According to a report by the Centre for Science and Environment, India has witnessed some form of natural disaster almost every day in just nine months for the year 2022. These disasters have claimed 2,755 lives, affected 1.8 million hectares of crop area, destroyed over 416,667 houses, and killed close to 70,000 livestock. This surely shows that there is a huge gap when it comes to building a resilient strategy and response system that can cater to such emergencies nation-wide in a more effective manner. More such consultative workshops followed by some real actions being taken, can accelerate not only the idea of such a model but even its implementation on the ground. This can even provide more opportunities for the Startups.

Highlighting that India’s disaster management model has potential to go beyond the standard operating procedures (SOPs) to be flexible and agile to deal with exigencies on the ground, Dr Mansukh Mandaviya, Union Minister for Health and Family Welfare said, “Being a vast country with diverse terrains and geographies, India can have its own model for disaster or emergency response which can be emulated by other countries. 

Addressing the consultative workshop on the National Emergency Medical Team (NEMT) India, Mandaviya said, “While it is important to learn from global best practises and follow SOPs, let us learn from the national examples of emergency and disaster response in the past few decades and enrich our model from learning and insights from these.” “Multi-sectoral and multilayered learning need to be incorporated in the training and capacity building modules of the national architecture of emergency response and management,” he added. 

The Government of India (GoI) intends to bring together all stakeholders of the NEMT initiative for a two-day workshop to deliberate on the initiative’s policy, strategy, roles, and responsibilities, as well as to prepare a roadmap for integrating the country’s needs for disaster preparedness and aligning health needs during disaster situations in accordance with standard disaster response. 

Rajesh Bhushan, Union Health Secretary, also present at the workshop, stressed the importance of collaborative efforts among the “multiple building blocks in existence,” including the NDMA, NDRF, state agencies, emergency service providers, trauma centers, et cetera. Noting that these largely work presently in a fragmented state, he highlighted the crucial need for synergising efforts between them to ensure agility, rapid and effective response. 

The National Emergency Medical Team (NEMT) initiative aims to revamp the traditional responsive mode of healthcare manpower deployment in response to disasters and public health emergencies. Globally, it has been seen that EMTs, defined as a group of healthcare professionals providing direct clinical care to populations affected by outbreaks, need to be trained, standardised, and quality assured to give predictable on-ground support to disaster response. The two-day workshop will deliberate on four crucial aspects relevant to emergency medical teams, including system, staff, supplies, and structure. Health emergency prevention, preparedness, and responses form one of the priority areas under the G20 Health Track agenda. This is the first meeting soon after the G20 Health Working Group meeting in Thiruvananthapuram.

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With an objective of making quality generic medicines available at affordable prices to all, Pradhan Mantri Bhartiya Janaushadhi Pariyojana (PMBJP) was launched by the Department of Pharmaceuticals, Ministry of Chemicals & Fertilizers, Government of India in November, 2008. From Oct 31,2022 around 8819 Janaushadhi Kendras are functional across the country and cover over 1759 drugs and 280 surgical items. This scheme not only can provide a self-employment opportunity but also provide financial assistance to various groups of the society. 

The Centre has approved inviting online applications for opening new Jan Aushadhi Kendras (JAK) in 651 districts in different states/UTs. The proposal will be sent by the Pharmaceuticals and Medical Devices Bureau of India (PMBI), the implementing agency of Pradhan Mantri Bhartiya Janaushadhi Pariyojana (PMBJP). 

Under this scheme, there are already more than 9,000 JAKs functional across the country. The government has set a target to increase the number of Jan Aushadhi Kendras to 10,000 by March 2024. 

The product basket of PMBJP comprises 1,759 medicines and 280 surgical devices covering all major therapeutic groups. PMBJP was launched by the Department of Pharmaceuticals, Ministry of Chemicals & Fertilisers, in 2008 with an objective of making quality generic medicines available at affordable prices to all.

