Information Technology Archives - InnoHEALTH magazine

Telemedicine Force Multiplier for Healthcare Delivery

InnoHEALTH Magazine — Mon, 13 Jan 2020 06:13:54 +0000

In any developing country, there is huge inequality in healthcare distribution due to various reasons such as poor infrastructure, poor communication, inadequate transport facilities, etc. Doctors find it difficult to stay in rural centers due to the above reasons.
It is also well known that 65% to 75% of the population resides in villages that are scattered and not well connected by roads. Hence, the rural population has to travel nearly 8-10 kilometers to access basic healthcare in nearby towns. They spend most of their out of pocket health expenses and at many times borrow money for these expenses.
Keeping this in the background, governments have been working on Sustainable Development Goals launched by the United Nations. Aim of these goals is to ensure healthy lives and promote well-being at all ages. Sustainable health is a huge challenge and it can only be achieved by adopting technology and innovations to improve healthcare delivery.
India now has a robust information technology manpower and the established communication technology is freely available at the village level, mobile phone applications in healthcare and wellness are being used in the rural bridge. Telemedicine is the combination of its communication network and healthcare promises to reach the rural-urban divide and it is also the cheapest and fastest way to reach the unreached population.

Government Initiatives in Telemedicine
Numerous telemedicine projects are now running in the country under the aegis of the National Health Mission. Rajasthan government has initiated a PPP model telemedicine project on BOOT (build own operate & transfer) concept. The Global Health System Kolkata is the vendor who has been operating the Telemedicine project for the past 3 years. Mahatma Gandhi Medical College and Hospital Sitapura Jaipur have signed MOU with the vendor for rendering telemedicine consultations to the periphery (100/ 150 nodes).
Mahatma Gandhi University of Medical Sciences & Technology (MGUMST) Experience
The experiences gained by providing healthcare through telemedicine is very interesting, it may be noted that the telemedicine consultations have grown with each passing year. It was interesting to note that the teledermatology was increasing on analysis, it was realized that dermatology revolves around photography and visible rules to make a diagnosis.
The numerous efforts made over the years can be analyzed based on the number of consultations: while dermatologists data showed 4011 consultations in 2017, it grew to 31436 in 2019. On the other hand, general medicine was ranging from 4759 consultations in 2017 and dropped down to 2889 consultations in 2019. Cardiologists/CVS/cardiac surgeon consultations were 324 in 2017 and dropped down to 238 in 2019. Obstetrician/gynecologist showed an increase from 854 consultations in 2017 to 1135 in 2019. Oncologist consultations were 33 in 2017 and dropped to 29 in 2019 while orthopedic was at 525 in 2017 and increased to 747
in 2019. Pediatrician/neonatologist was at 6260 in 2017 and drastically reduced to 585 in 2019. Overall consultations during the years 2017-2019 were 105,269.
Conclusion
Telemedicine is the future healthcare system as it reaches the unreached and it allows the remote health workers to avail consultation with territory care specialists in urban areas. The growing number seeking teleconsultations from the peripheral medical setup is proof that telemedicine delivery of healthcare is now being adopted by the rural population.

About the author

Major General Ashok Kumar Singh (retd) from the Indian Army has served all over India – Lucknow, Assam, Mizoram, Nagaland, Agartala, Delhi, Pune, Srinagar, Udhampur and many other places and been on official duties and attended conferences in Austria, Bhutan, Canada, and Sweden. His area of interest is rural health through telemedicine. He is currently serving as an Advisor in Health Informatics at Mahatma Gandhi University of Medical Sciences and Technology at Sitapura, Jaipur. He is also running a BSc course in Hospital and Health Information Administration.

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Healthcare Startup Interview | Nishant Nambiar | Inforich Technology Solutions

InnoHEALTH Magazine — Thu, 26 Dec 2019 06:07:29 +0000

Healthcare is transforming from a human touch of doctors nurses and allied health professionals to devices and now, information technology. AI based healthcare solutions can help in making healthcare services more proactive, moving from ‘sick care’ to ‘true healthcare’.

In an interaction with Nishant Nambiar from Inforich Technology Solutions to understand how he fills the gap for innovations in healthcare.

1. Tell us about yourself and Inforich technology solutions.

Actually Inforich technology solutions was born in April 2012 and from that time onwards our focus has to solve the healthcare problems in the health informatics space specifically so, we were trying to build a solution or a platform which will solve the problems for entering the data from the doctors perspective, a nurse perspective and ultimately from all the stakeholders in the ecosystem. With this solution, we two founders started this off and it’s been like a long journey of seven and a half years of experience and this has taught us and we have all created client bases across the Middle East, South East Asia, and India and we hope you’ll take this as a global product.

