Libra Social Academy

Libra Social Academy brings to you Library of PankajGuptadr Healthcare Management YouTube Channel -- valuable insight into the teachings of Dr Pankaj Gupta and Team, well know HealthTech and Healthcare Management experts. 

All the documents, design, code and content is published in opensource for the larger public good as per MeitY opensource policy and under the MPL 2.0 License.

BWHealth - Bharat Swasth Mahotsav - Padma Awardee Doctors Conclave - 22 Aug 2022
See the first panel discussion on HealthTech.

10th Elets Healthcare Innovation | Technology in Healthcare pushing the Atmanirbhar Bharat Mission

Building Unique and Innovative strategies for Healthcare & Life Sciences Sector

Training on Successful Implementation of a Digital Financial Services for Health Project

Message on Universal Health Coverage

Biospectrum India at Healthscape Summit India 2017

Elets Interview- Dr. Pankaj Gupta, at Annual HIS

At Global VC Summit with Dr Pankaj Gupta.

Elets Healthcare Award 2019 : Dr Pankaj Gupta

CII DX Summit 3.0 | Day 1 22 February, Session on  Building Unique and Innovative strategies for Healthcare & Life Sciences Sector - Opportunities & Road Ahead.

Elets Annual HIS 2019

Healthscape IDE 2017 Panel Discussion Video1

Jaipur National University - one day virtual international conference - See 4:51 to 6:45

BRICS CCI: Webinar on 'Exploring Opportunities in the Digital Health Market' - See 1:42 to 1:46

HPIE Day 1: Friday,17th September, 2021- Healthcare Planning & Infrastructure Expo and Conference - See 3:09 to 4:07 

Improving process standards in healthcare webcast

APICON 2015 presentation by Dr Pankaj Gupta 19Feb2015 Gurgaon

Elets Exclusive: How TeleMedicine is Being used on the Frontlines of the Coronavirus Crisis

Dr Pankaj Gupta speaking @ IoT Grand Slam

Learnings : Teleconsulting - Changing Paradigms

India's National Digital Health Blueprint: From Paper to Practice

Panel Discussion: Transforming Healthcare Ecosystem Post Covid-19

NDHM will Integrate Digital Health Infra in India

Pharma Digital Transformation Conclave 2018 Panel Discussion

DR PANKAJ GUPTA | VOICE OF CHANGE

2017 Healthscape Summit | Dr. Pankaj Gupta, 3737 North | Testimonial

eINDIA 2012 Health Summit eHealth mHealth Dr Pankaj Gupta

Ayushman Bharat Conclave: Panel Discussion 5

Elets 2nd HTS-Day 2: Next Gen Realities: IoT, Machine Learning, Robotics & AI, Cloud and data Centre

2017 Healthscape Summit | Panel Discussion | Prescribing Technology

4th Annual Healthscape Summit | INTEGRATING SMART MEDICAL DEVICES INTO PEOPLE, PROCESS & TECHNOLOGY

Health Systems for a New India: eObjects #Opensource Building Blocks

 

Here is a sequence of events over the last 8-10 years that lead to the #Opensource eObjects.

India has been majorly a paper-based Healthcare System. However, there have been pockets of success in transforming paper-based processes to electronic systems. Max Healthcare was one such initiative that took a leap of faith well before the rest of the market could even think in that direction. I happened to be part of that journey with an eclectic team that got dispersed at the end of the project but continued the journey in their individual capacities. Who could think then that such small individual efforts could come together later for the transformation of the country as a whole? It probably happens once in a lifetime. Serendipity positioned a very strong National leadership that could collate all these pieces together for building the National Digital Health Blueprint.

It all began when Max Healthcare partnered and outsourced its IT infrastructure support to Dell Services formerly Perot Systems in September 2009 for developing and maintain their IT operations across all Max Hospitals in India. This unique partnership provided significant value to Max in terms of enhancing the quality of services and reducing the treatment costs. While doing the transformation at max healthcare the team stumbled and fell and then learnt to walk again. For India the full implementation of EHR, Registries, Meta Data, Master Code Directories and Interoperability were seen first time in action here. Max Healthcare gave invaluable learnings of applying the global standards and architectures to Indian settings, something that had never been done before!

