavior Change”, JAMA ;313(5):459-460. 15 http://alifeofactive.com/ 16 http://health.asiaone.com/health/body-mind/3-ways-busy-singaporeans-can-reduce-their-chances-getting-diabetes 17 Tikkanen O, Haakana P, Pesola AJ, et al. Muscle Activity and Inactivity Periods during Normal Daily Life. Johannsen D, ed. PLoS ONE. 2013;8(1):e52228. doi:10.1371/journal.pone.0052228. 18 Ryan, Richard M., and Edward L. Deci (2000) “Intrinsic and extrinsic motivations: Classic definitions and new directions.” Contemporary educational psychology 25.1: 54-67. 13 14

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Technology Trends However, the ALOA founders have found that the intrinsic motivation often encourages the creation of a variety of motivational techniques but not the behaviour change per se. In the meantime, there are cases where external motivators, such as cash rewards, positively influence behaviour changes. Such cases demonstrate that successful behaviour change initiatives, such as quitting smoking, changing diets and increasing exercise frequency, have been encouraged and facilitated by cash rewards.19 The ALOA founders wanted to determine whether health consumers would increase their level of physical activity if they were rewarded for walking more, and set out to become the external motivational trigger for members to become more active. The level of physical activity was measured by an increase in either the frequency of the consumers’ sessions or the number of steps taken. The consumers were invited to participate in weekly challenges, where they were asked to walk between 4,000 to 15,000 steps either in one go, daily or over five to seven consecutive days. The ALOA founders found that the monetary incentives proved to be a substantial motivator for the consumers to take part in physical activities. In fact, out of the 15 challenges ran from June until September 2016, those with monetary rewards were the most popular and had the highest number of members completing them. Interestingly, lucky draws (for big-ticket items) that represented the element of chance were not as popular as challenges with guaranteed monetary rewards. Based on the three months trial run of the portal, the ALOA founders conclude that the external motivation can serve as a framework or even a backbone of their programme to drive behaviour change. They identify three important lessons learnt: 1. Engage consumers in early stages of their adopting a new behaviour Giving health consumers realistic and achievable targets with the means to monitor their achievements is most effective when done in early stages of adopting new behaviour, i.e.

when the consumers are starting to establish new habits. 2. Customise and diversify Health consumers operate in a range of personal situations and no external trigger affects them in the same way. To that end, while the majority of members enjoyed receiving monetary rewards, the others looked to earn vouchers or lucky draw prizes that addressed practical matters. Therefore, diversifying and introducing a variety of engagement strategies and rewards, facilitates behavioural change. 3. Money talks It is necessary to establish baseline levels of activity to gauge fitness improvements and to determine behaviour change. Incentives, especially monetary ones, can help overcome inertia and procrastination barriers towards starting and maintaining participation in a walking programme. The ALOA founders state they are looking forward to the next stage of engaging with their members. Having built up an understanding of triggers and a walking programme baseline, they want to move into providing challenges on demand (‘Start a challenge just before the daily walk and earn!’) as well as stronger personalisation with thresholds, where the portal alerts the consumers when they fall under or go above their pre-selected milestones.

Challenges and Opportunities The world of wearables has its own challenges and hurdles to overcome. Despite the growing popularity of wristwear and other health technology wearables, the research suggests that, depending on a wearable, anywhere between 33% to 50% of health customers will stop using a device within six months from the day of purchase. This can be attributed to a number of factors, including the fierce competition amongst manufacturers of wristwear and other health technology wearables.

Gneezy, U., Meier, S., & Ray-Biel, P. (2011). When and Why Incentives (Don’t) Work to Modify Behavior. Journal of Economic Perspectives, 25(4), 191-210.) 19

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Technology Trends The reality is that for every one hundred of wearable devices, less than five per cent will be somewhat successful when they make it to the market.20 Other factors that pose a significant challenge when it comes to the use and adoption of wearables by health consumers are: 1. Safety Most of the health technology wearables give users a unique and enticing opportunity to be constantly connected to the smartphones via the means of Wi-Fi, Bluetooth and NFC. However, would a prolonged use of such devices expose health consumers to unwanted health risks? Most scientists believe that wearable devices emit low levels of electromagnetic radiation (typically two orders of magnitude less than a mobile phone) and therefore, pose no health risk. However, there are some researchers who are more sceptical on the matter and believe that more work needs to be done in order to unequivocally state that wearables cause no harm to their users.21 Another safety related concern is about the fact that at times wearables can be rather distracting. Whilst it is impressive to have a smartwatch that monitors all your email accounts, phone calls and messages in real-time, and notifies you the moment there is new activity detected (including health-related notifications), such alerts can be distracting and potentially dangerous in certain situations, e.g. when driving a car. 2. Unreliable or inaccurate data The drawback of most of the health technology wearables is that the data is not quite captured in the real-time. There is almost always a delay from the moment when the data is captured to the moment when it is displayed. This is not a critical issue in most cases, however, as more and more health consumers rely on the wearables to track their fitness activities, amount of calories burnt, etc. it is important to ensure that the information is tracked, analysed and presented accurately and the right way. Instead of taking collected data at face value without being concerned about how accurately it has been captured or whether it is correct,

