Category Archives: HealthCare

Personal Health Monitoring

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The hottest segment in Healthcare is proactive Health management. There are quite a few companies and startup’s focusing on providing required platform for us to begin.

Identify what you wish to track
It is very easy to be lost in identifying what you wish to track. Start with a complete Health check, identify what aspects you would need to monitor and start there. If you know you are in general Healthy, then start by monitoring your daily walking, calories burnt and exercise regime etc.

Start by setting goals – I will walk 10K steps a day or I will reduce my Carbohydrate in-take or reduce alcohol etc. Start with anything which can help you feel better and healthier.

Find the right applications/apps
Today, there are quite a few applications which can help you monitor your goals. Research on what practically suits your need and start recording using them. These motivate you and help you understand your lifestyle pattern.

Periodic evaluations of your recordings
What do you with all the recordings? At the moment, there are only few intelligent applications which integrate with your monitoring apps and help you suggest what you will need to do to achieve your goals. Also, they help you understand what you can do better.

Today, it is a stage of acceptance for the Health monitoring apps. All things you do (monitoring steps, calories burnt, food intake, workout regime etc) are mainly for you to understand how your life style has been. However, companies are partnering to share this data and Hospitals are just beginning to see your historical data to understand what your lifestyle has been.

The future of Healthcare will increasingly see more acceptance of personal Health monitoring and there by providing you guidance. Also, the day is not far when Healthcare Insurance will start using the data before they offer you better policies.

I recommend that you start today.

Utilizing Aadhar for Healthcare Delivery

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India launched the prestigious Unique Identification Project (Aadhar) on the 28th of January 2009. After 7 years, around 95,00,00,000 have Aadhar Card. Even though having Aadhar is not mandatory, Government has been increasingly launching initiatives which are linked to the Aadhar Card and hence the number of signup’s have been increasing.

How can we use Aadhar Card to improve Healthcare?

To begin with, tracking Health records. India’s Healthcare system is a three tier architecture – Primary Health Center (PHC), Secondary Care and Tertiary Care. The PHC is the first point of care for the Government and according to the design, there should be 1 PHC for every 5,000 population in the rural areas and 1 PHC for every 10,000 population in the urban center.

With the Aadhar number, personal health records can be created for every individual at the PHC level. In the urban areas, Aadhar number can be utilized to register individuals at Private hospitals/clinics or at the PHC. Alternatively, we can have a centralized website which can create Health records for Individuals and they can signup using their Aadhar Number.

When there is a birth, before issuing the Birth Certificate, a Medical record should be created and all the vaccination information should be pushed through electronically. Today, this is done manually through medical cards which carry important vaccination information for the child.

What are your thoughts?

Innovation in Healthcare – How India is thinking different?

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In an interview someone asked Dr. Devi Shetty, the Founder of Narayana Hrudayalaya (NH) as to why the Healthcare costs are increasing in India and he said “Over a decade ago, a heart surgery costed over Rs. 2 Lacs; and today it costs a little over half”.

Over the last decade, the Healthcare landscape in India is considerably changing. Healthcare is reaching to more people than before and many are benefitting with the new and innovative models Healthcare organizations are adapting.

One of the innovative models Healthcare organizations are adapting is the Hub and Spoke model. In this model, the central facility is situated in the urban area with all the specialists available. The Spokes are the smaller centers which are situated in smaller towns with connectivity to the Hub.

With this model, Specialist Hospitals are able to provide quality Healthcare to a larger population.

This one illustrates how India is innovating in its Healthcare reach. There are numerous data points which illustrate how India is behind in Doctor to Patient ratio, Number of beds to population, shortfall in the number of nursing staff etc. We are behind in most of the WHO metrics when compared to the United States and even with China.

Even though traditional methods are helping, reaching the over Billion population in the country needs different thinking.

Hospitals are increasing their reach and this does not mean we are compromising on the quality of the outcomes.

To add to these innovative models, startup’s in Healthcare are helping to bridge the gap even further. Over the last two years, there are more than 200 startup’s which have been addressing this problem. More than $500 million has gone into funding these startups. What also gains our attention is that these startups are not only focusing on care, but also building systems which connect anyone with a smartphone to the best of the care.