2. What was thought to create an entity to work on the problem of healthcare?

Basically it’s a very simple motivation because when you personally go to any Hospital you don’t have all your records in one place, so multiple times people ask you very simple things starting with what is your age what is your name. Those basic things are also not solved. We have a lot of IT systems at the moment in the hospital environment or the clinical environment but then these are more of billing solutions. Like electronic medical record system, you don’t have something very comprehensive just as a quick check. If you want just to go back and see whether you have your medical history for the last one year or two years. So that itself will answer your queries. This is the very strong pain point which is required but with the futuristic thing. There are a lot of technologies which can actually help you to predict diseases. If you have a history of data with you, you can actually predict and this will actually help you to prevent and protect yourself from more diseases and all falling sick. So the model which we are trying to focus used to move from ‘sick care’ to ‘healthcare’.

3. What were the challenges you faced in implementing an AI solution and how did you overcome it?

Basically this is a terminology which is widely used nowadays ‘artificial intelligence’. We were using this technology almost like seven years back but we did not put it the term like AI on top of it. The whole model is like when you have data in one place, then only you will have the AI and all to run on it whatever algorithms will be built. But the challenge at the moment is we don’t have data in a structured format from different sources. That is the first point and we are trying to solve that problem to aggregate the data into one place, so that all the hospital owners or the patient side or the doctor side, they all can accept the data in whatever form and then make meaningful outcomes out of it. That is where we will use techniques like AI and machine learning. These two things will help improve the efficiency of the doctors so that they can see more patients very quickly and more accurately. That is the most important point.

4. Data protection bill is coming in India. How the EMR companies like you will change its strategies in data collection storage and transfers etc?

Whenever any ERP solution which is like EMR is one of the database applications. Data is the most critical element, everybody says data is the new oil. Definitely you need to secure it. How would you secure it? There are a lot of protocols which are coming up which has to be defined authorized by the concerned cyber security team or the Ministry of Defense and all those guys are supposed to manage all this data. What we are trying to do is we have the capability in our product to chew it to tweak the data in such a way that you yourself will find the data in a secure place. The data regulatory companies can tell us what are the requirements and we can very easily comply to it, that is the strategy. So, we flipped it from that side we don’t have to change our product. The only thing is to tell us what are the regulations which you want to implement in the region. We can get compiled to it automatically because what we are going to build is a global product so may be the rules in India might be different from the rules in the US may be rules are different in Europe. Our solution is capable of adopting to multiple security levels at different country levels. This is where we have this kind of idea which is coming up like in Europe. We are working on GDPR because that is the way how you protect your data, so they are up to it.

5. You being an EMR and AI company do you think healthcare is prepared for it?

Healthcare at the moment is not prepared that’s what I said because the data is not in a single place at the moment. We have created a lot of silos. All your data is in different-different parts. The first thing is you have to integrate everything together, then only you can talk about AI. The first challenge for AI to be executed is to have the data in one place. That is where we are working on and we are getting all these stakeholders to put data in a structured format so that it is much easier to manage.

6. How does your organization fuel innovation in healthcare IT?

I think innovation actually comes in when you get closer to the customers. Our customers being the hospitals, clinics and doctors, we spent a lot of time with them. We understand what are their pain points, we don’t develop solution sitting in our offices. We actually get on the ground and discuss with the IT guys and the doctors to understand what are the problems. Technology has got a lot of benefits like AI, machine learning and all but doctors need not to understand that. It is our responsibility to understand the technology and it is the doctor’s responsibility to tell us the problems that they’re facing and technology can solve all the problems. Listening to the customers at their locations is the most critical element and that is how we think innovation is helpful. Otherwise, if I innovate sitting in my office that might not be relevant to them.

7. To all the startups out there who are hustling in AI and healthcare, what message would you like to give them?

My advice to all the healthcare startups is to focus on one domain like could be cancer, it could be diabetes, it could be obesity, concentrate on one and then build a huge database on that. Then maybe you trained your algorithms and all based on that. Then you go to the next lead where you can go and scale and use this evidence-based kind of solutions to take the what you call the best practices and all across different parts of the world. II think that’s the way to go forward, focus on one niche domain and then be the master in that, have a lot of data because the people are not very comfortable sharing data so first we need to build that confidence for them to share the data telling them that you will give them more insights from which they can take decisions based on that.

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AI and IoT in Healthcare: Need of Future

InnoHEALTH Magazine — Wed, 10 Jul 2019 08:54:11 +0000

Healthcare is transitioning from human touch of doctors, nurses and allied health professionals to devices and now information technology. In today’s world, healthcare is buzzing with new domain of Artificial Intelligence (AI) or should it be called assisted intelligence, machine learning, big data, block chain, Internet of Things (IoT), connected healthcare, mHealth, eHealth, cybersecurity and many more. These terminologies are being used by many without knowing its definition,use and limitation. It is creating a new community of providers. All this is good as long as we are not servient to technology and we control it for the benefit of providers and patients. Even medical personnel these days want to diagnose without touching the patients, without any concern for evidence-based medicine,human touch and compassion. Technology has made big in-roads in healthcare,but should it dispense health professionals as few think.