the manufacturers of the wearables should ensure that the health consumers can fully trust their devices. This issue can become paramount when such wearable devices are used for specific medical purposes (e.g. measuring blood glucose levels) and the collected data gets integrated into the hospitalsâ&#x20AC;&#x2122; electronic health records systems. 3. Privacy issues There is no secret that some of the health consumers are rather reluctant to share their data with the rest of the world. Therefore, manufacturers of health technology wearables have to ensure that the data is protected at all times. Along with data accuracy, data privacy is of particular importance if such data gets transferred to and stored in the hospitalsâ&#x20AC;&#x2122; electronic health records systems. 4. Information overload Wristwear devices that track health measurements on a daily basis, such as the number of steps taken, sleep patterns, heart rate, etc. generate a huge amount of data per user. Therefore, another challenge for the manufacturers of the health technology wearables is to make sure that the data is presented in a way that does not overwhelm with information, but instead allows the user to get an accurate synthesis of information that will enable them to make better decisions and lifestyle choices. The manufacturers of wearable devices collecting data that has a potential to be used by the physicians, face a similar challenge. In fact, one of the cases against health technology wearables is that encouraging physicians to work with data derived from wearable devices could result in a technology overload and drive physicians away from face-to-face patient-physician interactions.22 Therefore, it is important to ensure that the data that could potentially be used by the physicians is accurate, reliable and presented in a way that is easily understood and digested by the medical professionals. Moreover, engaging the medical community in the design of such wearable devices as

http://www.forbes.com/sites/reenitadas/2016/01/07/the-future-of-wearables-can-companies-avoid-the-pitfalls-threateninghealthcare-wearables 21 http://www.nytimes.com/2015/03/19/style/could-wearable-computers-be-as-harmful-as-cigarettes.html 22 http://searchhealthit.techtarget.com/essentialguide/Wearable-health-technology-in-medical-and-consumer-arenas 20

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Technology Trends early as possible will ensure that doctors and other medical professionals will get the right data at the right time and in the preferred format. 5. Over-engineering While most of the manufacturers strive to make their wearables user friendly, unfortunately it does not always work. One of the studies suggests that 24% of consumers find the monitor of their health technology wearable to be too complicated. Various factors, such as the number of functions available, a lack of wristwear buttons, the size of displays contribute to the fact that the users sometimes find it hard to understand multifaceted applications of their wearables, or appreciate their sleek designs.23 6. Limited plug-and-play features Some of the manufacturers of wearable devices, in an effort to emulate Apple, create products that are only capable to operate on a restrictive proprietary platform. Needless to say, this poses certain challenges for the health consumers as well as third party developers because it limits their application development options.24 Despite some of the drawback and existing challenges, the number of heath technology wearables and their applications keeps growing. Therefore, another question to ask is whether these gadgets are merely a trend or do they have real staying power and the ability to disrupt healthcare and create a substantial impact?

Where to from Here? We, the authors of this article, firmly believe that the future of wearables lies in a firm understanding of their existing limitations and challenges, and uncovering ways to overcome them. One of the very first questions that the

manufacturers of health technology wearables should ask themselves is whether they would like to position their device as a consumer device for health and wellness, or as a true medical-grade product validated for use in the clinical setting and approved for clinical decision-making. If certain health technology wearables are created and marketed as a health and wellness device used to track the number of steps and calories burnt, the manufacturers should continue on working with the users to build better and more user-friendly interfaces and desirable functionality. Given that smartwatches will reportedly replace fitness bands as the most purchased wristwear by 201725, the current wearables’ manufacturers along with other industry players might want to reassess their strategy and rethink their offerings in the near future. Moreover, such manufacturers might want to consider engaging with the consumers by proactively supporting them in managing health and wellness through utilisation of both ‘push’ and ‘pull’ methods of information delivery. Accurateness of measurements, privacy and security have to be of high priority as well, as discussed earlier in this article. There should be emphasis on value, i.e. identifying what functionality matters to the customers most, and high performance, e.g. there should be no noticeable delays in the device’s performance. The manufacturers might also consider a better adoption of outcome-based models and algorithms that will enable users to state their ultimate goals (e.g. their fitness goals) so that the device can work with the user towards achieving such goals, as well as remind the user to take necessary actions on a day-to-day basis. This functionality can be particularly appreciated by the users who share data collected by their wearables, with their insurance companies in order to get future discounts or better premiums.26

http://mobihealthnews.com/39382/global-survey-finds-8-percent-adoption-of-fitness-wearables http://forbes.com/sites/reenitadas/2016/01/07/the-future-of-wearables-can-companies-avoid-the-pitfalls-threatening-healthcarewearables 25 http://www.juniperresearch.com/press/press-releases/smart-wearables-market-to-generate-$53bn-hardware 26 http://www.asiainsurancereview.com/Magazine/ReadMagazineArticle?aid=35855 23

