New Healthcare Aggregators: SMAC and IoT

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See Dr Pankaj Gupta @ Healthscape IDE 2017 Panel Discussion Video 2: https://youtu.be/7RgY-5lp1qQ. Why are hospitals not moving to cloud computing?

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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 knew 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 many traditional HIS/EHR are losing market share as the market is moving from client-server to cloud and from Capex to Opex models e.g. Wipro HIS, TCS Med Mantra, HealthFore. Many of these players like Wipro, TCS, CSC are suffering in their primary market [USA] due to shifts in US Govt policy and Automation and hence lack the Executive confidence to invest in product upgrades for the Indian market. On the other hand many incumbent players are not able to shift out to cloud because of their long term negotiated contracts in client-server model e.g Napier, Akhil, Srishti. New cloud based players like Dwise, UBQ, SRIT, ICT, Attune are small in size and yet to reach size and scale. Whereas Practo is trying to solve a problem that doesn't exist! Someone was stupid to assume that Appointments and Scheduling will sell whereas we Doctors want to see long waiting line of patients outside our clinics. Also the patients like to see waiting queues - in Doc sahib ki chalti hai.

Effect of Demonetization -- many hospitals are going to be sold off to PE that can invest in FDI e.g. Fortis is on the chopping block. The new management is going to hit on the bottom-line, optimize processes, re-skill staff and invest in growing the topline. All this is obviously a compelling case for Digital! So the time is now when full conversion of Client-Server Enterprise class to Digital [SMAC, IoT, CRM, AI] will happen. Now Healthcare CIOs have a choice to make - keep eyes closed and risk losing their jobs or tighten the belt and ride the Digital wave. Welcome to the Future!

The Government push towards MDDS/EHR Standards is not helping the old horses. PM Modi has put the focus of his Digital India on Healthcare, Education and Jobs [see http://economictimes.indiatimes.com/topic/Digital-India]. Whereas Healthcare is a State Subject and District Health Officers are wondering how do we benefit from Digital! Hard for many to imagine SMAC is a unifying force across enterprises and IoT breaks the silos. PM Modi's Digital India can be quite a game changer!

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.

What happened in the FinTech space will now happen to HealthTech too. Just as the FinTech became a game changer to the Financial sector, a Digital Healthcare Ecosystem is taking shape. So many times bosses mocked new technology and got it wrong! Healthcare Businesses that are still in a denial mode will have huge re-skill challenges and risk shut shop.

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

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:

• FDA Form 483s From India: A Deep Dive Into the Problems: http://www.raps.org/Regulatory-Focus/News/2015/11/09/23562/FDA-Form-483s-From-India-A-Deep-Dive-Into-the-Problems/#sthash.bMMKjjGv.dpuf
• The Rs1 trillion FDA impact on Indian pharma: http://www.livemint.com/Companies/zcSsHW6iNvlulIW5K1qk9N/The-Rs1-trillion-FDA-impact-on-Indian-pharma.html
• Cadila Healthcare shares slump 15% on warning letter from USFDA http://www.financialexpress.com/article/markets/indian-markets/cadila-healthcare-shares-slump-over-15-on-warning-letter-from-usfda-december-31-2015/185907/
• Indians face risk from unproven drugs: Lancet http://timesofindia.indiatimes.com/india/Indians-face-risk-from-unproven-drugs-Lancet/articleshow/49029617.cms