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.

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The Vulnerability of Medical Institutions to Cyber Attacks

InnoHEALTH Magazine — Mon, 24 Jun 2019 10:39:58 +0000

McAfee’s researchers were able to modify the vital sign data in real-time providing false information to medical personnel by switching the heartbeat records from 80 beats a second to zero within five seconds. You would have woken up to news that Medstar patient records’ database was subject to ransom ware cyber attack and was asked to pay bitcoins. Unfortunately, the hospital did not have backup of medical records and in some cases, they had to turn away the patients. These incidents, unfortunately, are not stray incidents.

There are various technologies converging and a rapid increase in machine-to-machine communications. It is predicted that by 2025, most hospitals will have the ability to network connect more than 90% of their devices. However, many hospitals are yet to make their data security systems extremely robust. Data privacy and data security are the two important pillars that need urgent consideration. Just as financial data is loved by the cyber criminals, so is health data becoming a gold-mine with the cyber offenders. Specially so when the hospitals are run on legacy systems and there is no dedicated framework or surveillance on their own data.

Personally, identifiable data is an indicator of an individual, such as name, an identification number, location data, an online identifier or to one or more factors specific to the physical, physiological, genetic, mental, economic, cultural or social identity of that natural person.Several cyberattacks on medical institutions are initiated to extract the electronic health records (EHRs) of patients. These EHRs may contain their personal health information, medical history, diagnosis codes, billing information, etc., which can be exploited by the cyber offenders in various manners, for instance to get ransom from the medical institutions or to create fake IDs to buy medical equipment(s) or medication which can be resold or exclusively sold on prescription.

Take this example. On 12 May 2017, a global ransomware attack, known as WannaCry affected more than 200,000 computers in at least 100 countries. The ransomware attack also affected 80 out of 236 trusts (medical institutions under NHS) and further 603 primary care and other National Health Service (“NHS”) organisations were infected with the ransomware virus including 595 general practitioners. The trusts which were affected with WannaCry ransomware faced issues like patient appointments being cancelled, computers being locked out, diversion of patients from accidents and emergency departments, etc.

As reported in the investigation report on the WannaCry ransomware attack on NHS, published by the National Audit Office (“NAO”, an independent parliamentary body in the United Kingdom), all NHS organisations infected with the WannaCry virus had unpatched or unsupported Windows operating systems. NHS Digital (a national provider of information, data and IT systems for commissioners, analysts and clinicians in health and social care in England) informed the NAO that the ransomware spread via the internet, including through the N3 network (the broadband network connecting all NHS sites in England), though there were no instances of the ransomware spreading via NHSmail (the NHS email system).

In India, as reported by multiple news agencies, last year in the month of June, the Mahatma Gandhi Memorial (a trust-run hospital) hospital, Mumbai (MGM Hospital) was affected by a similar cyber-attack where the hospital administrators found their systems locked and noticed an encrypted message by the attackers demanding ransom in Bitcoins to unlock it. It was reported that the MGM Hospital had lost 15 days’ data related to billing and patients’ history, though the hospital didn’t face any financial loss.

Once these cyber offenders have access to the EHRs, they hold the systems of the medical institutions hostage for ransom, by encrypting all the systems completely inaccessible and unusable for the victimised medical institutions. The vulnerability to such cyberattacks may account to various reasons, such as outdated digital infrastructure, medical personnel unaware or untrained about cyberattacks. Cyber offenders may gain access to medical institutions’ systems through various ways and sometimes as simple as (a) using a USB drive; (b) exploiting vulnerable or expired software, (c) stealing medical personnel’s mobile devices, (d) hacking email or (e) phishing, etc. It is time that our healthcare providers upgrade their technologies, networks, and understanding on this subject.

Regulatory bodies across the world have suggested / adopted guidelines and cybersecurity processes and controls which help the medical institutions to mitigate cyber risks and vulnerabilities. In this article, we will be primarily focusing on various safeguards and standards put in place by the European Union and India to deal with such cyberattacks.

SCENARIO IN EUROPE

As a part of the EU cybersecurity strategy, the European Commission standards to ensure necessary adopted the EU Network and Information Security Directive (“NIS Directive”) on 6 July 2016 and it came into force in August 2016. As the NIS Directive is an EU directive, every member state had to adopt a national legislation which would transpose the NIS Directive by 9 May 2018 and identify operators of essential services under the transposed law by 9 November 2018.

