There is no doubt AI and IoT are big help in radiology and early diagnosis of cancer etc. but can never replace human intervention. India is also fast changing to adopt new technologies. As per a recent estimate, AI has potential of bringing $957 billion to the Indian economy by 2035. This may be the cause for luring young professionals to this new domain.

AI, as described by the domain experts – application of AI in healthcare, can be classified into Descriptive, Predictive, and Prescriptive. Our effort here is to learn and share newer knowledge by various initiatives taken by us through our annual conference, magazines, training programs, club meetings, webinars and the most recent delegation to Sweden under InnoBRIDGE 2019 to learn the best practices and explore synergies. On the request of our stakeholders, the next planned initiative is InnoBRIDGE USA 2020.

This issue is based on the theme of AI & IoT in Healthcare. The next one would be on Unmet Needs in Healthcare: Leading to Innovation. Do share your views and research for the benefit of all who believe in change through innovation. Let us think more on the basic issues of healthcare and how we can use technology to improve healthcare for common man at an optimum cost.

Ideate, Innovate and Incubate for the Bottom of Pyramid. Let us strive together to make India a developed economy from an emerging economy. The population of1.3 billion should be an asset and not a liability for the nation. A healthy India only can make wealthy India.

The meeting witnessed some very eminent and influential speakers from around the healthcare sector. The former Enforcement Director (ED) Karnal Singh who has investigated many high- profile cases graced the meeting as the Chief Guest.

Innovation is exciting and there are more innovations happening in the private sector, and with increasing technology come increased risks. With the rapidly growing technology, ranging from wireless devices such as mobile phones, tablets, and laptops to smart refrigerators, cars, and even medical devices like pacemakers, etc., it seems that the growing connections around us are difficult to detect. Therefore, the risk that comes together in operating within this brave, new and a connected world is high.

Shri Karnal Singh shared his expert viewpoint on the impact and importance of artificial intelligence, connected healthcare and need for cybersecurity in healthcare. How the digitization of healthcare is important and the rural and urban divide of same. He also insisted on the improvement of infrastructure and facilities available in the rural healthcare industry. In addition, he discussed the gap between the medical industry and government institutions where the research is needed and that we adopt mostly from our partnering and supporting foreign countries and how a change in mindset and adoption of new and improved technology can enhance the Indian healthcare. The future of healthcare is on the Internet and the Internet is vulnerable. Technology is the solution and it will come whether we want it or not. Therefore, the need of the hour is OUR PREPAREDNESS. We should welcome and be prepared for the connected network of healthcare.

An interesting session on the basic concepts of AI was the icing on the cake. It acquainted the participants with AI emphasizing on the fact that one should not get bogged down by the technology. Instead, one should focus on the use cases of it and there lies the innovation.

Often, the terms “digital health” evoke images of smartwatches or apps that can process the health data and can give a readout of parameters like heart rate, blood pressure, etc. That is a part of digital health, to be sure, but today we also focus on a newer aspect called “Precision Health” and the session “Prerequisite and journey of India to offer (precision) healthcare to all: Powered by Digital, Genetics, and AI” offered a far more expansive vision for digital health technologies, genetics and AI.

Precision medicine is an emerging approach of medicine which focuses on the cause of an illness, and not addressing the symptoms alone. Precision medicine may not be very well- known as Personalized Medicine. But they are the same. It takes into consideration individual variability in genes, environment, and lifestyle for each person.

Precision healthcare improves efficiency and accuracy to healthcare treatments. With precision healthcare, doctors can potentially develop targeted and precise treatment and therapies for masses as well as for an individual. This can improve patient treatment to large populations in countries like ours.

It’s based on evidence and data which comes from a series of medical tests on a patient. Thus, the data is its most important aspect. Very soon, along with genome sequencing and health sensors data coupled with the growing amount of Big Data, patient data will create large data sets of valuable information which can be used for more tailored treatments. But as an individual, a physician is not equipped to manually analyze these newly available data sets, which is where the advanced technologies such as AI come into picture.

The challenge that the clinicians see in the adoption of AI is the gap between the technical person and a clinician in regard to understanding the implementation of “normal reference values”. For example: If the normal value of hemoglobin for a person staying at planes (say Delhi NCR) is 13.5, the value 17.5 is perfectly normal at Ladakh. Is that incorporated in the AI system? Something that works in the USA might not work in India. The doctor or a clinician will have a great role to play in case of developing the AI as he/she can only give the correct inputs for the training sets.

With the new wave of digitization, medical records have seen a paradigm shift in the healthcare industry. As a result, the healthcare industry is witnessing an increase in the absolute volume of data in terms of complexity, diversity, and timeliness. Since the healthcare experts look for every possible way to lower the costs while improving the care process, delivery and management, and so is the aim of InnovatioCuris (IC), big data emerges as a persuasive solution with a promise to transform the healthcare industry. This paradigm shift from reactive to proactive healthcare may result in an overall reduction in healthcare costs and gradually may lead to economic growth. The above-stated and many more discussion points were there that became the part of the very interactive and interesting second session on “Mitigating data security and privacy challenges for digital healthcare in India”.

Data transmission is also an important aspect of implementing technology and safeguarding it. The Digital Information Security in Healthcare Act (DISHA) is one such step taken by the Indian Government in the long journey to securing the healthcare data of patients in India.

One of the biggest challenges is the lack of availability of data in a democratic manner and it’s all in silos in short data interoperability is a huge challenge. The major concerns that the clinicians have at the moment regarding the implementation of DISHA act are that it says that no court shall entertain any complaint unless made by the Central Government or central data authority, state data authority or the person affected and there would be times when PIL (public interest litigation) is there on the data security as well. The challenges will always pertain but what we need to do is to have trust in the law and protection by it. Major challenges regarding data security or cybersecurity, in hospitals or the clinical establishments, is that we do not have implemented laws that may protect our data. With the hope that they are definitely going to come, we can only stay prepared with our changed mindsets.

The forum highlighted the need of forward-looking policies and a proactive government to play a role in the development of smart cities & villages on the bedrock of JAM Trinity which has 1bn bank accounts (Jan Dhan) + 1bn Aadhaar + 1bn mobile broadband users, already organized for the technological revolution in this space, thus, Capitalizing the connected World with the help of modern & niche technologies like 5G, GIS, IoT, m2m and others. Likewise, the governments effort to connect 2.5 lakh Gram Panchayats with BharatNet project was discussed to leverage the smart villages concept in India.

5G vision for India was also one of the major highlights of the 2-day forum, as 5G technology has the potential for ushering a major societal transformation in India by enabling a rapid expansion of the role of information technology across manufacturing, education, healthcare, agriculture, finance and social sectors. The panelists voiced that India must embrace this opportunity by deploying 5G networks early, efficiently, and pervasively as well as emerge as a significant innovator and technology supplier at the global level. Emphasis should be placed on 5G touching the lives of rural and weaker economic segments so as to make it a truly inclusive technology.

Ms. Aruna Sundararajan, Honorable Secretary, Department of Telecommunications, Ministry of Communications, Government of India via her message highlighted, “A city is a complex system, involving many different domains, infrastructure, organizations and activity which need to be integrated for that city to emerge as a smart city. Standardisation forms a critical part of the work that needs to be done. Being smart cities, a new holistic and cross functional standardization approach is needed, breaking the old ‘vertical silos’ approach, through better cooperation and synergies.”

“While the cities of India are fast progressing towards digitalization, it is encouraging to note that digital solutions are being readily accepted amongst the rural population of India as well. To support this technology adoption, the Department of Telecommunications (DOT), Ministry of Communications, Government of India, has initiated projects to provide broadband connectivity for connecting various digital services and solutions across our Urban and Rural Landscapes”, added Ms. Sundarajan.

Elated about the forum Mr. Kunal Kumar, Joint Secretary (Mission Director – Smart Cities), Ministry of Housing and Urban Affairs stated, “The forum can make noteworthy contributions to the Smart City Program at large. By sharing and collaborating on topics such as technology, multi-country experiences and innovative approaches, I am sure that we can bring together the best minds, and the surest hands to co-create cities of the future.”

The attraction of the forum was, NOT TO BE MISSED ‘Technology Show – by FIWARE Foundation member companies namely – NEC Technology India, APInf, MobilePedia and Smart Cities Lab Ltd where they demonstrated the OPEN SOURCE PLATFORM designed and developed by the FIWARE FOUNDATION– a market- ready open source software, combining components that enable the connection to IoT with Context Information Management and Big Data services in the Cloud.

The forum also hosted a dedicated session on 'India-EU Dialogue on ICT for Smart Cities' which was organized by the prestigious project, namely, ‘India-EU ICT Collaboration Standardization’ of the Delegation of European Union to India, highlighting the absolute need for ‘Leveraging Standards for Smart Cities’, which brought together key stakeholders and smart city officials.

Participants from across the globe got the opportunity to meet Stellapps Technologies – an end-to-end dairy technology solutions company – the first of its kind in India, Sensorise – an IOT Services and Solutions company, Phoenix Robotix – a network-IoT and Big data company, Sensable – an IoT company offering end-to- end smart solutions using artificial intelligence and machine learning, C-DOT – an autonomous Telecom R&D Centre of Department of Telecommunications (DOT), Government of India – showcasing Common Service Platform for m2m communications on oneM2M Specifications.

“We appreciate the participation from our key partners, showing trust in the forum and the vision it stands for. The key speakers, thought leaders and industry leaders have made this forum a thought provoking one with dialogs on disruption these modern technologies can bring to make cities & villages smarter, and at the same time, mentoring the startups in this segment. We are proud to have EU partners to share their insight on business possibilities from across the globe. Thus, making the 6 th edition of this forum a success” concluded Ms. Shilpi Batra, Director, India m2m + iot Forum 2019

About India m2m+ iot Forum

India m2m + iot Forum is a cohesive and shared platform, which validates united and collective vision of the global m2m and iot ecosystem. It is the most awaited annual congregation of m2m + iot stakeholders representing the entire ecosystem comprising of academics, analysts and researchers, enterprises and industry, governments – policymakers and regulators, industry associations and organizations, media organizations, standards organizations, the student’s community and above all the end users from businesses, citizen services and government.

