The need to change the way of delivering care/service should be our priority. A paradigm shift in the way of offering services through connected health services and emphasizing that privacy and security concerns are of utmost importance when it comes to connected health. Responsibility and accountability after acquiring data are very important. The question is how to analyze the data and get actionable insight. Analytics and IoT should be considered together for actionable insight. The challenge of interoperability has turned up with an increase in the number of devices being used.

Trends and Opportunities of Medical IoT

IoT or Internet of Things is not new, but it has been gaining traction at a very high pace. Since the inception of the word IoT, there has been an ongoing conversation about how it might change healthcare, improve patient safety, affordability and accessibility for patients.

Healthcare in India has a huge potential in terms of IoMT or medical IoT solutions. There will always be challenges and opportunities in this sector. Connected health is contributing towards the growth in space of IoT, but is lagging behind many other connected sectors.

One of the key challenges in developing the algorithm for medical devices such as CT scans and X-rays. Application of artificial intelligence and machine learning in healthcare should be cautiously done because in case of a CT scan if we miss a module it has life risk and hence should be used carefully and should be a well-validated clinical algorithm.

Since the infant mortality rate in India is twice the rest of the world, and that is certainly alarming as the bottom of the pyramid is affected; there is a company which focuses on the mortality rate of low weight birth babies. They have come up with developing a bracelet which diagnoses hypothermia in low birth weight babies. This was a very simple and innovative device, but then they analyzed the intermissions they can work on and came up with baby cradle. The main challenges to develop and design such a product is to cope with the cost factor and the startups definitely need funds to develop such a technology.

The goal of connected health is not just early identification of health issues, but also effective patient care and safety. Today IoT platforms support integration of medical devices and wearables. The need for security is as important as when it comes to IoT and accessing healthcare data and strengthening advocacy for connected health.

Things change very rapidly and in very small time, and IoT is taking shape with it. But who will fund the cost of development/ Can government help the industry in making such policies?

Business Models of Successful IOMT in India and Challenges

The IoT healthcare business strategy is not yet robust because it involves a set of elements with new requirements such as new operational processes and policies, new infrastructure systems, distributed target customers and transformed organizational structures. Therefore, there is a need for a new business model. The IoT technology opens a new dimension of business opportunities for healthcare companies and the IoT platform becomes a key artifact in this transformation. Early movers who are taking a proactive approach to establishing their IoT healthcare ecosystem will tap into new business models. In this part of the business model, the panel discussed the basis of pricing and the way of charging for a product or service. Besides this, the panel also discussed the ways of revenue generation.

While there are many benefits of the Internet of things in healthcare, it isn’t without its challenges. As with any new technology in healthcare, hospital and IT executives are concerned about data security and IoT device management. What are the potential barriers to IoT adoption and how healthcare IT can overcome those obstacles?

AI and IoT change the way healthcare is delivered and we obviously are on the cusp of a revolution. This definitely poses a fair amount of concerns but also huge possibilities. The panel also discussed how Medicare is 100th the cost per person when compared to Obama care. So clearly, there must be more innovations coming from IoT and AI; they are going to help us reduce the cost.

In the past, how people tried to use the data for the benefit of both patients and providers, starting from the patient side faced huge failures, as nobody was willing to pay. And that’s where the thinking came from that; how do we really make this work? How do we really turn this data into a business model? And that’s where they pivoted the model, working with providers and using their data sets. But then the question comes up, “Why the providers would share their data?”. Thus, the first pitching that started was to use the provider’s data for their patient care. And it didn’t work well. The whole narrative was, “What’s in it for providers?”.Therefore, the business model turned out to be, as we kept on talking to people, we realized that the data is going to be useful for provider’s revenue success, and then the same datasets will help the patients. A solution that they projected is to help retain the provider with patients’ data, grow their revenues and help in patient care.

The MedTech certainly seems more complex. Where they are trying to come out with a dermatology solution and oral health solution for serious diseases where a cell phone image taken from an off the shelf mobile phone camera is sent to an AI backend and it gives a diagnosis and possible treatment options for a variety of skin diseases, particularly oral cancer. Such cases are very prevalent. What the panelist found is a landscape extremely complex in terms of the business model because when someone comes out with something like this, then figuring out who would it be paying is difficult. And suddenly the AI and IoT thing comes up and say that it can perform this diagnosis at par the level and in certain cases better than certain trained specialists. This does not support their case.

One of the panelists shared her thoughts on important factors to concentrate and realize why health care has not moved digitally as compared to other industries like banking, insurance and how a lot of digital interventions can happen in healthcare. There are a whole lot of opportunities.