The NIS Directive has three major parts to it (a) national capabilities, (b) crossborder collaborations and (c) national supervision of the critical sectors including health.

(a) National Capabilities: The NIS Directive mandates every member state of the EU to have certain cybersecurity capabilities, e.g., it is a mandate for every member state to have a national Computer Security Incident Response Team (“CSIRT”).

(b) Cross Border Collaborations: The NIS Directive encourages collaborations between EU member states like the EU CSIRT network, the NIS cooperation group, ENISA etc.

(c) National Supervision of Critical Sectors: As per the NIS Directive, every member state shall supervise the cybersecurity of critical market sectors in their respective country including health sector.

Further, as a part of the NIS Directive the NIS cooperation group through ENISA has developed guidelines regarding (a) identification criteria of cyberattacks, (b) incident notification, (c) security requirements for Digital Signal Processors (DSPs), (d) mapping of operators of essential services (OES) security requirements for specific sectors including health and (e) audit and self-assessment frameworks for OESs and DSPs.

With a view to prescribe certain standards of safety and quality, three recognised EU standards organisations namely (a) the European Committee for Standardisation (CEN), (b) the European Committee for Electro-technical Standardization (CENELEC) and, (c) the European Telecommunications Standards Institute (ETSI) were set up. By setting common standards across EU, CEN, ETSI and CENELEC ensure protection of consumers, facilitate cross-border trade, ensure interoperability of goods/ products, encourage innovation and technological development, and include environmental protection and enable businesses to grow.

The General Data Protection Regulations (“GDPR”) specifically define ‘data concerning health’, ‘genetic data’ and ‘biometric data’ and regards them as ‘special category of data’. This means that parties who are processing special category of data shall comply with additional higher safeguards and process it legitimately. Recital 53 of the GDPR states that special categories of personal data which merit higher protection should be processed for health-related purposes only.

THE INDIAN SCENARIO

Personal medical/health information in India is regarded as sensitive personal information as per the Information Technology (Reasonable Security Practices and Procedures and Sensitive Personal data or Information) Rules, 2011 (“Rules”).

The Indian legislature took an important step for addressing issues relating to cybersecurity when it amended the Information Technology Act, 2000 in 2008, through which they established an Indian Computer Emergency Response Team (CERT), a national agency for incident response. CERT is primarily responsible for handling cybersecurity incidents occurring in India and analysing information related to cybercrimes, but among other things CERT is also indulged in issuing guidelines, advisories, vulnerability notes and white papers relating to information security practices, procedures, prevention, response and reporting of cyber incident.

CERT-India has been entrusted with performing the following main functions (a) collecting, analysing and disseminating of information on cyber incidents, (b) forecasting and giving alerts on cybersecurity incidents, (c) laying down emergency measures for handling cyber security incidents, (d) coordinating cyber incident response activities, (e) issuing guidelines, advisories, vulnerability notes and white papers relating to information security practices, procedures, prevention, response and reporting of cyber incidents, and (f) performing any other functions relating to cybersecurity as may be prescribed.

CERT-India in the last five years or so has focused on making various institutions who are highly dependent on cyber/digital networks, i.e. are ‘cyber resilient’. Being cyber resilient allows these institutions to effectively anticipate the various threats and figure out the mechanisms of dealing with the cyberattacks. Anticipate, withstand, contain and recover are the 4 main contours of being cyber resilient.

Anticipate: Maintain a state of informed preparedness to forestall compromises of mission/ business functions from adversary attacks
Withstand: Continue essential mission/business functions despite successful execution of an attack by an adversary
Contain: Localize containment of crisis and isolate trusted systems from untrusted systems to continue essential business operations in the event of cyberattacks
Recover: Restore mission/business functions to the maximum extent possible subsequent to successful execution of an attack by an adversary
Evolve: To change missions/business functions and/or the supporting cyber capabilities, to minimize adverse impacts from actual or predicted adversary attacks

To strengthen the framework and ensure that reasonable security practices and procedures are followed, the Department of Information Technology introduced certain rules. The rules require each and every corporate body including medical institutions who collect sensitive personal information to have security measures as documented in their security policy/programme which is considered to be a reasonable security practice, keeping in mind the nature of their business and considering the fact that they are collecting sensitive personal information. One such international standard as recommended under the Rules is the IS/ISO/IEC 27001.

Taking a step further, the Ministry of Health and Welfare has introduced a draft bill for Digital Information Security in Healthcare Act (“DISHA”). One of the key purposes of DISHA is to ensure reliability, data privacy, confidentiality and security of digital health data. DISHA prescribes that the storage of digital health data so collected would be held in trust for the owner and the holder of such data would be considered as the custodian of data, thereby making such holder responsible to protect privacy, confidentiality and security of data.