Solving the Healthcare maze

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When India got Independence in 1947, average life expectancy was 47 Years and today, average life expectancy is at 66.21 Years (we rank 139). Japan leads the list with average life expectancy at 84 Years followed by Spain, Andorra, Australia, Switzerland, Italy, Singapore and San Mario at 83 Years. The country with the least life expectancy is Sierra Leone at 49 Years.

Previously, technological solutions in Healthcare have been focusing on advancing the care (how to provide better solutions), but now, we are focusing on advancing the care process (how to deliver better solutions).

In the Indian context, Tech startup’s focusing on Healthcare have increased over the last few years. This is good and it will help bring Healthcare to the fingertips.

Most of the startups are focusing on providing “services”, meaning, connecting the consumer to the service. Apps for finding Doctors, finding Services available, e-Commerce, Wellness etc. This is a good approach. All of us have an inherent fear for Health. We are over cautious and we generally tend to avoid visiting the Doctor/Hospital and also at times go with self-medication. The technology today is focusing on providing introductions to the end user to managing Health proactively. With the advent of apps for monitoring nutrition, work out’s, doctor appointments, enrollments into wellness programs, the common person is now getting to understand how to manage and monitor his/her health.

Also, with Health programs getting advertised, many who did not have an understanding of various health scenarios are now getting educated. If you are someone who is born after 1990’s, chances are that your parents are maintaining your health record with all the vaccinations were given and the history of your well-being.

Biggest health problems cannot be solved in one day and the approach is painstaking. Governments should focus on building the infrastructure and organisations (startups and the big one’s alike) should help support the initiatives by connecting people with the care providers.

There is no short-cut’s especially in managing Health of individuals and the nation alike. Connecting the dot’s proves pivotal in creating a healthy nation.

In the next decade, I am sure India would be in a much better place in creating a healthy environment for all of us. With initiatives like the Aadhar (UID) slowly gaining popularity, am sure solutions would stem out connecting people to Government (to prioritise their health initiatives), Insurance firms coming forward to provide better Insurance assistance and Hospital’s connecting to communities to provide better proactive care.

Personally, I think we should look at various models across the globe and adapt what worked well into the new system we are creating. India being the world’s second most populated country, if we create a system which works, then the entire landscape of Healthcare in the world would change.

Landscape of Wellness

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Wellness has gained attention in the last few years. With proactive health care management gaining attention, fitness centers, food monitoring apps and health management centre’s have gained a lot of attention.

It is estimated that the Wellness industry is a $3 Billion Market in India.

What is the landscape of the Wellness? Even though the definition is broad, primarily the industry revolves around Weight loss, Nutrition Management, Workout monitoring and sports. Home care and post operative care is also becoming part of Wellness.

The concept of wellness has gained importance in today’s context when people are looking for ways to maintain health and being proactive to managing their wellness. Organisations are adapting to provide proactive wellness management facilitates to their workforce to ensure the productivity levels increase.

Is wellness new? Didn’t we need it earlier? We needed them. With the changes in globalisation, changes in the work style, travels and the basic living, being proactive to manage health not only requires effort but a little of education too.

There are various kinds of medicine systems and understanding and utilising them to better our health would be very good. How do we get there? Startup’s are focusing to bridge the gap. In India, Ayurveda, Unani, Homeopathy are various kinds of medicine systems and today, we have technology helping people utilise the benefits of all the systems. Recently, I met a founder of a startup who is focusing on bringing a collaborative approach to proactive health management. They understand the persons medicine history and help connect them to a combination of medicine formats through their doctors and also help the person monitor their progress through their technology offering.

This is a very good start and with the growing awareness, the concept of wellness is moving upward from just sports tracking apps to health management apps.

Health Apps in India

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Over the last few months, I have been working on curating information on Startup’s in HealthCare.

There are many applications/app’s which are being worked on to bring HealthCare to fingertips of consumers. With my observations on around 100 Startups in HealthCare IT, I started to categorise them into three sections.

Lifestyle Apps
These apps focus on monitoring your Steps, Calories burnt, Floors walked, Heart Beat Rate, Sleep Quality, Food in-take, Weight monitoring etc.

The benefits of these apps is that they show you what your lifestyle has been. Using lifestyle apps in India is completely based on self-motivation. Few organisations are motivating their workforce to use these apps and providing small benefits for reaching their goals.

The absolute connection between living a healthy lifestyle and being healthy are yet to be established. In the US, for example, employers motivate their workforce to use Fitbit or Garmin step counter devices for themselves and their family. Based on the activity employees are given discount on their Insurance payments. In India, this might take time to come, but with the speed at which things are changing, I foresee this happening in the next 2-3 years.

Why use these services?
Using these services and tracking Food in-take, steps taken each day at least provides information on how your lifestyle has been. According to the walking site, a sedentary person walks about 3,000 steps a day. In the 1960’s, in Japan, they had a 10,000 steps counter. Why 10,000? Well, at least we know it is an activity which takes effort and walking definitely helps you be more healthier. Probably, this 10,000 steps came from the 10,000 Hour Rule.

Care Apps – Apps Providing Care
Look at apps like myLabYogi, DoctorC, CyberLiver, Achiralabs etc. These are focusing on providing care at home like Blood Collections, Monitoring Liver Health, Medical Diagnostics at Home etc.

Why use these services?
Predominantly, these services are for elders at home and others who are busy and cannot afford to go to a Diagnostic lab just to give the sample and collect reports. Also, instead of going to a Hospital/Clinic, today you can book an appointment with the Doctor and go at your specific time-slot which saves you time too.

Service Apps – e-Commerce, Booking appointments etc.
Practo, Zipnosis, Surgical are few of the best examples of Service oriented Apps. You can book doctor appointments, consult with other Doctors etc.

Why use these services?
There is a surge in requests for Doctor Appointments, collecting samples from home, second Doctor reference etc. Apps/Services in this category are beginning to streamline Health service requests. Even though these services are currently being used in select cities, they are fast penetrating into the complete country. Over a period of time, we see that if not all, most of the Doctor community will be online and services will start to get better. Since we do not have a central medical system (like the NHS in UK), these apps can bring about the change in reaching out to Doctors and how we start looking at improving care.

PS: I might change the categorisations if required and would go deeper into each categorisation over the next few weeks. If you are interested in getting a complete report on Companies working on various Health related applications, subscribe to my HealthCare Technology Report.

Considerations for #healthtech Startup

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We see that on an average, there are at least 10 new startup’s every month across the country trying to address Health Care IT Problems. Are we really solving or are we complicating things?

According to IMS Institute for Health Care Informatics and Health Care IT News, there are more than 165,000 Health-related apps available and a mere 36 of them have 50% or more downloads. Just 10% can connect to a device or sensor and 2% can sync into providers systems (US App’s).

In the Indian Health Care app scenario; there are around 100 Apps and Websites which are addressing the Health Care segment (My personal research) and quite a few are coming up. Out of these 100, around 40% are catering to search (Doctor, Hospital, Diagnostic Center etc.), 22% are in the Wellness segment, 10% in e-Commerce (Medicine delivery), and the others are distributed in Nutrition, EMR/EHR, Medical Devices, Personal Health Management, Chronic Disease Management, Doctors Networking, Analytics etc.

If you look at the big picture and identify sectors in Healthcare which startup’s are trying to solve, majority of the solutions are coming out in Doctor Search, Booking online appointments, Home Tests and Medicine Home Delivery etc. One concern I personally see is that these solutions are being focused on particular region and this poses challenges for scalability. In India, where we have diversified Health Care models it is very important to understand the scalability, adaptability and acceptability for the solutions which we design.

The other vulnerable area specifically in Medicine delivery is that the control, distinction and distribution of duplicate / fake medications.

There are certain key contributing factors for Startup’s and large organisations alike to bare in mind while defining the problem and designing the solutions.

The Big Picture – It is very important for aspiring entrepreneurs who are attempting to solve Healthcare problems to understand the big picture as to how the system is structured and how can we take this solution to the maximum consumers. Also, one should understand if the solution which is being designed will scale up to address the problem at the Nation’s level and will it contribute to uplift Healthcare delivery. Why is this important? Because scattered solutions do not help.

