The companies who pitched and the expert panel were:
Companies Pitching:
● DocOnline Health India Pvt. Ltd.
● EMPE Diagnostics
● HealthCubed India Private Limited
Expert Panel:
● Adarsh Sharma, Financial Expert
● Sohini Mandal, Lawyer
● Nidhi Gani, Regulatory Expert
● Dr Vidur Mahajan, Industry leader
● Vishal Gandhi, Investment banker
● Dr Ravi Gaur, Industry leader
● Kshitij Chaudhary, Investment facilitator

Ajit Nair, DocOnline Health India Pvt. Ltd presented A Doctor Consultation Platform. Their core product offerings include – Last mile Clinical Delivery Platform/E Clinic Solution. They also enable a Clinical marketplace for their customers. DocOnline Health provides Doctor Consultation via video/audio and chat. Our Product is a secure platform ensuring data privacy. Provide Electronic Health Records for our customers. Doctor Consultations are provided in multiple regional languages. Flexible platform to derive clinical insights and Artificial Intelligence.

Pawan Asalapuram – EMPE Diagnostics presented his EMPE’s indigenous, customized test kits that can provide YES/NO answer in 60 min by developing visual signals and provides reliable clinical information already during the first contact point between the doctor and the patient. Our affordable tests are designed to operate even in resource-limited clinical laboratories, including medical camps.

Sridhar Ramanathan, HealthCubed India Private Limited has enabled better diagnosis for a patient by creating an ecosystem comprising of a multi-parameter point of care device operated with an easy to use the software on a mobile platform. It can screen for Vitals, Non Communicable diseases, and infectious diseases. It can expand the number of tests from 24 today to 65 based on user needs. Data is instantly backed-up in the cloud for further analysis.

Young Indian Innovators Compete with Best Brains

There are several innovations happened in healthcare delivery. Some of these are given below (figure 1):

• Product innovation
• Process Innovation
• Service design Innovation
• Service delivery Innovation
• Business model Innovation
Innovations in healthcare improves adaptation and affordability.

Product Innovation is concerned with introduction of new types of goods and services for the external markets. This includes significant improvements in technical specifications, components and materials, software, user friendliness or other functional characteristics. Examples include wearable devices, portable ECG of GE, Intra Ocular lens of Aravind Eye Hospital, Jaipur foot etc. These innovations help in generating incremental revenues [2]. Some of the main products include patient monitoring devices, home care and health and fitness. Wearable devices market is growing at the rate of 4.8% on year-on-year growth [3].

Process Innovation is mainly implementation of a new or significantly improved production or delivery method. This includes significant changes in techniques, equipment and/or software. These innovations help in improving internal capabilities and quality improvement [2]. Some of the examples include use of computerisation of medical records, improvement in the use of medical equipment like in Aravind Eye Hospital where surgical equipment is being used for two tables.

Service Design Innovation mainly focus on design of man-machine system compatibility including customisation of devices and its functioning. For example, customising the pulse rate of pacemaker implanted to a patient. Examples include telemedicine, mobile healthcare units, small clinics in the vicinity of patients, collaboration with other stakeholders etc. Figure 3 shows

Service Delivery Innovation include the use of new methods in delivering the service and helps in cost reduction as well as turnaround time of care delivery. This include innovation in medication, surgical interventions, procedure etc.

For example, use of iphone for taking picture of eye and checking for preliminary diagnosis in place of a computer or other equipment. MRI, CT Scan, Cataract surgery etc. Figure 4 shows arrangement of eye check-up equipment on a two wheeler which can reach to the location where four wheeler mobile unit cannot reach.

Apart from these four innovations, one of the most important one is business model innovation. This is mainly focuses on number of alternatives and pricing of products and services. Examples include offering two or three options for surgical services along with other support services like room with air conditioner or without air conditioner etc. Providing enough number of winning alternatives refers to business model innovation.

Diffusion of innovations in healthcare requires acceptance of innovations by the different stakeholders mainly the care receivers (patients), care givers (doctors and others). This requires alignment of knowledge, technology and institutionalisation of practices. Innovations in healthcare helps government to provide conducive environment for innovation and collaboration opportunity between public and private organisations. Facilitate in implementing healthcare initiatives in large scale by optimising resources and their deployment.

References:

1. S rivastava S C and Shainesh G (2015), Bridging the service divide through digitally enabled service innovations: Evidence from Indian Healthcare service providers, MIS Quarterly, Vol 39(1), pp: 245-267.

2. O machonu V K and Einspruch N G (2010), Innovations in Healthcare delivery systems: A conceptual framework, The Innovation Journal: the public sector innovation journal, vol. 15(1), pp: 1-20.