To bring it all together:

Majority of the cyberattacks reported worldwide are caused due to reasons which sometimes are trivial and perhaps ignored more often, such as outdated Windows operating system patch, lack of proper antivirus or reasons such as phishing, lack of awareness among the people about cybersecurity, etc.

The EU, through GDPR has made data security an integral part of law and India is taking strong steps to set up a robust data protection and data security law. Various regulations, programmes, codes, standards, etc., discussed in this article are some key indicate steps that can be implemented.

Law is just one part to solve the issue. The real question is who is responsible for safety of our personal data, commercial data, data assets, etc.? We secure our houses with a lock, burglar alarms, video cams because the house owner wants to protect it. Similarly, individuals, organizations, healthcare personnel, hospitals and other institutions who collect health data for multiple reasons should be aware of various cyber-threats and must take steps to safeguard their networks and systems from such threats.

About the author:

Sharda Balaji is the founding partner of NovoJuris Legal, and along with being a qualified lawyer is also a company secretary and has been at the core of evolution of technology and IT laws in India.

Manas Ingle is a legal associate at NovoJuris Legal and works as a technology lawyer, where he deals with various legal projects relating

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Cyber-Biosecurity: Are we ready?

InnoHEALTH Magazine — Thu, 02 Aug 2018 08:42:50 +0000

Bertrand Russell once said, ‘War doesn’t determine who is right−only who is left”, thus ‘we need to update, upgrade and be prepared for our own survival’. These words sound more relevant in the contemporary phase in the wake of fast changing global scenario and emerging inevitability for updating virtually by spilled of seconds.

Amalgamation of biotechnological and information technology advancement in the 21st century has altered our world at the fundamental level which is evident in the area of health, manufacturing, and food security. Humankind has also witnessed malicious bugs like Y2K and Wanna cry in biological and cyber field respectively. We have reached new landmarks on our understanding of how biological systems work and also discovered ways to meaningfully manipulate these systems as per our advantage/ requirement. Biotech tools, such as gene drives, can deliberately engineer inheritable genetic traits into wild populations, offering a powerful new way to escape from certain vector-borne diseases.

Gene editing tools such as CRISPR-CAS9 (Clustered Regularly Interspaced Short Palindromic Repeats associated protein-9 nuclease) are being used globally for quick and precise gene editing. Researchers like to use computers to analyze DNA, operate lab machines and store genetic information. In the health sector, the digitization of biology & metabolic engineering accelerated the development of new vaccines, drugs, and painkillers. Agriculture is becoming smarter/digitized, with farmers relying on data-driven decision acquired through sensors planted in the ground, satellites guiding tractor movements and other new practices. But these emerging capabilities come with a whole new category of vulnerabilities and risks.

Also Read: IIT Kanpur Braces Up to Prevent Cyber Attacks

Over the last five years “technological barriers to acquire and use biological weapon has been significantly eroded.” The security impact of biotech advances goes beyond bioweapon. For example, developments in metabolic pathway engineering also offer opportunities to produce illegal drugs such as heroin. Scientists have already identified how to make the active compounds in other narcotics, such as for cannabis and precursors of LSD. What if a terrorist group or a despotic regime tries to spread modified organisms aimed at striking troops, frightening civilians, or putting food production in disarray? The failed attempt of Japanese cult to obtain Ebola strains from South Africa is one such indicator.

Recently Jean and coworkers (2018) highlighted the risks of using gene sequencing technologies to corrupt the databases by altering sequences or annotations. In this article, computer scientists designed a DNA sample that when sequenced, resulted in a data file which enabled the hacker to control the sequencing computer remotely and gave access to the hacker to make changes in DNA sequences. These alterations could delay a research program causing capital, labor loss or can be used in act of terrorism for uncontrolled production of toxins or infectious agents. To mitigate these risks, the culture of the life sciences community needs to shift from trusting blindly to a highly aware and trained community. This also requires intricate relationships between the computational and experimental dimensions of product development workflows.

The diverse nature of pathogens and toxins with their potential to be used as a biowarfare agent (BW) could be attributed to multiple factors. These include infectivity (the number of organisms required to cause disease), virulence (the severity of the disease caused), transmissibility (ease of spreading from person to person), and incubation period (the time from exposure of a biological agent to the onset of illness). All these attributes are manageable by modern biotechnology and information related to such experimentation trials is key to any covert attack using these for BW.

Similarly, in the cyber world, there is a diversity of malicious codes. These include viruses (programs that replicate in target machinery); worms (self-sustaining programs) and carriers such as a trojan horse to perform a legitimate function with malicious activity. Additionally, Botnets, or networks of computers infected with malicious code, can be coordinated to perform distributed denial of service attacks. For biological weapons, delivery vehicles range from advanced aerial spray technology to contamination of food products or water, while malicious code in cyberspace can be delivered by usage portals, email, web browsers, chat clients, web-enabled applications, and updates. The cyber threat has expanded dramatically in recent years with a series of damage. Terrorists are using cyber capabilities over traditional methods to target 104 countries including India.