The main thing to focus on is What is the problem? What is the solution? And who’s going to pay you? Because that’s where the panelists believe that lots of startups have a scope.

The customer is one, the doctor is another and hospital, the other spectrum. So how to manage this change and address the change management. If you give a thought on what to overcome, it gives you a kind of value that you try and achieve success and how do we overcome the quality assurance issues, change issues, challenges that one sees in terms of adoption. Let’s say for the doctors, it took a hundred years to the doctor to adopt stethoscope. Today, it’s widely accepted. IoMT is something that is obviously very innovative, very useful. But then not every doctor will accept it right away. How does one plan to overcome that barrier? So, they might just want one to focus on change management issues.

There are three components of the IT embedment in a hospital. One is the business side of it, which gets adopted immediately. There’s just no resistance to it. The second side is the paramedical side of it; it has pathology, radiology, and other such things. They take a little time but they come on board. The learning curve is much shorter over there. The third one is the clinical side, which is the most difficult, as in a hospital system there are doctors who are most resistant to changes and the reason being their upbringing and learning of clinical practices in a certain way.

The question arises “How does one change their practices?” Changed management is already happening at the college level. The medical students who are coming out now are more hands-on and are accepting the new technological changes. We will have to wait a little while, but they will accept it. When we talk about a change in the management, the problem that arises is not specific to India only. In the USA, George Bush had said that he wanted EMR to be adopted by everyone within the next ten years. Surprisingly, he didn’t even get 15% conversion in those ten years.

It is important to secure the data and look over the cost implications of data security issues in connected health work moving forward. There is a need for appropriate interventions at the transition level of doctors and patients, as well as the importance of advocacy and awareness‐raising at community level about connected health. There is also a need for financial support for encouraging the tech enthusiasts of the country to address health issues in India with connected health solutions. One needs to understand customer value as well. How do we speak the right language in terms of what would appeal to that particular user or customer or doctor or hospital for that matter only then we will see more IoMT adoption happening. Yes, there is a need to understand the regulatory framework. Startups needs to adopt a lean structure in collaboration with the medical partners and come up with innovative solutions. India has a fantastic opportunity, but clearly it does need elements to come together and work together.

Q1. What is the prime objective of the institute you are leading: Australian Institute of Health Innovations?

The Australian Institute of Health Innovation (AIHI) at Macquarie University conducts world-class research with national and international research communities, governments, policymakers, providers of health services, managers, clinicians, patients and the community. Our work underpins health reforms and systems improvement, providing new tools, perspectives and evidence to help stakeholders who are interested in making the health system more effective, efficient and productive. Our overarching aim is to produce new, high-quality research evidence to support change, prevention and improvement.in the Australian health system, and internationally.

Q2. Could you share some of the achievements of the institute in the recent past?

As highlights of 2016, we are currently running over 77 different funded projects valued at almost $40 million, and participating in another 17 grants administered by other institutions worth a similar amount. Overall, we attracted new funding in 2016 valued in excess of $15 million. One notable milestone is that we secured the largest grant ever awarded to the Institute and the largest to Macquarie University in 2016: the NHMRC Partnership Centre in Health System Sustainability, valued at $10.75 million. In that project we are trying to create more sustainable systems of care.

Q 3. The contributions of the institute (and yours) limited to Australia or its implications are international? Can you elaborate on it with some examples?

In 2015 Professor Enrico Coiera won the highest international award for digital health—the IMIA Francois Gremy Award of Excellence. He is a highly influential commentator on national e-health strategies, advocating strongly for rational policy making based on sound evidence. His work has translated into policy and practice changes for e-health safety, multiple patented inventions, as well as for a US-based consumer e-health start-up company. He is author of one of the earliest textbooks on health informatics, which is widely used internationally, translated into multiple languages and now in its 3rd edition. Professor Coiera is the lead researcher, along with colleague Dr Annie Lau, of healthy.me, a personal health management system.

Professor Johanna Westbrook is an elected a Fellow of the American College of Medical Informatics (AC MI) – one of only four Australians. In 2014 she was named Australian ICT professional of the year by the Australian Information Industry Association for her research contributions. In 2015 she was appointed as an Associate Editor of the Journal of the American Medical Informatics Association (JAMIA). She was also appointed Chair of the Deeble Institute Advisory Board by the Australian Healthcare and Hospitals Association in 2015. The Institute has a major focus on driving evidence-based health policy. In 2016 Johanna was elected by members to the Sax Institute Board. In 2016, Professor Westbrook was appointed by the Federal Minister for Health to the Board of the Australian Digital Health Agency and chairs the national Digital Health Quality and Safety Governance Committee.

