How can IoT deliver the much- needed booster shot to people living in the far-flung areas and hinterlands of the country?

Imagine rural folks sitting in front of an Internet-connected screen, listening to a doctor sitting in a Metro hospital who, basis on their heart test results, gives them sane advice to either go for specialty tests or resort to prescribed medicines easily found in the vicinity; or envision a city-based doctor looking at a patient’s chest X-ray and decides on the next course of action – all via connected network of IoT devices.

The benefits of IoT are multifold – in providing telemedicine, personalized healthcare, video-based consultations and future wellness strategies – without the patient leaving the village sans emergency.

The IoT infrastructure needs is reliable internet, low-cost IoT devices, security and data analytics and India is slowly picking up on these fronts.

Thanks to the 4G revolution, better Internet connectivity has reached most of the parts in the country, helping the stakeholders in the healthcare industry aim for the last-mile connectivity.

As far as low-cost devices are concerned, several IoT health start-ups have now come to the fore, and are set to change the course of the healthcare industry.

Since IoT is a concept of devices talking to one another, there is a lot of data transfer happening.

To make sense of the data, Artificial Intelligence (AI) and Machine Learning (ML)-capable solutions are already here which – with the agility, scalability and security of cloud – can give predictive analysis of a patient’s data in a jiffy to the doctor.

India’s IoT market size is expected to expand to $9 billion by 2020, according to market research firm Deloitte, and healthcare sector is going to be the main beneficiary.

In a country like India, building state- of-the-art hospitals at every nook and corner is a daunting task. Telemedicine, where patients sitting in remote areas are brought face-to-face to a city doctor via a laptop is the best option.

Therefore, a heart patient can begin talking to a specialist working in a super- specialty hospital in New Delhi, discuss reports, and together work towards whether the patient needs to visit a nearby District Hospital for further check-ups and come to the Capital for advance check-ups or medical procedures.

Once back after a medical procedure or a surgery, the rural patient need not go back again for follow-ups.

Now bring low-cost IoT devices into the picture and the data that is being generated, goes in the Cloud and reaches the doctor faster. This helps the specialist better understand the case and build an online repository of research for future references. The process of well-documented research has today made telemedicine very efficient.

In rural India, nearly 37 per cent of people have access to In-Patient Department (IPD) facilities within a 5-km distance and only 68 per cent have access to an Out-Patient Department (OPD).

Most patients in rural areas do not have access to specialists. Thus, several big hospital chains are offering remote consulting services in rural villages using IoT network capabilities. The doctors can see and interact with patients in remote telemedicine centers, with the case history and medical data automatically transmitted to the doctor for analysis. With the advent of new technologies, various state governments are now leaning towards IoT.

Take the example of the Telangana Government which is using Microsoft’s Cloud-based advanced analytics IoT solution to screen children from birth to 18 years of age for major conditions affecting their health. The data is useful to safeguard rural population. It provides the capability of applying ML and AI to cardio-vascular health records to develop an Indian-specific heart risk score. This data can provide rich insights to doctors on treatment plans and early diagnosis. Such solutions for diagnostics in rural India, with the help from Machine Learning algorithms, can accurately diagnose and predict conditions.

In a paper “IOT in Healthcare: A Study,” M Surya Prabha and B Sarojini from Avinashilingam Institute for Home Science and Higher Education for Women University in Coimbatore mention that IoT devices are being used in many hospitals for patient care and get their health details in India.

“IoT healthcare system connects all the available resources as a set of connections to perform healthcare activities such as diagnosing, monitoring, and remote surgeries over the Internet,” they note. The monitoring of the patients has become possible through the wireless solutions connected through the IoT. These solutions help to securely capture a patient’s health data from a variety of sensors, apply complex algorithms to analyze the data and then share it through wireless connectivity with medical professionals who can make appropriate health recommendations. IoT devices also boost patient’s confidence and satisfaction by allowing patients to get connected with their doctors virtually.

The concept of IoT, say the researchers, has been comprehensive to cover more type of devices such as Global Positioning System and mobile devices. Smartphones (India has over 450 million smartphone and over 700 million feature phone users) can be used to build an inclusive IoT network.The mobile devices can aid healthcare workers to diagnose, track and control infectious diseases.

There are now apps to help rural population. India’s largest online health camp called “myUpchar” recently launched a “Saathi” app. “myUpchar” partners in operating villages along with volunteers and support staff who collect basic details of the patients such as weight, height, blood pressure, glucose, pulse and temperature, and shares those on the app with the doctor.

A recent study published in the journal Nature found that people can make use of apps that employ the phone’s camera to interpret test results, and send them to local clinics or healthcare workers before being uploaded to a central online database.