Also Read: Time To Take Some Intelligent Decisions

Governments and security experts have singled out the life sciences sector as being significantly vulnerable to cybercrime. In cybersecurity terms, innovation is fast 50 Volume 3 | Issue 3 | July-September 2018 becoming a double-edged sword for life sciences clients. Recently FireEye disclosed the threat posed by two Advance Persistent Threat (APT) groups which gained access to the environment of a leading pharmaceutical company for up to three years prior to detection. They stole IP and business data from the victim, information on bio cultures, products, cost reports, and other details pertaining to the company’s operations abroad. There is nothing more important to a pharmaceutical organization than the formula for one of its new drugs.

For cyber biosecurity, employee training should be given priority. It can greatly increase an organization’s general awareness of these new risks. Similar to biosafety training, cybersecurity training modules and policies should be introduced. Secondly, organizations should perform a thorough analysis of its exposure to cyber biosecurity risks not covered by existing biosafety and biosecurity policies.

Training exercises based on this type of analysis will encourage participants to review their workflows and identify their vulnerabilities. It is high time now to evolve a policy framework to detect and prevent security threats that may compromise life sciences assets. It includes guidelines on synthetic DNA targeted companies that provide DNA synthesis services to monitor research focus and relates features.

Bioinformatics software is still not hardened against attack. Encouragement of widespread adoption of standard software best security practices like input sanitization, the use of memory safe languages or bounds checking at buffers, and regular security audits is necessary. Patching still remains challenging as the analysis software are often located in individually managed repositories and not regularly updated. One solution is to use a centralized repository to manage updates and deliver patches, similar to the APT package manager.

These could also be signed to ensure their authenticity. In the case of file sharing, the sequencing files themselves could be signed by verified research groups before uploading them to centralized databases. This is just the glimpse of the long list of strategies that need immediate deployment, continuous review, and improvement with time.

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OPERATIONAL INNOVATIONS AND ITS IMPACT ON HEALTHCARE DELIVERY IN INDIA

InnoHEALTH Magazine — Mon, 01 May 2017 10:35:53 +0000

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Operational Innovations and its Impact on Healthcare Delivery in India

Arvind Sivaramakrishnan is Chief Information Officer, Apollo Hospitals Enterprise Limited. He is currently responsible for the IT strategy and implementation across the Apollo Hospitals group. He has previously worked as the Director of Clinical Applications at Healthcare Practice of Computer Sciences Corporation, Michigan USA.

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The surge to bring out the potential of Indian Healthcare market needs to aim at finding suitable solutions to increase precision treatments, extending reach of healthcare delivery beyond urban cities, and to reduce considerable healthcare delivery cost. It is true that the Indian IT sector is expanding with more and more mobile phones and Internet cafes connecting people from even the most remote places in the country. This trend can be leveraged for reducing complex workforce and overheads in Indian healthcare operations. Telemedicine as an option can bridge distances while inducing minimal infrastructural cost.

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As per estimates, the telemedicine market is made up of at least 800 million Indians. While lack of accessibility, infrastructure, and quality healthcare services have impaired healthcare delivery in rural areas, it is heartening to know that with the support from the government, India as a country is warming up to the concept of convergence of healthcare and technology, and how it will bring about optimized and precise results. Indian healthcare is today taking the centre stage with its growing potential to merge tools of Information Technology to deliver better healthcare services in our country.

However, India as a country can no longer afford slow transformation in healthcare. We need a dynamic change in ways of how healthcare can be better delivered to all. CRISIL projects the healthcare delivery market to grow at a CAGR of 12 percent and attain a reach 6.8 trillion by the year 2020, which implies that there is a vast scope for penetration and innovation in the current Indian healthcare condition.

The most approving route to reduce healthcare costs is to invest more on process innovation than product innovation. Healthcare providers innovating their business processes, not only reduce cost but also enhance efficiency and quality of healthcare delivery. With growing interest from the government to bring in more PPPs it is rather a good time for Indian healthcare players to horizontally and vertically innovate their separate healthcare activities.

It is true that the Indian IT sector is expanding with more and more mobile phones and Internet cafes connecting people from even the most remote places in the country. This trend can be leveraged for reducing complex workforce and overheads in Indian healthcare operations. Telemedicine as an option can bridge distances while inducing minimal infrastructural cost.

The usage of predictive data analytics can help in bringing about speed in diagnosis of patient conditions thereby ensuring that the right treatment protocol is initiated as quickly as possible. This translates to an overall increase in the operational efficiency of the health system.