Looking at the successful transformation of Max Healthcare, Perotsystems was contacted by the Ministry of Health India to conduct current IT systems study in health sector in India and do the health checks. Due to merger of PerotSystems and Dell Services, Dell Services could not undertake the task. Later I picked-up that work and submitted the Public Health IT Study Report through Sector Innovation Council on Health, India. Since it was not possible to study every system being in use in a country like India, I and my team picked up the representative set that was diverse enough to extract critical findings that needed immediate attention. Later these findings and recommendations from the Public Health IT study became important part of Twelfth Five Year plan.

Setting up Meta Data and Data Standards was an initiative taken by the Ministry of Electronics and Information Technology under National e-Governance Plan (NeGP). It intended to promote the growth of e-Governance within the country by establishing interoperability across e-Governance applications for seamless sharing of data and services. Domain-specific committees were constituted under MDDS initiative. MDDS for Health Standards committee was one such initiative, which was constituted on September 2012 under the chairmanship of Joint Secretary MoHFW in pursuance of communication received from Secretary, Ministry of Electronics and Information Technology (MeitY).

Role of Meta Data and Data Standards in Primary and Public Healthcare
MDDS for Health Data Dictionary
Facility Registry: NIN HFI Project Report
National Digital Health Blueprint

eObjects were first written by Prof Dennis Streveler and Dr Pankaj Gupta in a white paper in Nov 2018 that was published by Niti Aayog in the book Health Systems for New India, Chapter 5 - Reimagining India's Digital Health Landscape Wiring the Indian Health Sector in Nov 2019.

ACCESS Health Digital Strategy Council defined the details of the NDHB building blocks - Minimum viable products including the eObjects and microservices architecture to comply with the NDHB Standards. ACCESS Health Digital runs a Social Entrepreneurship Accelerator to accelerate the implementation of the NDHB Standards through these building blocks.

The eObjects have now been adopted by Joint working Group of National Health Authority NHA and Insurance Regulatory Development Authority IRDAI Sub group on common IT infrastructure, in its report published on 11 Sep 2019 and will be built into the India’s national Health Claims platform.

The eObjects were designed for interoperability across the healthcare ecosystem on a federated architecture. eEncounter, eDischarge Summary Objects are for Provider-to-Provider interoperability; such that the data can flow across healthcare facilities, State HIE and National Data Lake. Whereas the eClaims Object creates a Financial Lever for the market. If the providers submit the claims in standard eClaims Object format then the turnaround time for their payments can be expected to be faster. Clearly eObjects are an innovative breakthrough.

This is very similar to what happened in the FinTech revolution in India where Government of India created the Unified Payment Interface UPI platform and then created the BHIM App and released the related Application Programming Interface APIs to the market. Later the Market used the API’s and built the hugely successful Paytm, Googlepay, Phonepe wallets. In 3 years the UPI transactions went from negligible to 1 Billion transactions per month.

Financial lever and strong governance for digital health transformation, plays a vital role in ensuring successful outcomes of such undertakings. India would do well to heed this truth.

My ACCESS Health Digital team got an eGovernance Award for the work.

The details of eObjects are published in #Opensource under MPL 2.0 #Opensourcesoftware license on OpenBodhik blog: www.openbodhik.in
FHIR based eObjects published in CSV/XML/JSON
Library of 1000 Data Elements and 140 Code Directories published in XSD
National Formulary of India - Generics Drug List Published in CSV
Healthcare Delivery Information System [HDIS] Minimum Viable Product [MVP] Definitions and Microservices Code Published

eObjects also published by ExpressHealth

eObjects referenced extensively by Nachiket Mor in his paper and book published by John Hopkins USA

Healthcare Wallet will Emerge!

 

Healthcare Wallet will Emerge!

India is poised for 10 fold increase in digital payments. Will become 4th largest in the world after Singapore, Sweden and USA. This will have a profound impact on Digital Health. Will become a major driver in adoption of Digital Health across payer and provider systems.

Consider This:

Health Insurance coverage has gone up from 3% of Indias population to over 40% with Ayushman Bharat.

90% of Health Insurance claims is reimbursement of out of pocket out patient expenses related to the inpatients episode.

Insurance is more comfortable reimbursing a Digital expense because it reduces the chances of fraud and abuse. From a Actuarial perspective the risk comes down because of full traceability.

Patients will gravitate toward clinics and hospitals that provide Referrals, Prescriptions, Reports in Standards based electronic format. Because Insurance companies will clear the standard eClaims format faster.

About 8% of out patient gets converted to inpatient procedures for any hospital OPD. Any reduction in out patient foot fall will negatively impact the inpatient load and hence the top line.

A Fintech based rating engine will appear to rate the clinics and hospitals. This rating engine will be far more pervasive than the Practo rating engine because money in the pocket is always a more powerful driver.

A whole new sand box gets created for the digital health startups, software vendors and fintech companies to play. Someone will fill the vacuum. For lack of a better word a Paytm or Jio Wallet for Healthcare expenses and reimbursements is on the anvil.

India will be the next battleground for Global Retail and Healthcare! After USA, India has the largest user base for the Internet Giants like FB and Google. Amazon is in India. Walmart is picking up majority stake in Flipkart. All the Internet and Retail giants have expressed interest in Healthcare.

Can you extrapolate the Dots? I can see the Trend! Fintech fueled transformations are underway.

The real innovation in mobile payments in India began a few months prior to the cash ban. It’s called a unified payment interface, or UPI.

With more than 140 Indian banks sharing the interface, and Alphabet Inc.’s Google and Facebook Inc.’s WhatsApp offering instantaneous payment services on it, UPI has become a keenly watched experiment. By the looks of it, things are going well: From nothing to 800 million monthly transactions in less than three years, India’s UPI has taken off. Growing smartphone use and crashing data costs have helped immensely.

Google and WhatsApp will fight for market share. So will PhonePe, now owned by Walmart Inc. as well as new entrant Amazon Pay, which hasn’t made much of a dent globally into PayPal’s dominance of e-commerce. Indian banks that run their own UPI services. Indian tycoon Mukesh Ambani’s Jio with its 300 million subscribers will push JioMoney. Masayoshi Son and Warren Buffett will keep an eye on their Paytm stakes.

Now RBI has removed charges on RTGS/NEFT transactions; and asked banks to pass on benefits.

Cities Perspective:

Tier 1 cities: Pune, Bengaluru, Chennai are leading the wave in UPI transactions. Pune topped the city list, with the highest average digital spend — per person per month — of ₹16,513. Followed by Chennai at ₹14,208 and Bengaluru at ₹14,000.

Tier II and III Cities: Razorpay says by 2020, 40 per cent of digital payment transactions in the country will be driven by businesses and consumers in Tier-II and -III cities, and 50 per cent of internet users will be using digital payments. Whereas Paytem says - We have been witnessing a tremendous increase in adoption of digital payments in tier II & tier III cities that constitute 50% of our total user base. Surat, Durgapur, Rajkot, Meerut, Imphal, Rohtak, Panipat, Mangalore, Ranchi, Puducherry, Rajamundri, Warangal, Jodhpur, Thrissur, Karnal, Madurai and Jamnagar are among the fastest adopters and are leading the wave of digital payments adoption.

Users of wallets are not updating their KYC (know your customer) details. Instead, they are using UPI (Unified Payment Interface) to make digital payments. Anyhow total payments via digital instruments are expected to be between $400-500 billion in 2020, up from $50 billion in 2017.

Hold your breath guys! Fintech is the digital health roller coasters.

Modicare: Worlds Largest Healthcare Coverage Social Security

PM Speech on #PMJAY Launch on 25 Sep 2018

#PMJAY #AyushmanBharat a.k.a NHPM a.k.a Modicare will bring an era of Digital HealthTech platforms [read IHIP] with EHR and MDDS for Health Interoperability Standards to Deliver the worlds largest Health coverage.

Big opportunity for global Health Insurance companies, FinTech and InsurTech to line up and get listed for the program. With Govt acting as a Payer, Provider and Re-Insurer.

Healthcare is a state subject. Centre govt funds 85% of most public health programs. However all the regulation and execution authority is with States. The states are free to accept or totally reject any healthcare ruling from the center. India is too diverse to expect a single Healthcare solution across all States. Unity in diversity is elusive. Hence MDDS for Health based IHIP Exchange platform is required to deliver Health insurance coverage across India.

#PMJAY > Health Insurance will be the driver for the shift to Standard Code Sets based HIS/EHR e.g. ICD-10, SNOMED, LOINC, NPI, etc. As defined in EHR and MDDS for Health Standards. This was the missing link in the Healthcare Ecosystem thus far in India.

JAM (Jandhan Aadhaar Mobile) coupled with NIN HFI Registery will be the delivery model to reach every beneficiary. Similar to Pradhan Mantri Ujjwala Yojana.

#PMJAY > Health Insurance will be the driver for the shift to clinical protocols, pharmacogenomics and precision medicine driven managed care. I can see the end of the 'Doc Sahib Bhagwan hai' era.

#PMJAY > Health Insurance will bring a check on unnecessary tests, expensive drugs, high end procedures and overcharging frauds. Machine learning and Analytics on the EHR data will be valuable in making the system adhere to protocols.

The Hospitals, Doctors and all other medical establishments are concentrated in Tier 1 and Tier 2 cities. #PMJAY will shift the demand to Tier 2 cities and below. It is a no brainer that the supply side will follow.

Big opportunity for EHR, Telemedicine, global Healthcare providers to line up and get listed for the program. Takeover the District Hospitals and upgrade them and convert 24 of them to Medical Colleges. With Govt acting as a guarantor in PPP model.

Big opportunities for global, online and organised Pharmacies to line up for listing in the program. Drug supply chain is set to be completely redefined. 70% cost of any treatment is drugs. Govt has started restructuring the NPI and essential lists.

India's private hospitals jack up prices of drugs and consumables up to 18 times. A study by National Pharmaceutical Pricing Authority shows that hospitals in Delhi-NCR routinely make a margin of 350-1,700% on consumables, and 160-1200% on drugs outside price control. The modus operandi? Pressuring manufacturers to print higher MRPs on products in lieu of bulk supply orders, and profiteering from sale of such medicines at their pharmacies. “This is a clear case of market distortion... patients have to incur huge out-of-pocket expenditure,” NPPA said. Consumables, drugs, and diagnostics make up nearly half to 70% of a patient’s bill.

Let's take the example of Diabetes as a disease burden. India has 65-70 Million Diabetics. The absolute numbers make India the Diabetes capital of the world. But as a % of the population its under 7%. Per month average cost of Diabetes management is INR 3K-5K. Only 33 out of 100 Diabetic patient days will need any kind of Hospital intervention. Hence #PMJAY coverage of 10 Cr families i.e. 500 Million people i.e. 40% of India's population can collectively pickup the Diabetes disease burden and more much more...

------

100 Days Report Card: In little over 3 months, #PMJAY has been able to distribute nearly 5 Million #PMJAY cards, serve about 700K patient admissions, in 16K em-paneled hospitals, > 66% claims are from tertiary care.

Going Forward: Ayushman Bharat is set to provide coverage to 40% of India's population. Millions of claims will be coming daily from plethora of unstructured non-standard HIS systems. How many claims can be processed with manual vitrification? Hence the TPA industry is ready for disruption. TPAs have been servicing merely 3% of India's population i.e. covered by the private health insurance. Now this market is shooting up to 40% of India's population. Obviously we stand at the cusp of a new paradigm of intelligent revenue cycle management [RCM]. We need a digital claims engine built on meta data Standards to automatically process the millions of claims. Hence I see MDDS for Health Standards is the logical way forward...

-- Dr Pankaj Gupta is the Managing Partner @ Taurus Glocal Consulting --

References:

# MDDS for Health Domain Standards Notified by the STQC, Meity, GoI

India will be the next battleground for Global Retail and Healthcare!

India had 60 million online shoppers in 2016, which is only 14% of the internet user base in the country. This will rise to over 50% by 2026, according to a report by Morgan Stanley.
On top of that India has over 900+M mobile phones. 60% of these are smart phones. 90% of these are Android phones. 200M Jan Dhan Accounts have been opened at the bottom of the pyramid. Digital transactions have crossed 1 Billion every month. Rupay has emerged as the largest payment gateway in India dislodging Visa and Mastercard. Electricity has reached 500K villages. All this is expected to fuel the organized retail market.

