Wednesday, June 8, 2016

Key Note Address @ Science and Technology Week JWTC GE Bangalore


I got a rare honor: I was invited by GE to deliver a Key Note Address @ the Science and Technology Week in JWTC GE Bangalore on 16th May 2016. I spoke about the New Healthcare Aggregators: SMAC and IoT.

The era of hierarchical command and control is over. Now is the time for horizontal networking across Communities of Practice [CoP]. Whatever gets the maximum likes becomes the In Thing. Whatever is the In Thing gets used the maximum. Students are learning more from the online networking than from the formal classroom and professors. Research will reach the point of use as soon as it gets published. Primary care Providers in semi-urban and rural areas will have access to latest therapeutic recommendations. The old Adage that 'Knowledge is the only form of power that is not expendable but grows when shared' has become true.

There is a huge Vacuum in Indian Healthcare-IT space. Large Healthcare-IT vendors have exited the market. Either they lost interest and exited or got bought out. Also the market is moving from client-server to cloud and from Capex to Opex models. New cloud based players are small in size and yet to reach enterprise class. Existing players are not able to shift out to cloud because of their long term negotiated contracts in client-server model. The time is now when full conversion of Enterprise class to SMAC will happen anyways. Healthcare CIOs can keep eyes closed or tighten the belt and ride the Digital wave.

https://www.linkedin.com/pulse/new-healthcare-aggregators-smac-iot-dr-pankaj-gupta

Tuesday, May 24, 2016

CAUSE Methodology for Healthcare Organization Change Management

For Boot-Strapping Healthcare Organisation Change Management, I follow my proprietary CAUSE Methodology for managing change in people, process and technology. This has emerged out of our collective experience of managing change in healthcare organisations.
  • Consciousness of need to change: The people must be informed by the Head of the organization again and again until they are very clear in their mind about why the change in needed. There is no over communication for this. Treat the organization like an anxious child about to undergo a surgery and will need a lot of reassurance.
  • Aspiration to support change: The organization must Aspire to support the changes. Since the organization is going through a transition this is an opportunity for the organization to redefine itself across the organization. The Aspiration must come from within not without.
  • Understanding how to change: Once the organisation is conscious of the need to change and they aspire for the change from within then they are ready to be trained. Before this stage any trainings will be futile. Now train the team on new processes and technology extensively, again and again till it becomes second nature to them. Keep Checking for gaps in knowledge between expected and achieved.
  • Strength to over come hurdles and implement change: It is important to realize that processes will break and problems will happen when such a major implementation is done. Trick is to recognize the problem areas before it is too late to avoid big failures. Top management should be ready to cope up with the hurdle and internal resistance and not buckle down under pressure.
  • Ecosystem to support, sustain and adopt change: Lot of support is required in terms of hand holding and training till the change gets adopted by the users and is irreversibly embedded into the ecosystem. Unless you support the change till it becomes an ecosystem the change will not last. It will swing back to zero as an elastic and throw the organization into chaos.

My experience spans Organization change management, Business transformation, Clinical transformation, Knowledge management, Transition management, eHealth Consulting, mHealth Consulting, Chronic Disease Management, Solution design, Implementations. Due to my background and experience I am interested in Healthcare Operations, Pharma, R&D Labs, Medical Devices, IoT, SMAC, next generation technology platforms for Digital Hospitals.
CAUSE Methodology is an outcome of having done organization change management over and over again. I have applied this framework to many healthcare organisations in terms of IT, Process, Quality and Management changes. 

Tuesday, April 26, 2016

MBA Healthcare IT course jointly by Chitkara University Chandigarh and ProMed.Network AG Germany

Specialised 2 year Full-Time MBA Healthcare IT course is starting July 2016. Brought to you jointly by Chitkara University Chandigarh and ProMed.Network AG Germany <www.promed-network.in>. Students wanting to make a career in Healthcare-IT can fill the MBA Application of Chitkara University <http://www.chitkara.edu.in/mba>; Tick the MBA Healthcare and with pen write Healthcare-IT on top of it. Hurry!

The course is unique because it has 1 year of classroom and 1 year of hands-on practicals and internships. The classroom training goes equally deep in Healthcare and IT. Taught by people who have Healthcare and IT knowledge in the same brains. Be prepared to be drinking from the fire hose!