3. http://www.todaysmedicaldevelopments.com/article/wearable-medical-devices-2016-market-72816/
https://www.innovation.cc/scholarly-style/omachonu_ healthcare _3innovate2.pdf

About the author

S Venkat is an Associate Professor in Operations Management at IIM Lucknow, India. His interests include healthcare operations management, affordable healthcare design for bottom of the pyramid consumers, Managing operations in religious organisations etc.

Ransomware epidemic is spreading in healthcare like wildfire due to its increasing digitalization which is and will attract more attention of hackers.

The healthcare industry has been a victim of various cyber attacks in the last few years. According to recent studies, healthcare has outnumbered financial services and become the most cyber attacked industry. The latest in cyber-attack is ransomware wherein the hacker encrypts the data and threatens to publish it until the ransom is paid in form of bitcoins. In US alone, healthcare industry was the victim of 88 per cent of all ransomware attacks across industries last year.

The recent case of WannaCry ransomware crippled the IT systems of NHS, UK. And after hitting NHS, it spread globally targeting more than 99 nations. The hackers demanded payment of £300 – £600 to unlock systems and have earned about £55,000 in ransom.

Ransomware has indeed become a lucrative revenue source for hackers due to which the number of attacks is predicted to quadruple by 2020. Medical records have 10-20 times more value than the credit card data in the internet black market. Ransomware epidemic is spreading in healthcare like wildfire due to its increasing digitalization which is and will attract more attention of hackers. Also, the vulnerability of the health data tends the organizations to pay the ransom to get the data back to maintain privacy and confidentiality of patient data.

Even after so many cases of cyber attacks compromising millions of electronic health records each year, the healthcare industry is inadequately prepared to prevent and resolve these attacks. Whether it is India or US, cyber security is always discussed in forums and budget is allocated for the same but is not put to proper use. Cyber attacks happen due to outdated security infrastructure or employee negligence.

Hospitals and insurance companies have been the main targets of hackers. But, a new vulnerability is catching everyone’s attention i.e. medical devices. The next nightmare in ransomware attacks could be hacking of medical devices such as insulin pumps, pacemakers, defibrillators, implants etc.

Disfunctioning of medical devices can be catastrophic. Just imagine, hackers take control of one’s pacemaker and ask for ransom or else they would manipulate the device which could be fatal. This kind of attack has been showcased in the very famous TV show Homeland wherein the Vice President dies due to hackers remotely disable his pacemaker.

Just like the serial, the former US Vice President Dick Cheney’s doctors disabled his pacemaker’s wireless functionality due to fear of possible assassination attempts as revealed by him during an interview in 2013. This clearly showcases that medical devices can be the next target for hackers.

Regulators such as FDA are increasingly getting concerned about medical device security and have issued warning. In 2015, for the first time FDA issued safety notice to hospitals which strongly discouraged hospitals to use an infusion pump which was found to be vulnerable to cyber attacks. But it has been observed that FDA did not force the company to fix the devices being used in the hospitals and didn’t investigate other insulin pump models. This shows that FDA needs to be more stringent towards medical device security. The vulnerability of infusion pump was pointed out by a white hat hacker Billy Rios during his hospital stay.

Few of the medical device companies/providers have been proactive in strengthening their device security such as Johnson & Johnson in Oct 2016 warned 114,000 diabetic patients about a security lax that a hacker could exploit in one of its insulin pumps (J&J Animas OneTouch Ping). The hackers can disable or alter the dosage which could be fatal. J&J suggested ways to the patients for mitigating risk.

There have been no documented cases of medical device hacking till date but demonstrations have been conducted in research environment. One such example is of Barnaby Jack who succeeded in hacking an insulin pump and demonstrated giving off lethal dose of insulin without the pump alerting the user. Another example is that of St Jude Medical’s implantable devices such as pacemakers, defibrillators, and resynchronization devices. The radio frequency (RF) enabled St. Jude medical implantable cardiac device and corresponding Merlin@home Transmitter enables transmitting and receiving patient data stored on the device to the physician to monitor his health. But FDA reviewed the device and confirmed about cybersecurity vulnerabilities, if exploited, could be fatal.

Also, researchers at TrapX Security analysed three hospitals for medical device hacking. The deception technology was installed which utilized emulated medical devices in the hospitals. These emulated devices attract and trap hackers so that TrapX could trace the hackers activity. These fake medical devices such as Radiation Oncology system, LINAC , Fluoroscopy, PACS and Xray system appeared real to the hackers and TrapX could monitor hacker’s activity.

According to TrapX, these hospitals utilized older version of Windows that made it vulnerable and most medical devices did not have additional endpoint security software which made the attack undetectable. It was also noticed that the main goal of hackers was to steal medical records not to manipulate the device.