Workflow oriented – When we design Technology solutions for addressing Health Care IT, the most important aspect we should understand is to create solutions based on the Health Care delivery workflows. Even though you design the best solution, if it is not following the delivery workflow, you are loosing consumers.

Scalability – The next important consideration. Why? Health Care IT is not a problem for a specific city / district / state. It is the Nation’s need. Diversifying solutions for each geographical location is not a viable solution. If not today, at a later stage we will need to codify and bring solutions to a common platform.

Adaptability – How are consumers adapting to the solution? India is a culture rich economy where we trust more from family, friends and acquaintances while attempting to utilise HealthCare services. How are we as Entrepreneurs attempting to address this scenario in the tools we build? Today, everyone is using technology to get suggestions and help for their requirements, but do not completely go with the solution they find, but definitely ask others around if it is a viable approach. We need to understand the adaptability of the solutions we design and this comes with additional research on what key areas are people likely to gain deeper understanding before attempting to utilise the services.

Contextual – (Will this solution help better the situation) – This goes next to understanding the big picture. The solution we design should be contextual and if required work in tandem with existing solutions to address the scalability and adaptability.

Data Security – Very important aspect of building Health apps. We need to builds systems/applications following he Data security rules because Health data is very vulnerable and it is the responsibility of the Entrepreneur to ensure security.

To quantify, Entrepreneurs wanting to address HealthCare IT, should begin with the end in mind, understand the System and help develop workflow solutions which contribute to the Macro level.

Which HealthCare System should India follow? 

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India is a very interesting, unique economy in this world and there are many reasons for that. We are the country with the highest “working population”, we are a country with various traditional medical practices (which prove to work), we are a country with considerable number of people Below Poverty Line, we are a country, where in the last two decades have seen changes in our lives, livelihood, migrations and better quality of life.
With this, even the HealthCare landscape in India is changing. The model we follow is the “Out of Pocket Model”. Even though the Government has a very good spread for reaching each person in the Country, due to various factors, this does not work as expected. Private players are increasing and Technology is playing a bigger role in bridging the HealthCare needs to the common man.
Let us quickly examine the 4 HealthCare models on this Planet:
The Beveridge Model
This model is named after William Beveridge, the man who designed and developed the Britain’s NHS (National Health Services).
In this model, the complete Health Services are funded by the Government from the tax’s collected from public. The best example of complete Beveridge Model adoption is Cuba.
The Bismarck Model
This model is named after Prussian Chancellor Otto von Bismarck. This is an Insurance Model where employers and employees pay for Health Insurance through their payrolls. The Government holds a very strong control on the payout’s and hence the HealthCare costs are controlled. This is a pure “not-for-profit” model and this is the reason even though there are private Health Services, the costs do not go up.
This model is followed in Germany (where there are more than 200 funds which contribute to HealthCare services) and other European countries including Japan and Latin America.
The National Health Insurance Model
This is a combination of Beveridge and Bismarck models. This model uses private providers but funding comes from the Government’s Insurance Programs to which people contribute to. Since payments are controlled by Government, there are no denials/exploitations in the costs and services.
Best example for NHI Model is Canada.
 
The Out of Pocket Model
About 25% of countries in this world have an established HealthCare Systems are the remaining are Out of Pocket Models.
This is a straight forward model where you pay for the services utilised (Minimal/free in Government Hospitals and completely paid for in Private Hospitals).
Is it time we follow a model / combination of models / Create a Model for ourselves? 

How to build India’s HealthCare System?