Friday, April 15, 2016

Free ProMed.Community for Clinicians

www.ProMed.Community is a free for use knowledge sharing medical community from Germany. This is for case based professional knowledge sharing, presentations, CME, ePublishing and eLearning media available only for medical students, nurses, clinicians, qualified doctors. It is based on standards such as ICD-10 for Diagnosis, LOINC For Lab, Drug Database, procedures. It is free. You can see details on Promed-network.in and register yourself on ProMed.Community
ePublish your articles instantly to thousands of Doctors, Nurses and clinicians worldwide! The ePublishing of Articles just went live on ProMed Community (https://promed.community) Simple Tools that allow you to use a Template to Post your article and share with a Targeted Audience on Social and Professional Media by  posting it just once! ProMed.Community is free for use. Knowledge is free. 


My Therapies is a perfect place for senior clinicians to publish their own clinical protocols. Most valuable for all clinicians to learn from senior colleagues. 
Public Health programs can post their program SOPs in My Therapies. All the Doctors, Nurses, ANM, ASHA and other clinicians can access it online totally free.
eLearning tool for Medical Colleges, Dental Colleges, Nursing Colleges, Allied Health Colleges. Professors post cases for students and residents to study, follow, comment, discuss. Provides Templates with standards like ICD-10, LOINC, Drug database etc. built into it. Students can like, dislike, share or email the cases. The professors can do so much more in the same time.
Perfect place to prepare and publish your cases for presentations, CME, Clinical meetings, Conferences. Provides templates that can be accessed online from meeting/conference venue. No formatting required. Just put your case content and you are good to go!
Acts as a free Medical tourism and second opinion portal from anywhere in the world.  Also wonderful tool for Slimming, Beauty, Wellness, Fitness clinics to post therapies, cases, articles and conference material.
It is in the interest of Insurance and Pharma companies to support it because it is promoting standards, clinical protocols and providing a medical communication platform.
Tertiary Care Hospitals also have much to gain from this targeted marketing tool that helps announce all the latest techniques and achievements from their specialists and thereby build a viable referral primary care network.
 There is a lot of intelligence built into the community. Clinicians can create and share their own favourites list e.g. favourite diagnosis/ medications/ tests/ procedures etc. The community also learns from clinicians and creates group level favourites. The favourites are a way to bridge the gap between experts and clinicians for using clinical guidelines and Ordersets e.g.1 Medications favourites list for a Diagnosis or e.g.2 Tests favourite list for a Procedure. The other important purpose of the favourites list is to eliminate/reduce the typing while posting cases/therapies/articles. The clinician can pick up directly from the favourite list rather than going to the elaborate master data e.g. ICD-10 or LOINC etc. These favourite lists are also available to the clinicians in the ProMed practice management system and practice management on mobile.
All this is bundled in Groups: Specialty based Groups and Region based Groups. Also Private Groups for organisations that want to keep their content hidden from others eyes.
Imagine the game changing benefits of an international online knowledge sharing community which is totally free for clinicians. All are welcome aboard !

Friday, February 19, 2016

Top Health IT Trends to Expect in 2016

Technology has transformed healthcare around the world at a faster rate in the last few years than at any other time in history. There are many exciting innovations poised to help improve patient outcomes and the landscape of healthcare as a whole over the next few years. For 2016, we can expect to see the following IT driven changes in India:

Expanding Telemedicine Services

The telemedicine market in India is expected to reach a valuation of about $18.7 million by 2017, according to Deloitte. Since telemedicine makes it possible to provide needed medical services from a distance, this may be particularly helpful for individuals in rural communities that do not have access to the larger hospitals and centralized facilities. Medical professionals can provide advice to patients and can even consult with patients about specific issues using video chat options.

Greater Integration of SMAC

SMAC, standing for Social, Mobile, Analytics, and Cloud technologies have transformed every business in India and around the world and healthcare is no exception. As medical facilities get on board with using social options, patients will be able to interact with their doctors and obtain information about their health and well being in new and convenient ways. Analytics in healthcare will allow information to be analyzed and cross referenced, assisting with research and outcome improvement.

Mobile integration puts health information at the patient’s fingertips in a way that was not possible in the past. This may help improve outcomes and communications between medical providers and patients in countless ways as the shift to mobile is embraced. The movement from client server to cloud is shifting the industry IT vendor landscape, with many smaller and newer vendors beginning to replace large vendors that have traditionally assisted with IT needs.

Increased Use of Medical Wearable Devices

The use of health and fitness wearables has increased substantially over the past few years and is expected to continue to increase at an ever-faster rate until about 2020. Start-up companies are experimenting with creating wearables featuring health IT features. We may see prototypes emerge this year that allow patients to instantly send remote information about biometric data that is obtained using sensors in various medical wearables. This could allow physicians to spot medical issues much faster.