Another research at University of South Alabama showcased how they hacked pacemaker and killed a medical simulator called iStan. The $100,000 medical dummy comes equipped with robotics that mimic the human cardiovascular, respiratory, and neurological systems. The researchers could speed the heart rate up or could slow it down. Not only pacemaker, researchers could manipulate an insulin pump or a number of things that would cause life-threatening injuries or death. This clearly illustrates why medical device security is important.

With the advent of IoT, where devices are connected via internet should focus on cyber security. Industrial experts are realizing that cyber security is prime priority for all the devices connected to the internet.

Devices such as wearables, smart bed, smart emergency system, etc. are all lagging behind in cyber security. Apart from medical devices, surgical robots are not being scrutinized for cyber security. Just imagine, surgical robots been hacked which could lead to life threatening situation of the patient. One such demonstration has been showcased by researchers at University of Washington in 2015. They hacked a tele-operated surgical robot, Raven II. The experiment demonstrated three types of attacks that made telesurgery vulnerable with this robot. The researchers demonstrated how they took complete control over the robot and disrupted the operation.

All of this sounds scary but it can be prevented if we are well prepared. It is important to understand that not only regulators like FDA need not address the challenge of cyber security but also the medical device vendors and providers should take shared responsibility. It has been observed that providers point the device manufacturers to be accountable for cyber security for responding to vulnerabilities and providing fixes for the same.

On the other hand, the device vendors hold providers responsible for their negligence and having outdated network  protection. To be safe from such attacks, organisations should review their cyber defence strategies and budget. Also, employee training and awareness needs to be tackled to avoid falling for opening phishing mails and change passwords regularly.

It has also been observed that providers such as middle scale hospitals, clinics or laboratories have often overlooked cyber security as priority as they believe not much data is present with them and only the big organisations are in trouble. Which is not true, as hackers are aware of the precious financial and patient data these clinics hold and are aiming at clinics or small hospitals also to get the data. So, they should also focus on medical device security.

The next big thing in helping fight against cybersecurity is artificial intelligence (AI). According to some analysts, the advantage of using AI is it can help predict cyber attack before it happens with the use of behaviour analysis. It alerts security team on any behaviour deviation or authentication failures while accessing records. AI not only helps in detecting threats quickly but it is also cost efficient compared to the money paid by companies in ransom. It does not replace security tools but acts as an additional layer of security. AI can also help in analysing employee behaviour for avoiding any internal security breach. AI can help in bridging the shortage of skilled cyber security professionals also. According to Centre for Cyber Safety and Education, there is a shortfall of 1.8 million cyber security professionals by 2022 worldwide. Companies such as IBM are already investing in AI system Watson for cyber security.

Also start-ups such as Cognetyx are providing cognitive cyber surveillance solution to healthcare organizations. Use of AI for cyber security in other areas has been showcased, for example, the Las Vegas city officials and UK government to monitor their Public Services Network and protect their records from security threats. Whereas, the successful implementation of AI in healthcare cyber security is yet to happen.

The next wave of medical device cyber attacks can be prevented by collaborative approach and commitment from all the stakeholders. Not only the healthcare organizations should make sure their security practices and strategies are updated but the government should also help in skill development of cyber security professionals and encourage more research on medical device security by providing medical device at low cost. Since medical devices are expensive and require license, it makes it difficult for researchers to explore this area. At the end, we should not forget that we have to stay a step ahead of hackers to be a hard target for them.

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Apollo Sugar set up by Apollo Hospital group in collaboration with pharmaceutical company Sanofi, plans to set up 100 clinics by the end of 2018 and 300 clinics over the next three years. It currently operates 52 clinics across India. It aims at providing quality comprehensive diabetes care under one roof at cheaper rates. Apollo Sugar is focusing on tier-2 cities and rural areas for expansion. Right now, it is operating in metro cities like Chennai, Bengaluru and Hyderabad.

According to estimates of Union Health Ministry, the total spending on diabetic care is about Rs 1.5 lakh crore per annum in India and every patient spends about Rs 30,000 a year on diabetic care.

ICESENCE3

IceCure Medical’s IceSence3 has been used by US doctors since 2011 to remove benign breast lumps in a 10-minute ultrasound guided procedure that penetrates the tumor and engulfs it with ice. The system is being clinically tested over the next few years against small malignant breast tumors as well. The procedure is done in a doctor’s office, clinic or breast center, and the patient can get up and leave afterward with no recovery period or post-care.

TOTAL LIFT BED

VitalGo Systems’ Total Lift bed is the world’s only hospital grade bed that can elevate a patient from a lying to a fully standing position and all points in between for treatment and transfer with no lifting required of the caregiver. Total Lift beds are used in the acute-care and home-care markets in the United States.