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Technology Trends However, if manufacturers decide to create a health technology wearable that can be used as a medical device in a clinical setting, the number of challenges to overcome grows exponentially. There is no doubt that there is a huge market for such devices, and they are much needed in this day and age. Most medical institutions and insurance providers might be willing to pay significant amounts of money for such wearables; various venture capitalist firms might consider investing large sums in such project, but most importantly, such devices have a real opportunity to make a huge difference in people’s lives. However, every one of such manufacturers will have a few hurdles to overcome before the devices can successfully reach their targeted patient base: 1. Specific health technology wearables developed specifically for the physicians and other medical professionals require an extensive collaboration between medical personnel and IT teams. Such devices will have to have the ability to deliver exactly what is expected of them, provide accurate data and be endorsed by the clinicians; 2. Safety is another serious matter that is taken to the whole new level once a wearable gets classified as a medical device, as it would have to undergo the Food and Drug Administration, USA (or similar organisations in other countries) regulatory scrutiny to ensure it is safe to use ;27 3. Privacy becomes a major challenge that has to be addressed. For instance, in the USA any data that comes from patient-bought wearables is not required to be protected under Health Insurance Portability and Accountability Act (HIPAA),

but hospital-assigned devices that contain protected health information must be HIPAA-compliant.28 Therefore, such device manufacturers have to make sure that their wearables are HIPAA compliant, or compliant with other Data Protection Acts (e.g. in Canada, UK, etc.). Amongst the three challenges listed above, privacy is one of the most complex and crucial ones. Case in point – when the creators of Google Glass realised that their device could be recalibrated and used in a clinical setting, e.g. to audio or video tape clinicians’ conversations with their patients and transcribe them directly into the hospitals’ electronic health records systems, or to assist the surgeons with certain realtime time data during complicated procedures, they faced the HIPAA compliance issue that is yet to be resolved.29 In conclusion, there is no doubt that health technology wearables have a potential to enrich lives of and help millions of people globally. In the technology enabled world where health consumers are getting empowered and willing to take responsibility for their lifestyle choices, the shift from intervention to prevention when it comes to healthcare is undeniable. There is little argument that increased interconnectedness and enhanced technological knowledge of the general population facilitates a slow transformation of patient care from episodic visits into continuous support of patient wellness and wellbeing, and health technology wearables certainly have a huge role to play in this powerful transition.

http://internetofthingsagenda.techtarget.com/feature/Wearable-device-heart-rate-monitoring-entering-the-consumer-mainstream http://searchhealthit.techtarget.com/essentialguide/Wearable-health-technology-in-medical-and-consumer-arenas 29 http://hitconsultant.net/2016/01/19/future-wearables-healthcare/ 27 28

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Pulse Healthcare Innovations Dr Avantika Batish is working as Director Strategy and Healthcare at International Health Emergency Learning and Preparedness. Also guest faculty for MBA HR and MBA Healthcare Management at various B-Schools and is a soft skills trainer.

Quadio launches the first ever revolutionary that could be the end of stitches and staples. It’s being tested in a trial in the U.S. after results from animal studies hearing app for android and iOS in India

earing loss is the second largest disability in the country that affects more than 120 million lives with majority sufferers over the age of 60. There are less than 2000 practicing audiologists in India and therefore most people have never actually received treatment until their hearing has degraded severely with age. Keeping this in mind Quadio Devices Pvt Ltd, a leading hearing care provider of India, introduced for the first time their path breaking Q+ hearing app in Mumbai on android and iOS platforms. The app promises to be a holistic mobile-based hearing solution complete with all the features of a conventional hearing tool. The Q+ app is a first of its kind free application that is ultra-advanced besides being affordable, accessible, controllable and customizable. Quadio uses the latest internet and mobile technology to push the boundaries of telemedicine and hearing care and merge the worlds of healthcare and technology. The Q+ app harnesses the processing power of your smart phone to enable it to be used as a complete and fully-functional hearing mechanism. It is designed to maximize the listening experience based on the results of a simple interactive hearing test. The app also gives you the ability to control and customize sound quality by intelligently enhancing hearing sounds and speech. With the Q+ app you can easily follow conversations using the phone headset in both quiet and noisy environments, and control the sound quality to customize it to your preference. The inbuilt hearing test in Q+ is calibrated for accuracy as per American National Standards Institute (ANSI) standards for audiometry.

Now, a magnet (Magnamosis) that may make surgical stitches history

A magnetic doughnut-shaped device has been developed

suggested it could be highly effective as reported by the Daily Mail. Researchers leading the California trial say the device could be suitable for tens of thousands of procedures and will “revolutionise this area.” The new device holds the two ends with a strong magnetic bond that researchers believe leads to a more secure anastomosis and faster healing and it is safer than standard techniques, as it can be done using less invasive surgery, meaning a lower risk of complications such as leaks. It’s also said to be cheaper. The new device, the Magnamosis, is a method of connecting the pieces using the attraction between two magnets, rather than staples or stitches. It consists of two ring magnets, each 23mm in diameter, which have concave or convex surfaces so that they fit snugly against each other. So far, this process has been shown to take less than a week using the magnet. It then automatically loosens its magnetic hold and is naturally removed from the body. A series of animal studies have shown that it is reliable and effective, and it is now being used in a clinical trial with patients for the first time.

Essilor Launches Varilux 3.0, the Latest Generation Progressive Spectacle Lens in India Essilor, the world leader in ophthalmic lenses, has introduced in India Varilux 3.0 series which is designed to provide the smoothest and sharpest vision to people above 40 years of age who are dealing with visual deficit across multiple ranges of vision. Varilux progressive lenses enable the wearer transition his vision smoothly between different distances from near to far, so that he can perform multiple eye functions simultaneously from checking his smartphone to watching the television without any unease or jerk of

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Pulse vision. Varilux 3.0 lenses comprise three ranges – Varilux, Physio, Varilux Comfort and Varilux Liberty. The Varilux 3.0 range incorporates highly innovative patented technologies including Binocular Booster lens technology, W.A.V.E 2.0 technology and Path Optimizer technology. VariluxPhysio lenses use the highly innovative Binocular Booster lens technology that simultaneously analyses the prescriptions of both eyes, taking into consideration that a person’s vision is at its best when both eyes are working together in sync. The W.A.V.E 2.0 lens technology used in both VariluxPhysio and Varilux Comfort delivers sharper vision even in low light conditions. The lenses are intelligently designed to better adapt to the pupil size and beam of light passing through in order to deliver vision with the best resolution in a more accurate and realistic manner. The Path Optimizer technology used in Varilux Liberty takes into account the wearer’s characteristics to generate a precise and optimal viewing path, from far to near and everything in between so that each and every part of the viewing path matches wearer’s eyesight. Varilux progressive lenses are tried and tested on real wearer’s and therefore guarantees optimal vision at any distance and allows the eye to transit smoothly and effortlessly from near-mid to far vision; this makes instant focus achievable for wearers simultaneously in different vision zones.

MiraCradle – Neonate Cooler, receives the CE and ISO 13485 certification MiraCradle – Neonate Cooler, an affordable cooling device developed by Pluss in collaboration with CMC Vellore, receives the prestigious CE certification and ISO 13485. UL, a premier global independent safety science company is the accredited body that certified MiraCradle. MiraCradle – Neonate Cooler is an affordable passive cooling device which uses the advanced save Phase Change Material (PCM) technology to cool newborns suffering from birth asphyxia. Birth asphyxia is the second largest cause of neonatal deaths in India and across the world. It is easy to use, safe, lightweight and portable and gives the precise temperature control of 33-34°C for a period of 72 hours with minimal manual supervision and no requirement of constant electricity supply. MiraCradle costs less than 1/8th of the present electronic devices available in the market.

Pluss, with global ambitions in mind, collaborated with UL in October 2014 to obtain the CE and ISO 13485 certification. After a rigorous process of audits, Pluss obtained the ISO 13485 certification in August 2015 and CE certification in May 2016. With the certifications in place, Pluss is now poised to expand the influence of MiraCradle across geographies (Middle East, Africa, South America and South East Asia). To ensure precise temperature control, MiraCradleNeonate Cooler uses a cascaded system of PCMs. Cascaded system is a patented technology that employs use of two or more form stabilized PCM mattresses with melt/freeze at different temperatures. By engineering the melting points, thicknesses, conductivities and placement of the involved layers, a “quasi-automated” cooling system is created, which, while being completely passive, behaves like a servoautomated cooling device.

AddressHealth raises US$1.5 million in series a funding Primary healthcare network, AddressHealth has raised $1.5 million in Series A funding led by Gray Matters Capital with participation from existing investor, Unitus Seed Fund. The Bengaluru-based company, which runs school-based neighbourhood clinics and school health programs, will use the investment to expand the model to other schools in Bangalore. Started in 2010 by doctors Anand Lakshman and Anoop Radhakrishnan, Address Health has reached more than 1 lakh children through on-site services and screening programs to identify health issues and provided early intervention to prevent them from suffering as young adults. The funding will allow them to expand the reach of their unique model of healthcare, which leverages schools, to deliver comprehensive primary healthcare to children proactively, at a low cost.

Lifespan India introduces unique, non invasive screening test for Diabetes, Cardiometabolic complication Lifespan, India’s largest chain of diabetes and cardiometabolic clinics introduces the R.I.S.C. test – a unique, non invasive, screening test for risk assessment. It screens an individual for risk of developing diabetes by

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Pulse calculating Insulin resistance. It also assesses one’s cardio metabolic risk score and autonomic neuropathy risk score. It tells about one’s body fat composition, heart functioning and the functioning of the autonomic nervous system, and pseudomotor nerves. The test assesses 30 vital health indicators which give an idea regarding one’s risk of developing neuropathies and heart related complications. This test does not require any blood sample, only demands a 3 hour fasting. The test helps to • Identify how diabetes is affecting your organs and what diabetic complications you may have developed and also are at risk of developing. • Detect cardio metabolic related problems, cardiac autonomic neuropathy, diabetic autonomic neuropathy, arterial stiffness and sudomotor abnormalities. • Analyzes a person’s present health status- the test checks for markers of underlying abnormal health condition by detecting small physiological changes.

HPE Bags Most Innovative Solution of the Year at Indian ISV Awards 2016 HPE’s eHC solution that provides access, availability & affordability of quality healthcare in remote locations, was judged the most innovative solution of the year at Indian ISV awards 2016, held in Bangalore on July 19th by Techplus Media. This disruptive innovation combines the best of Health & IT domains and provides underserved populations with access to quality, affordable healthcare thereby playing a critical role in contributing to healthy, vibrant communities and spurring economic growth. The Visitor’s Choice Award was awarded to Polmon Instruments Pvt Ltd to for the launch of innovative MP98 Automated Melting Point Apparatus. MP98 is a specifically designed apparatus that automatically identifies the melting points and melting ranges of three test samples simultaneously. With the advantage of the colour touch screen to display all melting operations, the apparatus can be independently operated without the need of an external PC or keyboard. The Jury’s Choice Award was given to Biopharmax Group Ltd for introducing the Biopharmax: The Next Generation of Pharmaceutical Pre-treatment Water Systems. The Pre-

treatment process ensures an environment friendly, clean, reliable and effective way of supplying chemical-free and hardness-reduced water for use as RO feed water, without the need of any additional treatment.

SRL Diagnostics introduces technique to diagnose alcoholic liver SRL Diagnostics, the leading diagnostic chain in India, for the first time has introduced a blood test to diagnose fibrosis in alcoholic liver. Introduced at a price of Rs. 3,900, this non –invasive test has high degree of accuracy in diagnosing liver damage due to alcohol. It is an innovative blood based test to diagnose the stage of damage to liver due to alcohol consumption. Alcoholic liver disease is the most common cause of liver damage in India. In this test, few milliliters of blood are collected and multiple tests are performed on the same. The results of the tests are fed into a mathematical algorithm, which gives out the stage of liver damage. According to the World Health Organization, 4.5 per cent of Indian men and 0.6 per cent of Indian women aged 15 years or more suffer from alcohol use disorders. Also, 395 men and 196 women out of every million population in India die of liver cirrhosis every year. According to estimates by SRL, alcoholic Liver Disease is a spectrum of disorders starting with fatty liver, which progresses to hepatitis and if alcohol consumption is unabated, it progresses to cirrhosis in 20 per cent of cases. Approximately, two-thirds of such deaths amongst men and one-thirds amongst women are attributable to alcohol related diseases. Such a blood based test would be available through the vast network of SRL Laboratories and could prove to be of great value in assessing liver damage due to chronic alcohol consumption.

The Paediatric Network Partners With Josh Software To Create A Collaborative Platform in the Paediatric Eco-system Dr Atish Laddad, a prominent paediatrician in Maharashtra, joined hands with Ruby on Rails Experts, Josh Software, to create a solution for providing an end to end solution, not only for the paediatricians, but also for the parents and their children. The Paediatrics Network, a brainchild of Dr. Laddad, simplifies and streamlines the process, makes it

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Pulse paperless and reduces the time of consultation significantly. This solution allows automation of prescriptions, patients’ historical records, appointments,vaccination records and capturing child’s milestones. This information gets stored on cloud and can be accessed from anywhere and anytime by both doctors and parents. It allows login for doctors, nurses, receptionists and parents. Josh Software developed The Paediatric Network using Rails APIs and Angular framework. They have also created a mobile application for The Paediatric Network, which will enable parents to access the portal while on the go and take a confirmed appointment with the regular paediatrician in less than a minute. The mobile application has been developed in ionic framework and work on both Android and iOS platform. It helps in bridging the gap between parents, their kids and paediatricians. By enrolling into TPN, a child will be more closely monitored by medical professionals. This program will help parents, especially working parents, to be at ease as challenges in the changing health patterns of their kid will be observed at initial stages and necessary actions can be taken well in time. The solution was opened to beta users in July 2016, and currently, a total of 12 paediatricians have registered on the platform and are providing their services to the parents. There has been great interest from the entire community for this platform, and the adoption looks to increase exponentially in the coming months.

This has resulted in saving of around INR 130 millions out of pocket expenditure to the patients which translates into an average discount of 69% on MRP. The Government is planning to open 300 new outlets in the country. The project has been floated in a tie-up with government-owned HLL Lifecare Ltd (HLL) which is mandated to establish and run the AMRIT chain of pharmacies across the country. HLL has informed that the value of drugs dispensed (till 30th May) from seven outlets is around INR 70 millions while the MRP for the same was INR 200 millions.

Indian Government launches patients’ feedback initiative ‘MeraAspataal’ Union minister of health and family welfare launched the “MeraAspataal “ initiative at the third National Summit on Good and Replicable Practices and Innovations in public health facilities at Tirupati, Andhra Pradesh. The initiative is an ICT-based Patient Satisfaction System (PSS) named “MeraAspataal / My Hospital” for implementation in public and empanelled private hospitals and is envisaged to empower the patient by seeking his / her views on quality of experience in a public healthcare facility. A multi-channel approach will be used to collect patients’ feedback i.e. web portal, mobile application, Short Message Service (SMS), Interactive Voice Response System (IVRS).

3M India, CII Young Innovators Challenge Award AMRIT will reduce the burden of out-of-pocket 2016 expenses on patients in India • Microbutor developed by Ganesh Bhere of Institute of With the aim to reduce the expenditure incurred by common patients on treatment of cancer and heart diseases, the Union Minister for Health & Family Welfare, Shri J P Nadda inaugurated the Affordable Medicines and Reliable Implants for Treatment (AMRIT) outlet at Safdarjung Hospital in Delhi. The AMRIT retail outlets will sell drugs at highly discounted rates. These outlets have a very comprehensive list of medicines that are available across range of products. Nine AMRIT Pharmacies have been set up and Safdarjung Hospital is the 10th of this kind. More than 195 drugs for treatment of Cancer and 186 drugs for treatment of Cardiovascular Diseases are being sold through AMRIT with a discount of more than 90% are available to patients. More than 1.77 lakhs patients have been benefitted till date.

Chemical Technology, Mumbai along with Ashwini Gaikwad of S.S Jondhale College of Engineering, Dombivali and Ashwin Pawade of IIT, Bombay is electricity free, handy and low cost equipment which can be easily used to detect microbial contamination of water. They were the winners in the technical category. • The runner up under the technical category was for SamaySancharak, Braille enabled wearable wrist watch and cellphone for blind people. The device was developed by Rohit Bharat kumar Singh of Thakur Institute of Management Studies & Research along with Hitarth Narsi Patel of K.J. Somaiya College of Engineering & Tanmay Vinay Shinde of Rochester Institute of Technology (RIT). The innovation displayed the integration of mobile phones with wearable watch design that can act as an interface for the blind to

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Pulse manage their calls and texts effectively. • In the Social Category, the winner was ‘Saathi’, the first fully biodegradable and ecofriendly sanitary pads made from waste banana tree fiber for women across India.

Cochlear launches first off-the-ear hearing deviceKANSO Cochlear Limited, the world leader in implantable hearing solutions, released its newest innovation – Kanso. It is a sound processor combining the most advanced sound processing technology with a discreet design. Kanso is the smallest and lightest off-the-ear sound processor in the market providing the wearer with both discretion as well as enhanced comfort. The new technology is simple, discreet and smart as it has the ability to automatically adjust to different hearing environments providing a seamless experience from visiting a restaurant, to going to the movies. Kanso includes state-of-the-art Cochlear True Wireless technology, which helps people use the phone, hear over distance and in noisy situations. The True Wireless range of accessories allows the wearer to stream conversation, phone calls, music and television programs directly to their sound processor. It has dual microphones, SmartSoundiQ with SCAN and True Wireless technology which all enable the wearer to hear better in difficult listening situations. Kanso provides wearers with best-in-class hearing performance in the real world. In Kanso clinical trials, 88% of people rated their overall hearing performance with Kanso to be the same or better than with their behind-the-ear sound processor. Most hearing impaired participants rated Kanso better than their own behind-the-ear sound processor on measures of comfort, look and feel and ease of use, with 93% of users rating listening to music with Kanso to be the same or better as with their behind-the-ear processor.

Dr. Reddy’s announces Purple Health, a unique patient-centric platform that takes care beyond the pill Dr. Reddy’s Laboratories Ltd announced the launch of Purple Health, a unique platform designed to inspire patient-centric innovation and deliver solutions that address unmet needs