On the other hand, connectivity issues, interrupted power, lack of trained people to manage the centres, and the preconceived notions of the prospective users — doctors and paramedical staff – come in the way of successful implementation. With combined effort of health institutions and with the government implementing various schemes to reduce medical cost, one could not deny that Indian Healthcare scenario is going through a revolution, the results of which will be reaped within a span of next 10 years. We as individuals need to accept and adopt the constant changes brought in through Information Technology in our health practices and make sure that India becomes the most preferred health destination of the world in the upcoming years.

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INNOVATION — THE CURRENT FRONTIER

InnoHEALTH Magazine — Tue, 25 Apr 2017 05:44:17 +0000

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Innovation – The Current Frontier
Sandipan Gangopadhyay is President and COO at GalaxE.Solutions, Inc. He has spent over two decades in high-profile roles in both Pharmaceutical and Information Technology companies around the globe, including designing and implementing innovative bulk drug manufacturing processes based on gravity feed, inventing fault tolerant operating systems and setting up one of India’s first private Software Technology Parks. He is a member of the Indian Institute of Chemical Engineers, and is certified in the Governance of Enterprise IT. He brings his passion for innovation and truly revolutionary technology helping people live healthy and forever.

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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.

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Does IT Drive the Most Innovation Today?

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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.

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How Can IT Innovations Drive Better Health?

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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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I-Tech to make Healthcare Hi-Tech

InnoHEALTH Magazine — Tue, 28 Feb 2017 09:15:17 +0000

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I-Tech to make healthcare Hi-Tech
Konda Vishweshwar Reddy is an Indian politician and a member of parliament from Telangana. He won the Indian general election, 2014. He worked as CEO & Managing Director of Wipro Healthcare IT Ltd., CEO & Managing Director of GE Medical Systems Information Technology and Managing Director, Citadel Research and Solutions, Ltd. He is involved in various health care programs and has conducted many health camps and health education programs with an emphasis on women and child health and nutrition.

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The human body is definitely the most complex machine that mankind ever had to work on. With Kurt Godel’s theory of incompleteness essentially meaning “no system can understand itself” becoming an axiomatic truth and David Hilbert attempting to prove that a system can be a complete system and can understand itself, he could not fructify his attempts through a mathematical process, now called the Hilbert Program.

In essence, what this means is that, the doctors have to work with something they do not completely understand – the human body. Yet their work is of utmost importance, the outcome of which impacts the quality of life and death itself. Unlike engineers who use logical mathematics to work on machines which are incomparably simpler than the human body, or lawyers who used law and reasoning in the profession, doctors do not have the luxury of simply applying logic or reasoning or mathematics on a complex and incomprehensible machine. Any such unscientific attempt may turn out to be risky. Doctors essentially have to be dependent on knowledge while practicing medicine.

Healthcare is a knowledge-based business. Data is sounds, electrical signals, lab parameters, names, numbers etc. When data is structured and labelled, it becomes information. When information is put into context, it becomes knowledge. Data has no meaning in itself and is not comprehensible. While information is comprehensible as compared to data, it is not sufficient to take executable decisions. Knowledge can be used to understand objects and conditions based on which executable decisions can be taken. Unlike engineering and law, modern medicine has taken this route as the professional approach and probably the only way when dealing with a complex machine such as a human body and mind.

Then came computers and information technology. And Information Technology is all about converting data into information and information into useful knowledge, exactly what doctors have been doing in the profession. The enlightened doctors knew the significance of Health Informatics in the seventies. Strange as it seems, Information Technology can help doctors more than it can help engineers, lawyers or Chartered Accountants.

Challenges in Health Informatics: The healthcare industry has been slow to adopt information technology. Many factors have been attributed to this: doctors’ reluctance to adopt new technology, lack of budget for computerization in hospitals, lack of suitable software and products, etc. However the biggest challenge was the very nature of information in healthcare as compared to the nature of information in other industries. In the banking industry, for example, the nature of data is related to account numbers, amount of money in the account, amount of money to be withdrawn or transferred to another account etc. This type of data can easily be converted to information and conveniently designed to fit into database. In an airline industry, the data is related to seats reservation, name of the destination, name of the passenger, cost of the ticket etc. Similarly, in the hotel industry, the information is about room reservation, booking dates, cost of the room etc. This information too is simple for conversion.. In contrast to this, the nature of information in healthcare is very complex and the content of data is humongous. In fact, a single 300-bed hospital can generate more data than the State Bank of India with more than 85000 branches in the country. And this is the reason that more than 20 years ago you could transfer money from one bank to another bank electronically; more than 20 years ago you could book a hotel room in Australia sitting in India; and more than 20 years ago you could even book an airline ticket from anywhere in the world to any other destination. Despite this, even today we are unable to transfer electronic medical record from one hospital to another.