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India is always compared to US, a nation which has established it’s 300 Years of Independence and quite a few times, the policies are compared and contrasted with the US. I personally feel we should not do this comparison and focus on how to build Innovative solutions to address the needs of a country like India.
India is 4 times more in population when compared to the US and we are an economy which has been struggling to establish itself in the 65 Years of Independence. I do not wish to go into history, but just a point of reference when in 1800’s, India was one of the richest land’s in the world and hence we have been invaded by quite a few people and finally ruled until 1947. There was a lot of damage done and we should take responsibility for it.
What is over is over and today, we are a nation of proud accomplishments. From the recent Mission to Mars to the complete eradication of Polio, it is not an easy task when a country has such a varied distribution of population and practices of many native medicine.
In India, the Union Government is responsible for allocating Budget for Health Services. This money is distributed to the State Government’s considering various parameters and the State Government’s are responsible for delivering Health Services to the common man.
If we go deeper into understanding how the HealthCare is structured in India, the Primary HealthCare Centre is the first point of contact for any of its 1.2 Billion Population. A PHC serves to a population of anywhere between 1,500 – 5000 people. For more information on the exact numbers and categorisation, please refer to my earlier blog post on HealthCare Infrastructure in India and my other posts under HealthCare in India category.
Today, the need of the hour is for us to push for some strong amendments to the HealthCare Law in India. Here are few of my thoughts on how we can work on building the foundations for a stronger HealthCare system in India.
1. On-line or Centralised Drug Database – This might look naive, however, this plays a very crucial role in building up a strong Health Delivery System. For technology to play a bigger role in building up India’s Health System, having a central Drug database is a must and the first step.
2. Fee Regulations for Private HealthCare – We hear the economic distribution of Private Vs. Public Health in almost all the case studies on HealthCare in India. 70% is still out of pocket. We need to have a law to regulate the cost of basic Health Services across the country. For example, for a first / basic consultation, the Doctor fee or the Hospital charge should be same across the country. This will help in more people approaching bigger/better facilities to ensure they receive the best consultation and there is no competition among Hospitals or for Doctors. My argument here is that the first point of contact for any consultation should be regulated.
3. Common Health Practices across the nation – We do not have a strong law in the country where the Hospital Workflow’s remain constant. Each hospital has it’s own rule and patients are bound to abide by them. If I need to fight out, i should take time out to go to the Court. We need to establish common rules of how Hospitals treat patients and the rights patients have to access their Health data.
4. Common Registration System – Each Hospital has their own rule of how they treat the Patient registration System. This has to be regulated to ensure the basic Patient demographic data is always constant and can be carried by the individual. Use of Adhaar like system to enforce this is very practical and brings ease of managing this aspect.
Last but not the least, we should encourage initiatives which bring in a stronger Health Law.

Does India Need an EMR?

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When we look at understanding how we can address the major gaps in providing Quality HealthCare, the one point which comes to mind is why we are not utilizing the power of Technology to bridge this gap.

Let me start with a story – Few years ago, I had to take my Dad to a Doctor for cough. We went to a Speciality Hospital near to a home (a Major Brand, do not want to use the name here though). This hospital had two facilities in the City. When we went there, the first thing which happened in the Registration. A Plastic Card (dimensions of a Credit Card) was printed with a picture and basic details – DOB, MRN and Place of Issue were printed.

After the initial check up, the Doctor wanted a test to be done which was not available in this facility and hence we were requested to go to the other one. After going there, I provided the card to bring out the details of the test ordered. The front office person informed me that they do not have connectivity with the other Branch and hence I had to pay the registration fees (Rs.100) and post that, looking at the Hard Copy of the Prescription, entered the details. Then I had to go to another Doctor (since the consolidated list of Doctors in the Hospital is not available and the prescription had to be cross checked) to re-confirm the test and then we proceeded for the test.

This hospital has made major investments in using Technology in their Hospitals. Staff are trained and the charges of this Hospital is also definitely not nominal.

What does this story illustrate? A simple aspect of integrating two facilities has not been taken seriously. Why? Is it because they lack the technological infrastructure? Or, is it because they can make more money (Double registration fees)? Or, is it unwillingness to invest further on the technology required to integrate? There are many questions which arise, however, for me, it is just the fact of lack of “Ownership” from the management side.

In a country like India where the demographics play an important role, there are many multi-national Hospital Chain’s and single facilities which have setup shop across the country over the last decade and continue to do so with huge investments coming up in the next decade.

The Government, with due respects has its own, things to do and hence am not even considering the fact that they should take ownership to force Hospitals to implement any automation to their care facilities.

With the vastness of the Country dynamics and considering the fact that the system works in a silo, is it easy to consider implementing basic EMR across all Hospitals and Clinics across the country? I do not think so.

Even though technology has become affordable, the socio-economic factors like affordability of Care facilities with-in a 10 KM radius across the country makes it difficult to even imagine implementing EMR across the country.

Continued – Part 2