of patients. Built around four pillars of awareness, access, adherence and experience of therapy for patients, Purple Health is another affirmative step forward by Dr. Reddy’s to institutionalize patient-centricity across theorganization, stemming from its core belief ‘Good Heath Can’t Wait’. As the first major initiative under Purple Health, the company launched a new range of innovative, patient-centric packaging that aims to enhance the therapy experience for over 20 million patients each year. The entire packaging initiative spanned a period of 24 months from research to concept development to implementation. Starting with the India market, the new packaging will be rolled-out in phased manner over the next six months for 25 of its focus brands. Dr. Reddy’s identified medicine packaging as underserved area to innovate, as it has traditionally been designed only to meet technical and regulatory requirements, with little to ensure patient convenience. The Company partnered with global design and innovation consulting firm IDEO, and applied ‘Human-Centred Design’ approach to finding solutions during the design phase of the project. The team met a cross-section of patients, doctors and pharmacists across the country, conducting in-depth interviews and observational studies to understand patient’s needs. Based on the insights, the company redesigned its blister packs and syrup bottles to address the pain-points. As a part of Purple Health, the company has also commenced a structured mechanism to assess its brand offerings on delivering care beyond the pill. Based on assessments by an eminent external jury, five of its brands have been certified as “Purple Star” brands for their patient centricity innovations. The five brands cater to needs of patients across various disease areas ranging from diarrhoea to oncology, with the assessment process underway for its other brands.

INNOVATIONS ABROAD TALKSPACE is an online mental health counseling service which brings a fresh sense of professionalism to the field, with a systematic approach customized to user needs and has over 300 licensed therapists in its network. New users can take a free assessment and work with Talkspace to get matched to the right provider, starting a long-term mental health journey on the right foot. How it’s changing healthcare: The people who can most benefit from talk therapy have often found it hardest to

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Pulse come by due to financial difficulties, geographic isolation, and other factors. Talkspace has the potential to change all that, especially after a $9.5M funding round in 2015.

Captain T Cell: Start-up from the MDC wins OneStart competition in London For the first time, a German team has won the world’s biggest life-science start-up competition. Captain T Cell, founded by Dr. Felix and several colleagues at the Max Delbrück Center for Molecular Medicine (MDC), beat 400 international startups to win prize money totalling GBP 100,000. The team will use the funds to further develop their innovative approach to cancer immunotherapy. Their goal is to create a platform for the production of personalized, cancer-specific T cell receptors. With the help of these receptors, the body’s own T cells, so called ‘killer cells’, are able to find and specifically

destroy cancer cells in the patient’s body. Captain T Cell is supported by the MDC’s own Technology Transfer Office and by the SPARK Berlin program -- a mentoring network from the Berlin Institute of Health (BIH) and the Stiftung Charité that promotes application-oriented projects in biomedicine both financially and through consultation and training programs.

Inbrace An orthodontics company, InBrace won the Americas stream for the first time. InBrace is the first truly frictionless, self-contained, self-activating, and self-limiting orthodontic device delivering treatment that is faster, more comfortable, and more effective while requiring fewer and quicker appointments.

Felicitating the erstwhile Estonian Ambassador to India. Ambassador has the copy of Dr Singh's book, Innovations in Healthcare Management.

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Interaction with Readers "Thank you for forwarding the soft copy of the first issue of InnoHealth magazine. At the outset, I compliment the Editorial Team and Article Contributors of the magazine for a well-projected publication. It undoubtedly conveys an interesting insight of Innovative and "Indovative" thought-processes. The articles aptly projects the various issues in brief in the healthcare sector on the g lobal perspective. Some or all ideas could be emulated for adaptation in the Indian healthcare scenario for enhancement of our own existing healthcare systems by use of appropriate digi-tech. Accessibility and Adaptability in the healthcare systems, as correctly projected by all has to be looked into. Theory versus practical applications on ground is mandatory for any system to be sustainable and replicable, especially the PPP models in the various States in India, which could be delved into in the future Issues of InnoHealth. With my best wishes and warm regards" Dr.Rajesh Bhalla, Atlanta, USA "Just finished reading the first issue of the magazine. It is a very high quality trade journal. Congratulations!" Dr. Shiban Ganju, Founder, Save A Mother, Chicago, USA "It looks very good. Many many congratulations to you and your team." LORD CRISP Nigel, UK, Europe "Thanks for sharing this and congratulations to you and whole team of InnovatioCuris for growing day by day . Will circulate in our network and do the needful." Dr Sandeep Bhalla, PHFI, India "My heartiest congratulations to InnovatioCuris (IC) for bringing out the excellent magazine â&#x20AC;&#x153;INNOHEALTHâ&#x20AC;?. The magazine color, size, paper material is excellent. The magazine topics covered are of good quantitative and qualitative work. The magazine is serving us a very good knowledge regarding in Healthcare, Importance of IT solutions, Health Communication, Innovation in Health, Right Digital Transformation etc. The magazine is also covering the topics related to innovative ideas. It is also sharing good platform to outdistance the knowledge regarding best practices of developed & emerging economies from across the globe. This magazine is coming up as International sharing platform knowledge to all of us. The InnovatioCuris (IC) team has done an excellent & a very dedicated work. I wish all the best for its more & more success." Dr. Brijender Singh Dhillon, Senior Professor & Head, Pt. BDS PGIMS, Rohtak, Haryana, India "Congratulations for the First issue of InnoHealth magazine and it is one of the few best compilations on this topic. well articulated articles, much needed topics by thought leaders.I look forward reading next issues of magazine to understand more about global and Indian innovations to solve affordable and accessible health needs of our country." Chitra, Trustee , Health and Environment Safety Workforce, India