Online retail is fast catching on, not just in the larger metros but also in the Tier II and Tier III cities. This growth can be attributed to increasing internet penetration and smartphone revolution. The Indian retail industry has come of age and has emerged as one of the most dynamic industries in the world. Accounting for over 10 per cent of the country's Gross Domestic Product (GDP) and approximately 8 per cent of the employment, it is expected to nearly double to $1 trillion by 2020 from $600 billion in 2017, registering a Compound Annual Growth Rate (CAGR) of 16.7 per cent over 2018-2020. Keeping in mind the growing online potential, brands and retail chains alike are upgrading their online presence to draw customers to their e-shops. India's growing per capita income, a rising middle class, changing demographic profile, urbanization, and attitudinal shifts in the consumer spending pattern, all indicate the retail sector's potential to be the real growth engine of the country's economy.
NHPM or Ayushman Bharat has created a huge Healthcare market i.e. INR 500K cover per family for 100 Million families in India. This is a game changer and all big players will run after it. Drugs form approximately 70% cost of any treatment. Obviously this Coverage needs an e-commerce platform, telemedicine apps, and digital community to support the physical Healthcare Ecosystem.

Myntra, Online retail store for fashion and lifestyle products, acquires smart wearables devices startup WitWorks. Flipkart owns India’s largest online fashion retailers -- Myntra and Jabong -- both of which it acquired. Together, Flipkart-Myntra-Jabong has a 70 percent market share of the online fashion business in India. It also owns eBay’s India business as well as popular mobile payments app, PhonePe. With over 100 million users and these popular properties, Flipkart is a valuable asset in the global internet economy for its long-term potential. Walmart is now looking to pick up majority stake in Flipkart. Walmart may rope in Alphabet [Google] also for Flipkart.

Amazon is already in India Retail sector. Amazon is already selling its services to many in Healthcare and has also announced it's desire to do more in Healthcare markets in US. Amazon said that it is working with Berkshire Hathaway (BRKA) and JPMorgan Chase (JPM) to better control costs and reduce spending on the health insurance they offer for the 840,000 people who work for them. Amazon has invested $4.74 billion in Amazon.in, to go after the India market and compete with Flipkart, Myntra, Jabong.

For traditional physical world Retailers, this means entering the playing field with the likes of e-commerce behemoths Amazon and Alibaba, both of which are leveraging big data and powerful AI algorithms to transform the retail space. The traditional Retailer Shopping giants are feeling the heat from Flipkart and Amazon in India.

Cooper Smith, who advises retail clients with Galloway's firm, L2, thinks we may be years away from a serious discussion on breaking up Amazon, but he advises retailers to not sit around and wait for that to happen. He thinks the announcement that Wal-Mart is partnering to sell some of its products on Google Home is significant for struggling retail survivors: "A lot of luxury brands like LVMH, which has refused to touch Amazon with a 10-foot pole, are talking about banding together to create a new luxury e-commerce space. Amazon hasn't been able to disrupt that market yet. Google and Facebook are the platforms with the reach, those are the alternative platforms that would help brands and retailers reach consumers without having to partner with Amazon."

In the US, Wal-Mart shoppers can link their Wal-Mart accounts to Google Express and quickly order — either through voice on Google Home or by shopping on Google Express. By linking a shopper's past Wal-Mart purchase history, Google will be able to more quickly learn the customer's shopping patterns and recommend suitable products. Using the platform now, a customer can say, "Google, buy peanut butter." Google will then suggest the brand it thinks the customer would like the most. The same can be leveraged by many other smaller struggling Retailers in India to compete with likes of Amazon and Alibaba.
On top of that Google is betting that the future of healthcare is going to be structured data and AI. The company is applying AI to disease detection, new data infrastructure, and potentially insurance.

FinTech mobile based payments developments supported by Govt of India's Digital India, Jandhan/Aadhaar/Mobile and BHIM App are only adding to the fire. Many local startups like Paytm and All big Internet and Retail giants are jumping into the ring - Flipkart, WhatsApp, Samsung, Android...

After USA, India has the largest user base for these Internet Giants. Obviously India is fast becoming the next battleground for Retail and Healthcare?

Can you extrapolate the Dots? I can see the Trend!

#India #Retail #Healthcare #NHPS #AyushmanBharat #Amazon #Flipkart #Walmart #Alibaba #Digital #e-commerce