Improved Mobile Access to Health Insurance

Private health insurance covers about three percent of India’s population. The government health plan covers about eight to nine percent of India’s population, while the rest is paid out of pocket. In 2015 the Parliament passed the Insurance Bill where the FDI in Insurance was raised to 49 percent and health insurance has been declared as a separate business. Also 100 percent FDI was allowed in medical devices. These two policy changes will bring a boom to the mHealth and health insurance market in 2016-2017.We predict Insurance support for mHealth solutions including outpatient visits and chronic disease management or non-communicable diseases [NCD] as it is called in India.

Many companies now also allow individuals to apply for health insurance using mobile apps. In 2016, we can expect to see even greater competition in the industry with more mobile access and improvements in automating the claims process.

More Complete Patient Histories with EHRs

EHR and MDDS for health domain standards were notified in September 2013 and approved in December 2013, respectively. As medical facilities adjust to using systems to keep electronic records, we can expect to see more complete patient histories begin to affect outcomes and standards of care. This is especially true across borders, as many developed nations are now employing the same standards for coding and keeping EHRs. We may see 2016 bring forth improved software that simplifies electronic record keeping, transitions of care, coding, and billing.

Widespread Adoption of Surgical Robots

India has been behind the ball in adopting surgical robots for some time now, but we may see many more robots flood the hospitals this year. Intuitive Surgical, the creator of the U.S. based da Vinci surgical systems, considers India an important market. The Vattikuti Foundation plans to increase the number of surgeons trained to perform robotic surgeries from about 147 currently to 300 by 2020.

IoT Revolutionizing Patient Care

The Internet of Things is an extremely beneficial addition to the medical industry. We expect IoT platforms to emerge that will enable integration of all healthcare applications, devices, and things. Health monitoring devices can track vital patient information such as blood pressure, heart rate, and blood sugar levels every single day and communicate this information to medical professionals. Pacemakers and other medical devices can also be connected so that information is transmitted daily and not just during doctor visits. Medical professionals can directly communicate when information is worrisome and can save time from running unnecessary tests when health signs are good.

CRM Improving Patient Relations

Customer relationship management has always been important, but is now easier than ever because of SMAC technologies and EHRs. Doctors can communicate more freely with patients and can track all interactions for future review. These options will help make doctor/patient relations more personalized. A personalized approach will improve patient satisfaction and may also help to improve outcomes.

Guest Author: Amanda Flowers is a graduate in Psychology, with minor in English Literature and Public Health. She draws on her knowledge of these subjects to create online content that addresses human needs in a simple way. Flowers is currently a freelance health blogger and working for Blue Cross Blue Shield of NC .


Co-Author: Dr Pankaj Gupta, Healthcare Business Executive, @pankajguptadr, https://in.linkedin.com/in/drpankajgupta

Thursday, February 4, 2016

New Healthcare Aggregators: SMAC and IoT

The old paradigm of business as a linear value chain is now facing extinction. Businesses are now ecologies and not merely producers and sellers ! That requires a change in thinking. Customer Relationship Management (CRM) needs to be a mission at every step of the process. This is hard to overemphasize! The internet is clearly the medium that allows such integration across time and space. It is time to take a more accepting look at Cloud and Social Media technologies. This offers the only universal layer of engagement across stakeholders. The investment in IT hardware as we new it in the past has been greatly optimized by mobile. It has brought a tactile feel to life and work for all of us. Mobile mirrors the nature of Healthcare in terms of immediacy and continuity so well. Healthcare needs to embrace it wholeheartedly. Healthcare can only profit from it.

There is a huge Vacuum in Indian Healthcare-IT space. Large Healthcare-IT vendors have exited the market. Either they lost interest and exited or got bought out e.g. TrakHealth, iSoft. Also the market is moving from client-server to cloud and from Capex to Opex models. New cloud based players are small in size and yet to reach enterprise class. Existing players are not able to shift out to cloud because of their long term negotiated contracts in client-server model. The time is now when full conversion of Enterprise class to SMAC will happen anyways. Healthcare CIOs can keep eyes closed or tighten the belt and ride the Digital wave.

Recently I spoke to a Director of State NHM in India. He said we are doing HMIS and Public health through ANM/ASHA. How do we benefit from SMAC IoT platform? Hard for many to imagine SMAC is a unifying force across enterprises and IoT breaks the silos. This can be quite unnerving for many. 

The era of hierarchical command and control is over. Now is the time for horizontal networking across Communities of Practice [CoP]. Whatever gets the maximum likes becomes the In Thing. Whatever is the In Thing gets used the maximum. Students are learning more from the online networking than from the formal classroom and professors. Research will reach the point of use as soon as it gets published. Primary care Providers in semi-urban and rural areas will have access to latest therapeutic recommendations. The old Adage that 'Knowledge is the only form of power that is not expendable but grows when shared' has become true.  