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Interaction with Readers "I take this opportunity to thank you for launching InnovatioCuris (IC) platform for healthcare innovations and introduce myself. I am a biomedical scientist working in the area of 'Botanical Therapeutics' for over 20 years here in India and USA. My wife and I while working at the Harvard Medical School, Boston in early 1990s thought how healthcare could be managed in rest of the world through modern medicine when it is collapsing in US as it has become un-affordable due to over reliance on technology, adverse drug reactions and non availability of safe and effective drugs to manage chronic diseases responsible for more than 60% mortality. At that point in time, we chose to return to India to engage in drug discovery on natural products i.e. plants and milk. Fortunately, we could develop US patented herbal formulation for safe and effective treatment of majority of the chronic inflammatory diseases including Asthma and other allergic disorders, Arthritis, Diabetes, Migraine, Psoriasis, cardiovascular and neurological disorders of inflammatory nature. Similarly, we could develop some other products for infectious conditions from herbs and milk. The products have been extensively studied for their clinical effectiveness as well for understanding their mechanism of action at Harvard laboratories. WHO defines health as a state of physical, mental, social and spiritual well being. It may be difficult to achieve this through modern Medicine alone and it is important that 'Integrative Medicine' programs are put in placed and promoted. This awakening is coming with speed in USA as such programs are now on offering at best of the medical schools in USA. It is time that this understanding also prevails in India without loosing any more time - as alternate systems (Ayush etc) alone may not be sufficient to address the situation. What we experienced in 1990s and subsequently with US healthcare system has not improved rather has become more complex. I feel that a shift to Integrate the modern with scientifically validated traditional systems will go long way to solve this crisis in healthcare." Ashok Kumar, Ph.D., Director, SK Biotherapeutics Pvt. Ltd., India (Former Vice Chancellor, AKS University, Satna, M.P. & Visiting Professor, Harvard Medical School, Boston, USA.)

We will like to have your suggestions/feedback for the magazine. Please write to magazine@innovatiocuris.com mentioning the issue number.

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Guidelines to Authors Guidelines for Contributors of InnoHEALTH InnoHEALTH magazine covers wide range of topics on Innovations in healthcare to reduce cost of healthcare delivery yet keeping the best quality of care. The magazine is published quarterly in the months of January, April, July and October every year in the print and digital form. The digital version would be sent to 25,000 health professionals worldwide as part of our community. The magazine is complimentary till we decide otherwise. We would publish articles to share an idea of innovation in devices, drugs, biotech, pharma, healthcare IT, Hospital design, management process and policy innovation. Mission is to share best global practices with each other to emulate. We are looking following when evaluating an article: a) You donâ&#x20AC;&#x2122;t have to be well known to be a contributor, but you must know a lot about the subject youâ&#x20AC;&#x2122;re writing about. You need to prove to your readers that it is backed by references/adequate graphs/drawings etc, b) It has to be original write up and not published elsewhere and you would be answerable if somebody challenges your work for plagiarism. If you can explain the thought process so that the reader understands how to apply the innovation in a real situation. It should be replicable and scalable to make it more powerful c) Article that are persuasive and pleasure to read. General Information We may not be able to publish all articles not because of quality but it does not fit theme of the magazine. You may be asked to do multiple rounds of revisions. We may rewrite your title on our advice to suit article contents and making it attractive for readers. We would need a one-two line summary of the article, a two-line bio of the author and a high-resolution headshot of the author along with the article. Once, our team edits the article, it will be sent back to you for the final approval before it is published. The pictures if any in the article should also be separately emailed in high resolution. We seek articles round the year. However, the issue in which they will be published might depend on the theme of the issue and the quarter in which they were sent to. The call for articles will be made to the contributors 3 months in advance with a one-month window to submit the articles. You may write work done by your organisation but do not write as promotional piece. InnovatioCuris (IC) which bringing this magazine holds copyright on the articles, but authors continue to own the underlying ideas in their articles. Please illustrate your points with real-world examples. Please send your article to magazine@innovatiocuris.com Thanks for considering InnoHEALTH for publication.

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Building on the success of InnoHEALTH 2016 we announce

Celebrating Innovation Week from 18th - 22nd September 2017, New Delhi & Bengaluru Organised by • 18th - 19th September, New Delhi : Conference , Innovator’s award and B2B meeting. • 20th September, New Delhi : Thought Leaders’ Forum and IC Innovator’s Club meet. • 21st - 22nd September : Visit to Bengaluru We invite proposals for partnership & collaboration. Write to us at: conference@innovatiocuris.com Industry Partners:

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FINDING METHODS, TOOLS AND TECHNIQUES TO DELIVER QUALITATIVE HEALTHCARE AT OPTIMUM COST AT ALL LEVELS.

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