This scheme provides an opportunity of self-employment with sustainable and regular earnings. Under PMBJP, an incentive of Rs five lakhs is provided to every JAK as financial assistance and one-time additional incentive of Rs two lakhs (as reimbursement for IT and infra expenditure) is provided to each JAK opened in the Northeastern states, Himalayan areas, island territories and backward areas identified as aspirational districts by NITI Ayog, or if opened by women entrepreneurs, ex-servicemen, divyangs, SCs & STs.

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Sleep-deprived drivers remain responsible for about 40% of the road accidents, according to enforcement officers patrolling the highways and major roads here. According to a report by the Ministry of Road Transport and Highways Transport Research Wing, road accidents claimed 1,53,972 lives and harmed 3,84,448 people in 2021. And according to data from the World Road Statistics, 2020, mentioned in the report of the Ministry of Road Transport and Highways Transport Research Wing, India is 2nd among 207 nations in terms of the total number of accidents. The World Road Statistics, 2020 lists 207 countries, with India having the highest number of fatalities

To prevent this chronic fatigue and to maintain safety while driving, our government is augmenting  the technology known as “Drowsiness Alert System”. This will prove to be a boon for the people’s safety while driving especially during night time.

The government will soon set the standards for “Drowsiness Alert System” which can be installed in cars, buses and trucks to give audio alerts to drivers in case they fall asleep while behind the wheel. The standard for the on-board unit (OBU) will be technology agnostic, sources said. 

The drowsiness alert systems, currently used across several countries, use different techniques to detect the problem. While some systems detect this by monitoring the steering pattern, others monitor the vehicle position in lanes and by monitoring the driver’s eyes and face.

Drowsiness is far more deadly when the vehicles are moving at a high speed as the drivers rarely get time to react and apply the brakes. While the issue is well documented in developed countries such as the United States and United Kingdom in their road crash reports, there is no such data in India. 

However, a study by the road transport ministry of drivers across 15 states in 2018 had found that 25% of drivers surveyed had admitted to have fallen asleep behind the wheel while driving. Global studies have shown that the chances of drivers falling asleep is high when they are travelling on highways and rural roads, and more so between midnight and 6am. 

TOI has learnt that an expert committee has prepared a draft Automotive Industry Standard (AIS) for the drowsiness alert system, and it would soon be put in public domain for seeking feedback from stakeholders. Sources said the roll out of the provision and whether to make the installation of the alert system in certain categories of vehicles mandatory will be taken in due course. However, they indicated that installation of the devices are crucial in trucks, buses and cars.

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Healthcare should be within the reach of every citizen. For providing basic health facilities to all citizens, the government has introduced and implemented various health schemes and programmes. One such initiative that the AP government launched with this vision was the Kanti Velugu program. This program aims to provide universal eye care to five crore citizens of the state through various phases. The first phase of Kanti Velugu was conducted for eight months by 827 health teams. Post pandemic the central and even the state governments are now more committed to provide accessible and affordable healthcare to the people and such initiatives prove to be the feather in the cap and more and more states can take inspiration from it.

The second phase of the Kanti Velugu programme began across Telangana on Thursday, 19 Jan 2023. In all the 33 districts of the state, mass eye screening camps were officially inaugurated by ministers, MPs, MLAs, and other elected officials. Over the next 100 days, the camps would be held in every gramme panchayat and municipal ward to screen 1.5 crore people. Free medicines and spectacles will be distributed among the beneficiaries.

Health Minister T Harish Rao and Minister for Animal Husbandry T. Srinivas Yadav inaugurated a camp in the Ameerpet area of Hyderabad and distributed spectacles. Speaking on the occasion, Harish Rao said that the aim of the programme is to ensure a blindness-free Telangana. He said Kanti Velugu has become another role model for the rest of the country. Harish Rao stated that Telangana was ecstatic that chief ministers from other states had stepped forward to implement Kanti Velugu in their respective states.

Chief Minister K. Chandrasekhar Rao formally launched the second phase of the programme on Wednesday at the newly inaugurated Integrated District Collectorate Complex at Khammam, along with his counterparts, Pinarayi Vijayan from Kerala, Arvind Kejriwal from Delhi, and Bhagwant Singh Mann from Punjab.

Samajwadi Party chief Akhilesh Yadav, CPI national general secretary D. Raja, and other national leaders also attended the programme. Later, addressing the inaugural public meeting of Bharat Rashtra Samithi (BRS) at Khammam, the chief ministers of Kerala, Delhi, and Punjab lauded the programme and declared that they would implement it in their respective states. The Kanti Velugu camps will be held between 9 am and 4 pm five days a week, for the next 100 days.

A total of 1,500 medical teams have been constituted to conduct the camps. Around 1.5 crore people will be screened, and 55 lakh spectacles and medicines will be distributed. Chief Secretary Santhi Kumari has asked the district collectors to break the record created by the state during the first round of Kanti Velugu in 2018 by conducting more eye screening tests during this round

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‘SUPPORTING VALIDATION OF NEW TECHNOLOGIES IN CLINICAL ENVIRONMENT’

Dr. Vasanth Venugopal, Chief Medical Officer, Clinical Project Lead at CARPL.ai and  Radiologist Delhi, India was the guest speaker. Sachin Gaur, Director at InnovatioCuris, opened the session by explaining the importance of clinical validation in  building confidence among clinicians for accepting the new built technology.  Dr. Vasanth, a technology enthusiast, explained his transition from being a clinician to being an entrepreneur where he built  CARPL.ai, a company focused on AI in radiology. In the initial segment, he described the  primary role of  

1. AI in Healthcare 
2. Personalized Medicine 
3. Enhanced Medical Imaging (Advancements in deep learning and convolutional neural network). 

He further emphasised on AI in Healthcare under the subdivision of: 

1. Improved diagnosis and treatment planning
2. Personalized medicine
3. Enhanced medical imaging
4. Streamlined clinical decision making
5. Predictive analysis for population health
6. Reduced healthcare costs through automation

The interception of technology has helped a lot during COVID-19 pandemic as the predictions of the number of mortality and the number of patients who are affected during this wave was made using deep learning tools and their overall approach for  future progression was nearly correct as the surge of new variants was also interfering with the studies. These applications helped the  authorities to curtail the expense as per the vision of the peaks that narrowed the spread of the disease.

Further wearable technology and sensors  was also discussed with suitable examples like Smart watches,smart goggles,smart socks,smart toilets and all the day-to-day activities. There were case studies pertaining to managing the chronic conditions like diabetes which is managed by a patch that has been put subcutaneously and used for two weeks helps in regulating the glucose tracking and monitoring. This patch also help in tracking the hypoglycemic levels and typically avoids hypoglycemic episodes that happen during sleeps as most of the patients end up dying in their sleep due to sudden rise in their sugar level.Physicians do remote monitoring of elderly patients as well as ICU patients today through various upgraded technology and there are times when patients can be monitiored by the physician from their home through monitoring sensors. These technological upgrades are also helpful for disabled and handicapped people. Case studies pertaining to virtual reality (VR) and augmented reality(AR) categories the medical professionals are being trained more extensively and more deeply

More than 500 AI applications have  received FDA approval, and 400 companies worldwide are already using AI in their practices  in the radiology department. 

To begin with validation process he informed the main requirements and principles for  validation: 

1. Patient safety 
2. Building trust among clinicians and patients 
3. Effective technology 
4. Limitations of technology 
5. Compliance with regulatory bodies.  

The validation process: Pre-clinical, Cinical, Post-market Validation.  He explained five basic rules for getting approval for validation in clinical environments 

1. Strong value, Strong evidence from pre-clinical trials, and clear structure of the data. (Preclinical validation- retrospective modelling, computer simulations, laboratory or  animal testing). The technology built/ Company that needs validation should be clear with- Whether the technology affects the final outcome of patients, Reduction in health care cost, Revenue Model, R&D Department performances, Whether these solutions will help  them with the problem of unstructured data.

A case study from CARPL.ai was discussed on the  transitioned from retrospective settings to clinical validation. Old data from hospitals were taken and  labeled using Tech Stack by CARPL, ran them on the solution  which gave them the  result under a huge bucket of classification of diseases, the solution used several  statistical performance matrices. 

2. Design Study – the overall strategy will be utilized to carry out a trial that defines a succinct and logical plan to tackle and have desired outcome.  

3. The need to be flexible and find ways to do trials in limited resources. (Compare  automated AI tools with semi automated available technology to help clinicians know the  efficiency.) 
(Build a strategy to work efficiently) 

4. The right set of tools should be provided to clinicians, linking validation with their  workflow, with a user-friendly process and transparent with intuitive results (Helping  clinicians know what happens behind the result screen).

5. The validation screen should have a design hack that explains failures and informs  clinicians about the solution to deal with limitations. (Outcome + framework that captures  the input on a similar screen / In a single interface.) 

A case study was discussed on how the existing workflow cannot be avoided to get affected  during a prospective study. 
CARPL.ai did the study in an hospital’s radiology department, one radiologist was asked to  take radiographs and after interpretation the data was given to the company. The data of the whole day  was tested again on CARPL’s solution, and another radiologist was asked to check their  validity and reliability, saving time and being no hindrance in the workflow.

In The last part Challenges that take place during the validation phase were discussed  
1. The speed and time required for the validation process should be considered 
2. Ethical considerations and the participation of all stakeholders. 

Last part was the Q&A round, 

First question asked was: The Lesson to tool builders for reaching the clinical validation phase and  not limiting themselves to published papers to which DR Vasanth suggested to peers to start with  the problem, find out what clinician’s problem and then build a solution.

Second Question, Framework for medical technology to be launched – the framework for – It  involves obtaining approval from the Central Drugs Standard Control Organization (CDSCO),  which is the national regulatory body for medical devices and drugs. 

Third Question, while digital therapeutics have been introduced in several countries,  including the United States and Europe, the development and adoption of digital  therapeutics in India are still at a nascent stage. To which answer was – there is a need for  regulatory frameworks that can govern the use of digital therapeutics in India. There are  challenges related to the infrastructure required for the implementation of digital  therapeutics.

Fourth Question, why not in India AI solutions has not been adopted yet– In India, the  current incremental value provided by digital solutions to radiologists is limited to only 2-3%.  This results in poor financial returns for radiologists. Additionally, the unit economics of  deploying such solutions vary across different markets, and the necessary infrastructure to  support these solutions, such as cloud systems and RAS systems, is often lacking in hospitals.

Fifth Question, was by Harmanjot a higher secondary student working on an IOT model  sensors to monitor Mental Health (a prototype has been developed and his next plan is to get  clinical trial – He was advised to find out research studies published on similar designs to  know evidence about effectiveness and safety of prototype, what kind of research studies  has been done and then move further.)  
Sixth Question, how to build a good data set to help solutions to test their technology to  which he answered that the government can play a vital role in facilitating the effective utilization  of data by providing policy clarity on data sharing with the public and promoting the creation  of structured data. 

Last Question, how to deal with subjectivity when comparing demarcations done by solutions  and Humans. The subjectivity in picture related comes in cognition phase of  demarcating outlines of any organ. The subjectivity can be avoided by settings hard and soft  ground rule. Now, if a lesion is being worked on the first point of test would be biopsy and  other tests then proceeding with demarcation for segmentation then we can follow hard  ground rule of working with cognitions and using solutions later. 
The session was ended by thankyou note by Sachin Gaur where Dr Vasanth was asked to  mentor for clinical validation in upcoming conference of Innovatiocuris (Topic – Clinical  Validation). We all are thankful to Dr. V.K Singh and team Innovatiocuris for organizing such an informative session and making the people aware about the importance of validation in the field of clinical environment.

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