Want to write for InnoHEALTH? send us your article at  magazine@innovatiocuris.com

Read all the issues of InnoHEALTH magazine:
InnoHEALTH Volume 1 Issue 1 (July to September 2016) – https://goo.gl/iWAwN2 
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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
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Want to write for InnoHEALTH? send us your article at  magazine@innovatiocuris.com

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 
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Time seemed to be flying, when I was in conversation with a very jovial person Dr David Kirkpatrick, a General Practitioner at Al Zahra (Pvt.) Medical Centre. His take on life is truly an admirable one and he makes you feel that life is all about exploring opportunities in the right way and with the right attitude it can be never too late to build on a dream and acquire it.

He came to UK when he was five years old, and completed his entire schooling there. For three months thereafter, he was clueless about the direction he would be taking in life. Medicine was not at all in the radar for him, not until he had worked in a hospital environment. Today, he has been a practising GP for about 30 years.

His mother one day remarked,“ You have gone through a very expensive education and you cannot stay like this Ð doing nothing”. He gave an interview for a job with the London Police and the Navy and finally found a job at Radcliffe Hospital, Oxford in U.K. where he worked for about a year as a potter in an X-ray dept.

Dr Kirkpatrick said, “When I went home returning from my job Ð one night, my mother said ‘Have you had any more thought about what you want to do?’ I replied, “You know mother, I wish I had done medicine, I really love that hospital environment.” Immediately his mother said that his grandfather had left some money in a trust and the trustees would be happy to know that he wanted to get back to school to study science.

Without wasting any more time, Dr Kirkpatrick decided to go to St. Edwards School in Oxford for 12 months to do ‘A’ levels in physics, chemistry and biology. He had done English, history and French. He joined the Middlesex Medical School and Hospital in London for further training and then went on with his further education in the field of medicine. By then he was already focused on becoming a General Practitioner.

He got married in 1976 and then they travelled to New Zealand, where his wife was offered a job. He says, “We had planned to stay in New Zealand for a year or two but we stayed there for 26 years. I had my own practice for 23 years in New Zealand but wanted a change from the same atmosphere. We had good friends, a nice lifestyle and house but when our boys left university and were independent, my wife wanted to travel again.”

“In May 2002, we stopped in UAE on our way back to England that time I gave a couple of interviews in a few hospitals in the UAE. On 2nd November 2002, we arrived in the UAE to settle here and I started my job with Al Zahra Hospital on 9th November 2002.”

He says, “It has been a good experience at Al Zahra, as I get to see an extraordinary range of cultures and nationalities walking into my room for consultation here in Dubai, which I did not see in New Zealand. I am happy to be working with nice people and in good surroundings.”

“Another good thing about being in Dubai is travel,” he says. “Travelling back home and visiting other places in the world from UAE is very convenient compared to New Zealand.” He has been to Africa, Morocco, Petra, Thailand etc…, but finds the Fiji Island the best travel destination. He wants to see the TajMahal and visit Bhutan and many other places across the globe.

He is also a passionate photographer, who likes to capture candid pictures of people and beautiful places on film. He has gathered thousands of photos in his computer. He states, “I disappear in my study area for hours to play around with my collection in Photoshop.” However, he admits it to be a very time consuming hobby.

He finds great delight in practicing his cooking skills on a regular basis. “I feel cooking is a great way to relax. When you get back home after a busy day at work, just put on an apron and get into the kitchen to try out some delicious recipes. It is a nice way to stay away from stress. I love playing golf, squash and tennis but don’t get much of a chance to play,” he discloses speaking about his pastime activities.

“I like to do some form of exercise every day. We have a gym and pool in our building; I manage to go for a workout 2-3 times a week. I feel exercising and walking helps me think better. I often find myself composing e-mails and narrating new ideas well while I am exercising.”

Talking about his philosophy as a doctor he reveals, “I feel that doctors should be teachers. When patients walk out of their room, they should have an idea of what is wrong with them. You have to set aside more time for each patient to explain to them what is going on with them. You have to simplify, a complicated matter to explain it to your patients.”

“I follow a simple rule, I limit myself to giving three bits of information to each patient and I repeat the information twice for my patient to understand it thoroughly and this works. The formula is simple distil down a complex matter into something that you can describe in a few minutes and hope your patient will absorb it and remember.”

“Another important thing to remember to be a good GP, is that it is important that you have to know what you do not know and you should be prepared to admit the same. In addition, you should have some idea of what is wrong with your patient and whom to refer to for further consultation.”

He concluded with his thoughts about being positive, “I feel good about what I do if a patient leaves my room happy and satisfied with my service. I am a positive person and I am positive about people and I think most people are good people.”

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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

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