For more information, contact:
Pratik Baurai
E-mail: pratik@saintsart.in
Mobile: 9871006258

Sonali Shyam
E-mail: sonali.shyam@saintsart.in
Mobile: 9891820253

Ajit Rangnekar emphasized one issue of major concern was the lack of manufacturing medical devices in India, to help overcome the problem, there was a need for new and stronger partnerships and alliances as 70% of medical devices are imported which has a vast area of opportunities for collaborations of stakeholders and we are very tiny in the global market.

He believed that India can make -cheaper -smaller -less Complex medical devices in comparison to global products in the market. Challenge is how do we react to the market.

Two big issues underlay in Healthcare
-Data
-Drug Discovery

We know what is the problem but from where the problem is coming from ? for the answer to the above challenge we would require to analyze and improve the data analytics in healthcare.

In summing up the conclusions of the session, Professor Venkat noted the importance of collaborative innovation is the need of the hour and partnership model in Healthcare and highlighted the significance in scaling up the inventions. While there was still room for further progress in the area, there appeared to be a strong need to start addressing emerging issues, in particular, those concerning regulatory board, scalable innovations, data analytics, and deprived the need of combination therapy of Big data and AI. Apart from the recent regulation for medical devices, we also need an enabling ecosystem for high-end manufacturing in the country.

Q&A session
● Invention and innovation difference?
The scalable invention is innovation; collaborative innovation is the need of the hour and partnership model in Healthcare
● No separate regulatory board for medical devices
Big data and AI – combination therapy is required
● Will ‘AYUSHMAN BHARAT’ drive to innovation – open question by Rajiv Nath to the audience.

Innovation is in our DNA. It always has been. In creating new antibiotics. In the automobile. In nuclear power. Just think about the pace of innovation in the past 100 years; with individuals born into a horse and buggy era living to see a man walk on the

moon, through the clouds. That pace of advancement is only increasing in the world of information technology – into the cloud.

Does IT Drive the Most Innovation Today?

Indeed, it is truly revolutionary. Never mind 100 years. How about the past Ten? Five? Two? The Internet, social networks, complex solutions for managing healthcare have been revolutionary. Innovation, especially in the IT space, is key to bringing economic growth, enhanced lifestyles, education and overall improvements in human growth, health and advancements. And, perhaps nowhere is that more important or challenging than in the healthcare space.

Just consider the goal, demands and what ultimately is at stake. First, costs are mounting. Increasing governmental regulations play a large part in that dynamic but there are others considerations as well: litigation; insurance; and expensive research into new medicines. Then, there is the very long, very complex delivery chain involved – from doctors to insurance companies to PBMs (Pharmacy Benefit Management) – with everyone taking their cut – and new regulations pushing for every item to be serialized

in every step of the way – that ultimately has to deliver the right medicine to the right person at the right time. The task has never been more daunting.

To be sure, technical innovation is managing the health of our nation and that of the world. So, how do you get desired physical outcome without breaking the bank? It requires a unified, orchestration of innovation in the business transaction processes. The best deals are applied; the best contractor applies; the best network – pharmacy network, prescriber network – apply. The best formularies are used; the best service providers are rewarded; more service providers are incentivized to become better. And, orchestration of such innovation needs to happen with delivery methodologies for new drugs; how they are invented; how they are commercialized in the marketplace.

How Can IT Innovations Drive Better Health?

Ultimately, all of these areas and considerations must be scrutinized and analyzed, in particular through new IT automation, in order to decipher the correct solutions that then must be well-coordinated and properly managed. Every situation is different. There

are no templated answers. Only areas to be contemplated and acted upon to enable the best medicines, healthcare benefits and final outcomes for individuals and those who serve them.

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This paper 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

Big 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.

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.

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:

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 Unites 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.

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 paper has been to identify the gaps in the wide scale implementation of Big Data vis-à-vis the ticket size of the players in the healthcare arena which in turn is the intellectual anchor of the paper.

Refernces:
[1] http://searchcloudcomputing.techtarget.com/definition/big-data-Big-Data, 8th August 2016
[2] http://www.businessdictionary.com/definition/health-care.html, 8th August 2016
[3] BIS Research Industry Report on ‘Big Data in Healthcare’, August 2015
[4] Bertsimas D, O’Hair A, Reylia S, Silberholz J (2013) An Analytics Approach to Designing Clinical Trials for Cancer. MIT Working Paper.
[5] https://www.hpcwire.com/2016/05/18/machine-learning-fighting-cancer , 16th August 2016)

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