Our landmark CareTrack Australia study revealed, in 2012, Australians receive “appropriate” healthcare in only 57 percent of consultations. A follow-up study to CareTrack Australia, “CareTrack Kids” will, for the first time, determine the percentage of healthcare encounters at which Australian children receive evidence- and consensus-based care for 16 paediatric conditions and examine the frequency and types of adverse events involving Australian children. We aim to deliver a range of important outcomes in this highly significant and overdue research. Led by Professor Jeffrey Braithwaite and Peter Hibbert, this research stream is building on CareTrack Australia’s findings to pilot new approaches to clinical standards and to explore digital platforms for their delivery. This stream aims to provide a new evidence base to reduce healthcare costs and improve care by helping clinicians deliver the right care at the right time to the right patients.

The Work Observation Method by Activity Timing (WOMBAT ) developed by Institute staff led by Professor Westbrook, and now used by over 30 research teams around the world, has produced new opportunities to undertake international collaborative studies. This measures how care is delivered using a hand held device, looking at how clinical care actually takes place.

Q 4. Are there any biological/medicinal differences in the needs and concerns of original Aborigines in Australia and its broadly expat population?

Everyone deserves good care. Australia has been trying very hard in recent years to provide high quality services to Aboriginal and Torres Strait Islands populations. Many live in remote areas, and it has been hard to narrow the gap between the health status of those populations and other members of Australian society. Governments in Australia are making investments in this situation.

Q 5. What is your institute doing to address the needs and concerns of Australian Aborigines, who are genetically distant from the rest of the Australian expat population?

While this is not our area of expertise, we strongly support colleagues who do research on these populations. This is very important work. Most of our studies include a wide range of patient groups including those from Aboriginal and Torres Strait Islander populations.

Q 6. Can you highlight some of the achievements of the institute in Emotional Health sector since it invests a lot in resources in this field?

We are very interested in doing research with clinicians who are want to deliver the best care that resources permit to patients. We are also interested in ensuring that patients are involved in decisions about their care. We have done a great deal of work with both groups.

Q 7. What, according to you, are going to be the biggest challenges for Australia and the world for securing a healthy society and combat future medical challenges?

To my mind, three things are important. One is digital health: ensuring we get the greatest advantage from investments in future e-health and information systems. The second is patient safety and quality of care. It is critical that we make further inroads into keeping patients safe and improving the quality of their care. In particular, we need to understand when things go right as well as when things go wrong. Third, we need to build sustainable health systems: ones that are built to last, and flexible enough that they can cope with future changes and innovations.

Q 8. On personal front, where do you draw the line between medical marvels and miracles?

I don’t personally believe in miracles. I am very much appreciative, as a scientist, of the benefits to be gained by the application of evidence, science and technology to improve the health system for the benefit of our patients. This is the real marvel.I don’t personally believe in miracles. I am very much appreciative, as a scientist, of the benefits to be gained by the application of evidence, science and technology to improve the health system for the benefit of our patients. This is the real marvel.

Q 9. What are your expectations from the global medical community and what direction would you see governments and people should invest in?

In my next edited book, involving care delivered to patients in 60 countries, I found four things that were success factors in improving care. One is to start with a pilot program, and then scale it up. A second is the importance of having good data on which to base decisions about systems and care. A third is to ensure that multiple stakeholders are involved in complex improvement initiatives. And a fourth is that the benchmark for improvement must be the patient, rather than other stakeholders’ views on the care we need to provide.

Q 10. How do you see innovations of your country linked to Indian which is well known for frugal innovations, do you think some collaboration at working level to take it forward for benefit of both countries in view of two countries’ Prime Ministers have signed recently MoU of collaboration?

This is an excellent idea. India and Australia have many things to learn from each other, and have been friends for many years not just because of our shared interest in cricket and because of our ties as members of the Commonwealth. We are natural partners in ensuring a better health system for our respective countries, and teaching each other about innovative things we have done.

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Read all the issues of InnoHEALTH magazine:
InnoHEALTH Volume 1 Issue 1 (July to September 2016) – https://goo.gl/iWAwN2 
InnoHEALTH Volume 1 Issue 2 (October to December 2016) – https://goo.gl/4GGMJz 
InnoHEALTH Volume 2 Issue 1 (January to March 2017) – https://goo.gl/DEyKnw 
InnoHEALTH Volume 2 Issue 2 (April to June 2017) – https://goo.gl/Nv3eev
InnoHEALTH Volume 2 Issue 3 (July to September 2017) – https://goo.gl/MCVjd6
InnoHEALTH Volume 2 Issue 4 (October to December 2017) – http://amzn.to/2B2UMLw

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