This also brings to us yet another problem – standards in health informatics. One is the very nature of information in the healthcare industry and the other is the challenge of standardization of the information across the enterprises in the healthcare industry.

Standards in Healthcare IT: The industry recognises the need of standards in healthcare IT. There are broadly five categories of standards:

1. Codes and Terminology standards – codes and terminology for clinical observation, for diseases / diagnosis, for procedures / surgeries, drug codes etc.

2. ID Standards – patient ID, physician ID, institution code etc.

3. Formats and contents standards – Data capture forms and minimum data sets.

4. Communication and messaging protocols

5. Security and access control protocols

The first category of standards that is the Codes and Terminology standards primary deals with the problem of health informatics – trying to put the code to a particular human condition so that it fits in a database. The observations of the doctors go merely

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beyond reading lab reports and patient vitals, the observations sometimes border on intuition. Clinical observations are highly nebulous data and codifying it and trying to fit into database is like trying to capture a cloud and putting it in a box. Capturing the severity of the condition is a special challenge that has not yet been overcome. The other categories of standards are more to do with technologies and implementation. Recognising the problems of lack of standardization through the 70s, 80s and 90s, many groups and organisations started developing standards for various aspects of Healthcare IT, leading to the problem of “too many standards” dwarfing the very purpose of standardization.

We are now attempting to overcome this situation and universal standards have begun to emerge. On the clinical side ICD codes, LOINC and SNOMED are becoming the most widely accepted coding systems. SNOMED has, by far proved to be the most comprehensive clinical coding system. While its very complexity is daunting, healthcare organisations and doctors are just beginning to use it.

Standards for Drug codes are as important as disease codes to avoid item identification errors. But going beyond standards for drug coding, if all the attributes of the drugs are captured and coded, then not only the item identification errors would be eliminated, but also potential medication errors by doctors, nurses and pharmacists can be avoided through Drug Decision Support systems. If the drugs are mapped to all their clinical attributes like indications, contraindications, side effects, drug-drug interactions, etc., then the system will have the ability to act as a drug decision support system, significantly reducing or eliminating medication errors. In India we do not have a National drug to start with, something that needs to be addressed urgently.

But the Holy Grail of health informatics is achieving semantic interoperability. Semantic interoperability goes beyond merely using the same set of codes – disease codes, drug codes, procedure codes between two systems. Firstly, the code or the term should have the same taxonomy, context and meaning in both the systems. Secondly, the code or the term should have the same taxonomy context and meaning in the system and outside in the real world, as to how the doctors, nurses and healthcare professionals understand and use the information. A simple non-clinical example- in the patient registration form, if the patient’s age is 6, then to the outside world, it means that the patient is a child; to the admission clerk, it automatically means that the patient should be admitted to a paediatric ward; to the billing person, it means that the payer is not the patient but the patient’s parent or guardian; to the F&B department, it means that the patient should be served child’s meals; to the housekeeping department, patient’s age 6 years means that the patient should be supplied with a child size patient gown; to the biochemistry department, it means that the patient’s lab parameters are different; and to the doctors and nurses, it means that the patient needs to be given paediatric dosage of medicine and many other such indications. In the outside world, the term “age 6” is merely the number of years since birth, but in the real world, the term “age 6” has lot more implications that the human brain processes automatically. And true semantic interoperability is achieved through proper taxonomy, mapping, capturing minimum data sets of attributes of the code or term. Semantic interoperability makes the system intelligent without the need for dependent on high cutting edge technologies like artificial intelligence etc.

Wisdom is a combination of knowledge and experience. In the human world wisdom comes with age. In reality wisdom merely means a lot of knowledge available at one point or person. And for humans, lot of knowledge by one human is accumulated only across years and years of gaining knowledge through experience. However, in a system where information and knowledge is accumulated from inputs and experiences of numerous individuals and their clinical observations, the system can gain wisdom in a short period of time. And we hear terms like wisdom management system in information technology.

Whether it is e-health or Telemedicine or EMR or Hospital Information Systems, the greatest challenge in health informatics is definitely not the technology or its costs. It is in the semantics- words and terms, their meanings, how they are codified and represented in computers, how their meaning essentially remains the same in the computerized information system and in the real world healthcare, standardization of terms and codes representing information across two different systems or two different enterprises – when these challenges of semantics are overcome, the true benefits of health informatics can be realised. Medical errors start to disappear; clinical knowledge gets institutionalized in a manner that junior Doctors can start performing like highly experienced doctors, best practices can be extracted from the system and database, EMRs start yielding clinical wisdom.

Now, this leap in technology for health informatics is what we look forth to!

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