Globally, the healthcare IoT market is expected to reach $72.02 billion by 2021. According to Nutanix, a global leader in cloud software and hyper converged infrastructure solutions, the healthcare organizations need to address a variety of critical IT needs, which include a need for increased security, protection of sensitive patient data and meeting regulatory compliance. From a patient’s and clinician’s perspective, adopting a cloud model, hybrid or otherwise, also allows for providers to undergo a digital transformation of healthcare delivery.

Infrastructure innovations allow hospitals to manage different appli- cations and data types, take advantage of automation and create new service lines such as telehealth or remote monitoring, thus leading to improved patient engagement. Healthcare companies outpace the averages for certain applications, such as data analytics and Internet of Things (IoT). The fact is that India has always looked to provide a premier healthcare system for its citizens. Thus, investing in the next generation IT and IoT infrastructure is the first step in preserving the current quality of care and bringing healthcare to all.

About the author

Meenakshi Iyer is a New Delhi-based freelance journalist covering health, technology and latest innovations. With more than 15 years of experience, she has worked with top media publications in the country.

The healthcare industry generates and collects a huge amount of complex data daily. Using data analytics technique, these large set of data can be broken down in a meaningful way to know the trends and make more accurate decisions for many major quality outcome projects. Through analyzing trends and forecasting the data, the healthcare providers will know whether implementing or changing any project would have a positive or negative impact on an organization. For example, if an organization wants to increase the overall mental health of their patient population, the provider should first know what percentage of patients are not undergoing their depression screening during an annual health checkup, says Thamarai. To identify the percentage of patients who did not have their depression screening done, the data analyst will collect data from the organization’s database for a year. Once the organization identifies the base population, the experts look at the data and analyze the gap by drilling down the data to find why a depression screening was not done. Finally, using the same data analytics method, an organization can decide whether this quality project needed to be implemented after performing management level decision such resource needed and financial status. According to Thamarai, however, though data analytics aids and helps the leaders to decide, it is utmost important to include clinical folk’s knowledge as there might be something beyond this analysis. In the above example, the patients who did not have depression screening may voluntary avoid (needed to be excluded from the base population) or there is no such information captured in the medical record altogether. In these scenarios, the doctors will come with ideas to close the gaps such as using a phrase or a flag in the medical record for the patients who voluntarily declined the screening. Hence, a combination of Small and medium enterprises (SMEs) and data analytics team is required to obtain a positive outcome for any healthcare quality project.

“Can this data analytics method be feasible in the Indian Healthcare System?”. Major Indian healthcare organizations still use surveys and administrative medical records data to analyze the quality of care. These resources of data are less reliable and collecting this type of data is always a challenge for the healthcare organizations because of lack of Electronic Health Records (EHR), says Thamarai. Though EHR implementation is slow in India, it is predicted to grow in years to come because of many government-initiated policies such as ‘The Digital India Healthcare Policy’, increase in EHR implementation in Major hospitals like AIIMS, etc.

Boarding a wobbly roadways bus, a dhoti-kurta clad young man, with protuberant vermillion dash on forehead, used to head for mythological twin city of Mathura and Vrindavan in Uttar Pradesh, clutching tightly his voluminous bag, stuffed with Ayurvedic medicines in tiny folded paper pouches for distribution to patients at ISKON center every weekend in early nineties.

But, recently, sporting a brick colored shirt and creamy Nehru jacket and matching black tight trousers, Ayurveda medicines practitioner Dr. Partap Chauhan unveiled world’s first Artificial Intelligence (AI) powered protocols modeled on the basis of a mind-boggling database of patients and their successful cure.

Moved by the protocols’ apparent efficacy, India’s AYUSH Secretary, Dr. Vaidya Rajesh Kotecha, has minced no words for exploration of a possibility to have a link of the protocols with the Ministry’s recently floated grid for the popularization of India’s traditional medicines at international fora.

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The world over, he said, moves are underway to reduce the cost of quality treatment. Recently, Amazon, Berkshire Hathaway, and JP Morgan have announced a company with an Indian American Dr. Atul Gawande as its CEO to work out healthcare of US employees. It might be typical of disrupting the healthcare industry whale cost, a conundrum is raging madly. The new company will be headquartered in Boston and will operate as an independent entity that is free from profit-making incentives and constraints.

Dr. Gawande is a globally-renowned surgeon, writer, and public health innovator. He practices general and endocrine surgery at Brigham and Women’s Hospital and is a Professor at the Harvard T.H. Chan School of Public Health and Harvard Medical School.

“I’m thrilled to be named CEO of this healthcare initiative,” said Dr. Gawande, “I have devoted my public health career to building scalable solutions for better healthcare delivery that are saving lives, reducing suffering, and eliminating wasteful spending both in the US and across the world”. This work will take time but must be done. The system is broken, and better is possible.”

He is the Founding Executive Director of the health systems innovation center, Ariadne Labs. He also is a staff writer for the New Yorker magazine, has written four New York Times bestsellers: Complications, Better, The Checklist Manifesto, and Being Mortal, and has received numerous awards for his contributions to science and healthcare.

“Medicine has triumphed in modern times, transforming the dangers of childbirth, injury, and disease from harrowing to manageable. But when it comes to the inescapable realities of aging and death, what medicine can do often runs counter to what it should”. Says Dr. Gawande in his book “Being Mortal”.

Dr. Kotecha envisions Indian traditional medicines’ colossal potential in ensuring cheap and best treatment and country’s values, coupled with such medicines, have answers of all these emerging challenges. He spoke briefly about the “Being Mortal” book and the newly formed company.

The AYUSH Secretary was of the view that Indian traditional medicines should be included in ICD -11 as Chinese medicines have entered the classification already. The International Classification of Diseases (ICD) is the international “standard diagnostic tool for epidemiology, health management, and clinical purposes.” Its full official name is International Statistical Classification of Diseases and Related Health Problems and is maintained by WHO.

Amid these developments, the protocols have been framed. Dr. Partap Chauhan, Director Jiva Ayurveda, narrated his arduous journey and said India’s traditional medicines efficacy was being recognized the world over, and his protocol would help according to it a scientific explanation on various parameters.

He had started his journey from a small dispensary in a garage in Haryana in 1992, and now a globetrotter is interacting with world-famous universities for deeper scientific researches on country’s 5000 years old traditional medicines.

The personalized treatment syndrome is catching up and researchers are underway on how to promote personalized treatment for more accuracy. He said the World’s first Diagnostic Protocols for Ayurveda would turn this ancient healing tradition into a data-and evidence-driven system of medicine and JIVA Health App.

These protocols, meant to standardize the practice of Ayurveda, have taken four years to develop after analyzing the consultation records of more than two lakh patients; the protocols have been successfully run on 20,000 patients till now, with dramatic results. This system will create a wealth of data and evidence that will go on to validate Ayurveda as a legitimate science of treatment, boosting its acceptability worldwide. The JIVA health app will provide authentic and actionable health and wellness information with content exclusively curated by Dr. Partap Chauhan.

JIVA group President Rishi Pal Chauhan has said the JIVA’s unique protocols are like an operating system for Ayurveda practice that structures the practice of Ayurveda and creates the wealth of data. It is well known that unlike Allopathy, which is focused on symptoms and standardized drug choices, Ayurveda is fundamentally a personalized system of medicine.

Even though thousands of years old, this traditional system of healing, conceptually, is a far more evolved science. For instance, personalized medicine (based on genomics) and the “systems view” of human health is only now beginning to come into fashion in allopathy, when Ayurveda has been built around these very concepts.

The reason is that the scientific community asks for data and evidence – on what basis are the medicines given and how is their effect proven? This data and evidence Ayurveda does not have. The big question is: “How do you standardize a system of medicine that is fundamentally personalized, with patients being given different treatment based on the root cause, even if the symptoms are the same?”

This is the challenge of mapping intuitive Eastern systems of medicine over objective Western frameworks. Data Analysis of Consultation Records of two lakh patients four years ago, Jiva Ayurveda began a huge data analytics project, reviewing the consultation records of two lakh patients that its doctors had treated over the decades.

After analysis, running into thousands of hours using artificial intelligence, machine learning, and computer modeling, the Jiva analysts concluded that while the Ayurveda treatment cannot be standardized for every patient, Ayurveda practice can surely be standardized. In other words, the way Ayurveda practitioners diagnose patients can be standardized by laying down definite protocols. This methodology currently exists only in the mind of the Ayurveda practitioner and each arrives at the diagnosis in his own way. The result of this is that no consistent data can be generated, and the methodology cannot be validated. And so began at JIVA the painstaking process of writing diagnostic protocols around the practice of Ayurveda by scanning the consultation records of lakhs of patients.

India’s first-ever Protocols for Ayurveda: the protocols that have been created over the last four years by Jiva. These protocols, and the decision support system built over them, help Ayurveda practitioners anywhere in the world arrive at the correct diagnosis in a data-driven way. The system also categorizes the diseases in terms of severity, which has a direct bearing on prognosis. As the consultation protocol flows, based on patient answers, the system starts assigning weights to different diagnostic possibilities and makes calculations to arrive at an authoritative diagnosis. It helps avoid judgmental errors and the cost of the wrong diagnosis. It also suggests diagnostic clues that the doctor may have missed which may lead to a possible different line of treatment.

Narrating all these, Dr. Chauhan says these protocols to standardize the practice of Ayurveda, the first-ever to be attempted in India, signal a revolutionary shift. They are akin to Ayurveda’s operating system that is accessible to everybody. This system will create a wealth of data and evidence that will eventually go on to validate Ayurveda as a legitimate science of treatment, boosting its acceptability worldwide. The protocols have been run successfully on 20,000 patients so far, with dramatic results. Three international universities are collaborating with JIVA to validate this data.

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.