The movie Avatar has beautifully depicted the concept of Small data ^ = Big Data where small knowledge base of each living being [App] is contributing towards the collective consciousness [Big Data] of Eywa. Now the question is will the future of SMAC/IoT be driven by technology or biotechnology?

Anyways for now - The time has come when you don't need big monolithic HIS software to run hospitals. Now you can do everything with small mobile based Apps for every function. Though I am already seeing many of these Apps in the market but what is lacking is a unified platform on which the Apps should be built such that the data can be seamlessly collated. Also it gives the provider the flexibility to select from a bouquet of Apps. 

IoT integration platforms are emerging that will integrate at the App level, Data level and Semantic level. Anyone in the ecosystem can slice, dice, run reports on the collated data.

Successful Cloud models have dug the grave for the Enterprise Hardware. Capex has got converted to Opex. Now you can pay for the software on the cloud like you pay your monthly electricity bill.

SMAC coupled with IoT has a potential to bring the Aggregator Business model to Healthcare. Soon the unorganised and fragmented primary care, secondary care and supporting care market will begin to get Aggregated. I see these Aggregators becoming larger than established capital intensive Enterprise market similar to what happened in the Automobile market. It will be in the interest of Insurance, Pharma and Govt to go all out and support this emerging SMAC/IoT driven Healthcare Market Aggregation.    

References:

Why Healthcare must Re-imagine itself - and how
https://www.linkedin.com/pulse/why-healthcare-must-re-imagine-itself-how-arun-kumbhat
Why All Indian Hospitals IT is in Bad Shape
http://healthcareitstrategy.blogspot.in/2014/04/why-all-indian-hospitals-it-is-in-bad.html
Global HIS/EMR vendor nightmare outside US
http://healthcareitstrategy.blogspot.in/2012/08/global-hisemr-vendor-nightmare-outside.html
Thick client vs Thin client
http://healthcareitstrategy.blogspot.in/2008/08/thick-client-vs-thin-client.html
There is no Market for EMR in India
http://healthcareitstrategy.blogspot.in/2012/10/there-is-no-market-for-emr-in-india.html
Size of Healthcare-IT Market in India
http://healthcareitstrategy.blogspot.in/2012/06/size-of-healthcare-it-market-in-india.html

Saturday, January 2, 2016

Indian Pharma companies on US FDA lens

Why are so many Indian Pharma companies failing on Data and Quality standards and getting warnings that can lead to 483? Currently, 40+ Indian manufacturing sites are listed on FDA’s import alert list..

Global Supply-Demand issues: Indian Pharma is a major supplier of Generics to the world. If shun atleast 2/3 of the world runs a risk of demand-supply gap in Generics. Hence it is in the interest of UN, WHO and Developed Economies to help Indian Pharma climb the FDA compliance.

Cultural Issues: Traditionally Indian Pharma industries lack respect for Data and Quality paradigm. IT and Quality are the least paid and lowest in Hierarchy. Compare it to the Global Pharma MNCs where the IT and Quality hold Director or C-level positions.

Regulatory Issues: Highlighting weak regulation and monitoring of the domestic drug industry, three recently-introduced medicines are being prescribed and sold though there is a lack of rigorous trials on crucial safety and efficacy parameters. The pharmaceutical industry in India should face the same stringent regulations as elsewhere in the world, rather than continuing to allow patient safety to be put at risk by unproven drug treatments, says an article published in TOI. The Quality issues arise because Pharma Industry is under Ministry of Chemicals not under Ministry of Health @MoHFW_INDIA. This is a huge accountability gap in India. It will be in the interest of Public Health agencies like WHO and Global Fund and Global Pharma MNCs to demand the Dept of Pharmaceuticals to be located under the Ministry of Health with proper accountability established.

Data Reliability: Majority of the FDA observations are for relatively commonplace documentation or procedural issues...so many of the observations are for egregious errors like altering official documents in front of an inspector, or documenting important manufacturing or electrical data on scrap paper in pencil. Manipulated clinical trials data. “Generic” user accounts had been created in the Laboratory Information Management software system.

QA/QC Issues: Manager has admin rights on the software to edit or overwrite the data. Fudging of attendance records such as same employee working in 2 different sites at the same time. Even unauthorized QA document control stamps are reported. 

Other issues: Partially completed and/or unofficial training records. No response to consumer complaints. Incident reporting cover ups. 

References: