iSPIRT Foundation’s Response to Union Budget 2022

Union Budget 2022 – Imprints of using Digital public infra with Private innovation

iSPIRT Foundation, a technology think-and-do tank, believes that India’s hard problems can be solved only by leveraging public technology for private innovation through open APIs. 

This “innovation architecture” is now going mainstream. The Union Budget 2022 mentions five efforts that iSPIRT has been intimately involved in:

  • India Stack – Promoting digital economy & fintech, technology-enabled development, energy transition, and climate action.
  • Health Stack – An open platform for the National Digital Health Ecosystem will be rolled out. It will consist of digital registries of health providers and health facilities, unique health identity, consent framework, and universal access to health facilities.
  • Digital Sky – Use of ‘Kisan Drones’ will be promoted for crop assessment, digitisation of land records, spraying of insecticides and nutrients.
  • Digi-Yatra & Logistics Stack – Multimodal Movement of Goods and People. The data exchange among all mode operators will be brought on the Unified Logistics Interface Platform (ULIP), designed for Application Programming Interface (API). 
  • DESH (Digital Ecosystem for Skilling and Livelihood) Stack – This aims to empower citizens to skill, re-skill or upskill through online training. It will also provide API-based trusted skill credentials, payment and discovery layers to find relevant jobs and entrepreneurial opportunities. 

This embrace of the new innovation architecture is a seminal moment for our economy and society. However, more could have been done.

Some low-hanging opportunities missed are:

  1. A few positive announcements have been made for the funding ecosystem for Indian startups (such as capping the surcharge on long term capital gains and an expert committee to suggest measures to boost venture capital and private equity investment in startups). While these are in line with iSPIRT’s ‘Stay-in-India’ checklist effort, immediate actions on some of these (as well as other) issues in the checklist will help further. 
  2. Ease of Doing Business is mentioned in the Budget speech, but no specific actions are announced. 
  3. 5G is a big opportunity. India can leverage this to become a telecom equipment provider in Radio Access Network (RAN). iSPIRT’s SARANG effort is focused on this. There should have been specific capital allocations and Design Linked Incentives (DLI) for OpenRAN as a strategic area in Mission mode.

Overall, the Budget is well-balanced and ushers in new thinking about innovation in emerging sectors that are strategic to the country.

Sharad Sharma, Co-founder & Volunteer – “In the coming years, India needs to usher in a product economy in Defence, Electronics, BioPharma, ClimateTech (including EVs), FinTech, HealthTech and Software. This Budget sets the stage for this new innings by having a focus on sunrise industries.” 

Sudhir Singh, Fellow – Policy Initiatives – “Since the announcement of National Policy on Software Product (NPSP), no Budget has been able to consider making it active and announce measures, e.g. Digital Product Development fund could help bolster “Digital India” and other strategic measures could help galvanise a Software product Industry of India.” 

Sanjay Khan Nagra, Member – Donor Council & Volunteer – “Some of the measures announced by the FM for startups (tax parity for unlisted and listed securities, extension of concessional tax regime for startups and manufacturing startups, setting-up a committee for encouraging VC/PE investments in startups, etc) and digital assets/blockchain ecosystem are commendable and in line with long-standing industry demands. We hope the momentum continues with the pragmatic implementation of these policy measures and further regulatory actions building on top of these measures.”


About iSPIRT Foundation – We are a non-profit think-and-do tank that builds public goods for Indian product startups to thrive and grow. iSPIRT aims to do for Indian startups what DARPA or Stanford did in Silicon Valley.

iSPIRT builds four types of public goods – technology building blocks (aka India stack), startup-friendly policies, market access programs like M&A Connect and Playbooks that codify scarce tacit knowledge for product entrepreneurs of India. For more visit: www.ispirt.in

For further queries, reach out to Sudhir Singh (+91) 96505 76567, Email us:  [email protected] or [email protected]


iSPIRT’s Official Response to Union Budget 2021

Boost for HealthStack, but no gains for Industry

The Pandemic had decided much of the flow of financial planning in a country like India. The emphasis on Atma Nirbhar Bharat right at the outset in PART A of speech is on expected lines in a changed scenario post pandemic. Health being given importance forming the first pillar of six pillars was also expected based on ongoing developments.

For decades, India has underinvested (both in public and private spend) in the overall health of the population, and it took a global pandemic to dedicate a new Pillar of the budget to improving health outcomes and increase funding by 130%. It is heartening to see a substantial budget allocation of 64,000 Crore towards the Aatmanirbhar Swasth Yojana to improve primary, secondary and tertiary care. With the National Health Authority ​getting veteran RS Sharma (former Chairperson of TRAI and UIDAI) as its new CEO, this scheme could be implemented in a digital-first manner taking advantage of the advanced architecture of the National Digital Health Mission.

At iSPIRT we are pleased to see this development, and look forward to a year of accelerated efforts to establish key public digital infrastructure that could improve healthcare.

It was also encouraging to see Innovation and R&D mentioned as one of the pillars; this is a sign the Government is keen on supporting an innovation driven economy and the Indian products eco-system. The National Research Foundation outlay of 50,000 crores over 5 years is applicable across all sectors. Production linked incentive (PLI) schemes were announced for 13 sectors. This is a welcome move to bring in a thinking of promoting Indian Product Champions. However, the details of structure and which sectors and playgrounds the Government is attempting to promote will determine the success in the global landscape.

At iSPIRT we have been advocating development of niche playgrounds in sectors where India has a competitive advantage such as Software products in all sectors including defense, telecom etc. Whether the outlay of 1.97 lakh crores, over 5 years starting FY 2021-22 will be enough is to be tested.

The Continued emphasis on digital payment promotion with a new proposal of 1,500 crores and not losing sight of startups movement is heartening for the Software product industry. Improving norms to formation of a 1 person company will encourage innovation, entrepreneurship and startups. The Government seems to also be inclined to use technology to improve compliance via faceless assessment and a reduced limit on reopening of assessment limits, which are also efforts in a positive direction.

The biggest missed opportunity was around support to MSMEs – which are the key to driving scalable innovation. The MSME sector continues to need life support post the pandemic. While the Government slotted in a 2X budget estimate for MSMEs, it is not clear what this will go towards or that it will help the sector at scale. What remains to be addressed is critical changes that could MSMEs, ease frictions to accelerate growth.

We wanted to see more action on Ease of doing business, especially around removing bottlenecks for tech companies across sectors. In a digital economy, the small business sector is the lifeblood of future growth, and the government will need to think hard about the true means of galvanising this sector.


About iSPIRT Foundation

We are a non-profit think tank that builds public goods for Indian product startup to thrive and grow. iSPIRT aims to do for Indian startups what DARPA or Stanford did in Silicon Valley.

iSPIRT builds four types of public goods – technology building blocks (aka India stack), startup-friendly policies, market access programs like M&A Connect and Playbooks that codify scarce tacit knowledge for product entrepreneurs of India. visit www.ispirt.in

For further queries, reach out to Sudhir Singh​, email: ​[email protected] Or ​Karthik KS​, email: ​[email protected]

Announcing Healthathon 2020

  1. Context
  2. Format
  3. Ideas & Themes
  4. Speakers & Judges
  5. Event Calendar
  6. Sponsors & Partners
  7. Prizes
  8. Registration Details

Context

Those of you who have been following this blog would know that as we speak, India is rolling out a piece of public digital infrastructure known as the National Health Stack (NHS). This project, which is being put into place to futurize the nation’s health technology ecosystem, has exciting and important ramifications for the entire country.

The ground reality in India is that the doctor:patient ratio in the country is low and inequitably distributed. Moreover, the digitization of health data is minimal and the availability of care facilities is sporadic. Taken together, these factors contribute to a relatively subpar standard of public health, which in turn affects happiness and productivity. In a country like India in which each percentage point of productivity and growth corresponds to millions of people moving out of poverty, it is doubly important to bring up the standard of public health as quickly as possible.

One of the components of the NHS which can do this is the Personal Health Records (PHR) system. This system establishes a standardized interface for storing, managing, and sharing medical data, all with user consent. If users can assert greater control over their own health data, they can derive more utility, convenience, and value. This might take expression through easier access to teleconsultations, or perhaps through a better consumer interface to canvas second opinions about some test reports or medical images. The PHR could also allow for individuals to securely and voluntarily contribute their anonymized healthcare data towards data sets used to map and manage public health trends over time.

The possibilities for the PHR system are many, but it will require a collaboration between the public sector, private sector, and medical community to make the most of this technology. For this reason, we are excited to announce the launch of the Healthathon 2020.

This four-week long virtual conference aims to bring together different stakeholders to work on solutions and products stemming from the PHR system. One key group of stakeholders is the public sector bodies like the NHA and MoHFW,  without whose support this initiative can never reach all of the 1.3 billion Indians. The second group is the private sector players such as health tech companies, entrepreneurs, private equity investors, and technology providers – without their creativity, capital, and execution capacity, it will be hard to make any project sustainable or scalable. The last stakeholder group is the medical community of doctors, hospitals, labs, and others; it is clear that without the buy-in and support of this group, no technology intervention can pinpoint or solve the most pressing problems. 

Format

The Healthathon 2020 will feature two competitions: the Hackathon and Ideathon. The Ideathon is a 2-week long event aimed at students, medical practitioners, and non-technical parties. During this event, teams will compete to come up with the best business plans and product ideas around the PHR system. 

In contrast to the Ideathon, the Hackathon is a 4-week long event aimed at startups, corporates, entrepreneurs, developers, and health tech enthusiasts. As part of the Hackathon, teams of developers will work on building projects on top of the new PHR APIs provided by our sandbox providers. 

Participants in both competitions will receive the mentorship, guidance, and resources they need to put out the best possible submissions. Panels of judges will then award prize money to the best teams from each competition. 

In addition to the Ideathon and Hackathon, there will also be a slew of masterclasses, panel discussions, and other events. These sessions are intended to generate engagement, awareness, and innovation around the PHR system, and they will all be recorded and open to the public. 

We hope that the event will draw in participants from different fields and backgrounds, united in the purpose of leveraging technology to make India healthier, more inclusive, and more efficient.

Hackathon & Ideathon Themes

Some of the themes that teams could choose to work on for the two competitions could include:

End Use Apps:
  • Apps that can read healthcare reports and provide some additional context or insight using AI
  • Platforms to help create real time monitoring and alerts for doctors using their patient’s wearable device data
  • Doctor-facing apps that help unify and analyze patient’s health records across different data sources
  • Health lockers for secure and convenient long term storage of health data
  • Matching systems that pair patients with the right kind of care provider given a medical report or treatment history
  • Anonymised health trends/dashboards for epidemiological studies
  • Preventive care applications that promote healthy living by tracking health markers and gamifying healthy living
  • Applications that provide and track continued & personalized care plans for chronic disease patients (eg. cancer care) 
  • New insurance products, possibly featuring fraud prevention and auto-adjudication based on PHR 
Consent Management:
  • Apps that help the user discover, link, and share access to their medical data
  • Building assisted and accessible consent flows for low-literacy or non-smartphone users
  • Systems to delegate patient consent in case of emergencies or other extenuating circumstances
  • Consent lifecycle management systems ie. generating, storing, revoking, and  safeguarding consent
  • Easy and informed consent experiences eg. “scan to share data”, “understand what you are consenting to”
Middleware and Utilities:
  • Secure data storage and management facilities
  • Tools to help medical institutions adopt and use the PHR system
  • AI utilities to decipher and parse medical data
  • Developer tools to simplify and abstract the workflows for PHR development 

Speakers and Judges

Here is a list of some of the speakers and judges for the event:

  • Kiran Mazumdar Shaw, Executive Chairperson, Biocon
  • Dr. C. S. Pramesh, Convener, National Cancer Grid
  • Sanjeev Srinivasan, CEO, Bharti Axa General Insurance
  • Arvind Sivaramakrishnan, Group CIO, Apollo Hospitals
  • Nachiket Mor, Commissioner, Lancet Committee on Reimagining Healthcare in India
  • Shashank ND, CEO, Practo
  • Gaurav Agarwal, CTO, 1mg
  • Dr. Ajay Bakshi, CEO, Buddhimed
  • Dr. Aditya Daftary, Radiologist, Innovision
  • Kiran Anandampillai, Technology Advisor, NHA
  • Dharmil Sheth, CEO, PharmEasy
  • Pankaj Sahni, CEO, Medanta
  • Veneeth Purushotaman, Group CIO, Aster Healthcare
  • Yashish Dahiya, CEO, Policybazaar
  • Abhimanyu Bhosale, CEO, LiveHealth
  • Prabhdeep Singh, CEO, Stanplus
  • Rajat Agarwal, Managing Director, Matrix Partners India
  • Tarun Davda, Managing Director, Matrix Partners India

Prospective Talks and Masterclasses

  • “An overview of the NHS architecture and objectives”
  • “A deepdive into the PHR APIs”
  • “Medical imaging data: Changing the Status Quo”
  • “Using delegated consent to bolster efficacy in emergency care”
  • “Technology challenges and opportunities for hospitals and labs”
  • “Health Tech in India: successes and areas of improvement”

Sponsors and Partners

Principal Sponsors
  • Matrix India Partners
  • Swasth Alliance
Knowledge Partners
  • CHIME India
  • HIMSS India Chapter
Sandbox Providers
  • National Health Authority
  • LiveHealth
Organization Partner:
  • Devfolio

Cash Prizes

Six teams in the hackathon will be eligible to win prizes of Rs. 50,000 each

Five teams in the ideathon will be eligible to win prizes of Rs. 20,000 each.

Dates, Registration, and Outreach

Registration Link (for both events): https://healthathon.devfolio.co

Registrations Close (for both events) : 22nd October, 2020

Opening Ceremony: 24th October, 2020

Ideathon submissions: November 6th, 2020

Hackathon submissions: November 19th, 2020

Closing Ceremony: 22nd November

Outreach: [email protected] (Email subject: “Healthathon”)

Blog Post Image Source: SelectInsureGroup.com

iSPIRT NHS Open House Session #2: PHR and Doctor Registry

iSPIRT hosted the second open house session on the National Health Stack (NHS). 

In this session, our health stack volunteers dived deeper into the Personal Health Record (PHR) system and also covered the concept of the Electronic Doctor Registry.

In the first part of the session, our volunteer Siddharth Shetty answered technical questions pertaining to the PHR system. These questions, which were all submitted by the community, covered topics ranging from blockchains and zero-knowledge proofs to assisted consent flow for low tech-savvy users. A link to a recording of the session can be found at the end of this post.

In the second half of the session, our volunteer Kiran Anandampillai explained the concept of the doctor registry. The electronic registry system is a mechanism for managing master data about different entities in the healthcare ecosystem. Although some of these entities do appear in existing databases, these legacy systems are often incomplete, outdated, and seldom accessible via APIs. In contrast, the registries in the NHS are intended to capture trusted, non-repudiable data and enable self-maintainability. These registries will also have open APIs and will allow for secure authentication and data sharing. 

In the context of doctors, the electronic doctor registry can be used to:

  • Prove their identity and credentials as doctors
  • Electronically sign documents such as prescriptions, insurance claims, operating theatre notes, and more
  • Streamline workflows such as joining or telehealth application or registering for CME points (Continuing Medical Education points necessary for renewing a doctor’s license)

A recording of the entire session, including a breakdown of the design principles, APIs, and timelines behind the doctor registry, can be found below.

Inquisitive readers are also encouraged to submit their technical questions around the NHS to [email protected].

We will be answering those questions at the start of next week’s open house session, which will begin at 11:30 am on Saturday, 6th June. An invite to that session will be sent out to all participants who sign up at this link: https:// www.bit.ly/NHS-OHD

Although these sessions have so far been focusing on technical features of the NHS, the business and design aspects are also crucially important and will be covered in short order.

The blog post is authored by our volunteer Aaryaman Vir and he can be reached at [email protected].

iSPIRT Open House Discussion on National Health Stack [Virtual]

The National Health Stack is a set of foundational building blocks that will be built as shared digital infrastructure, usable by both public sector and private sector players. 

Healthcare delivery in India faces multiple challenges today. The doctor-patient ratio in the country is extremely poor, a problem that is exacerbated by the uneven distribution of doctors in certain states and districts. Insurance penetration in India remains low, leading to out-of-pocket expenses of over 80% (something that is being addressed by the Ayushman Bharat program). Additionally, the current view on healthcare amongst citizens as well as policymakers is largely around curative care.

Preventive care, which is equally important for the health of individuals, is generally overlooked. The leapfrog we envision is that of public, precision healthcare. This means that not only would every citizen have access to affordable healthcare, but the care delivered would be holistic (as opposed to symptomatic) and preventive (and not just curative) in nature. This will require a complete redesign of operations, regulations, and incentives – a transformation that, we believe, can be enabled by the Health Stack.

iSPIRT Foundation in partnership with Swasth Alliance is hosting an Open House Discussion on the following building blocks of the Health Stack

  • Doctor Registry
    • The ability for doctors to digitally authenticate themselves and share their electronic credentials with a third-party application such as a telehealth provider
  • Personal Health Record (PHR) System
    • The ability for every Indian to be empowered with control over their health data such that they can share it with trustworthy clinical providers to access a digital service
  • Open Health Services Network 
    • A unified health services network that comprises of a common set of protocols and APIs to allow health services to be delivered seamlessly across any set of health applications, doctors, and providers. 

The virtual session will be from 11:30 AM to 1:00 PM on Saturday 23rd May.

To confirm your participation and receive the virtual link, please click here.

Recommended Reading 

The history of technology is about to change radically. India must seize the moment

There are no atheists in foxholes, and there appear to be no capitalists in a global pandemic either. The head of Honeywell’s billion-dollar GoDirect Trade platform, which uses a permission-based blockchain to buy and sell aviation parts, declared on March 20 that American corporations had a “walled-garden” approach to data. “They need to start sharing data, a huge paradigm shift”, said Lisa Butters. Only a couple of weeks ago, Honeywell had been defending the virtues of a permission-based system, saying enterprises “needed some constraints to operate in”. 

What a difference a few days can make. 

Historically, the aviation industry has been one of the most secretive among ‘Big Tech’ sectors, with its evolution tied intimately to the Second World War, and the US-Soviet Cold War rivalry that followed soon after. Concerns around China’s theft of aerospace IP was among the foremost drivers behind the Obama administration’s negotiation of the 2015 agreement with China to prohibit “economic espionage”. It is the ultimate “winner-takes-all” market — but Boeing, its lynchpin, has now approached the US government for an existential bailout. Honeywell’s call for a “paradigm shift” is proof that the sector is not thinking just in hand-to-mouth terms. The aviation sector may get a lifeline for now, but as an industry forged by a global war, it knows more than most that a transformational moment for technology is upon it, which needs to be seized. 

As the economist Branko Milanović has highlighted, the correct metaphor for the Covid-19 pandemic and ensuing crisis is not the Great Recession of 2008, but the Second World War. To win WWII, and retain its military superiority, the United States pioneered technology complexes that placed innovation at the trifecta of a university lab, government, and market. (The blueprint for this model was drawn up in 1945 by Vannevar Bush, founder of Raytheon and director of the Office for Scientific Research and Development, and presented to the US government. The document was titled, “Science: The Endless Frontier”.) This was by no means a Western endeavour alone. Several countries, including India, followed suit, trying to perfect a model of “organised science”. In India, the Council for Scientific and Industrial Research was the totem for this effort and created a centralised network of national labs. The primary difference between Western models and ones in developing countries like India was the role of the state. In the US, the state retained regulatory agency over the process of technological innovation, but gradually ceded into the background as the Boeings, Westinghouses, GEs, Lockheed Martins, and IBMs took over. In India, the state became both the regulator and purveyor of technology. 

India’s attempts to create “national champions” in frontier technologies (think Hindustan Antibiotics Ltd, Electronics Corporation of India Ltd, Defence Research and Development Organisation, etc) failed because the state could not nimbly manufacture them at scale. Even as India pursued “moonshots”, those businesses in the United States that were incubated or came of age during the Second World War began to occupy pole positions in their respective technology markets. Once those markets matured, it made little sense for America to continue creating “organized” technology complexes, although research collaborations between universities and the federal government continued through the National Science Foundation. The banyan-ization of the internet and Silicon Valley — both seeded by generous assistance from the US Department of Defence — into a market dominated by the FAANG companies affirms this shift.

In the wake of the Covid-19 pandemic, however, the tables are turning. The United States is not only shifting away from “moonshots” but also pivoting towards “playgrounds”, settling on a model that India has perfected in the last decade or so.

The United States has often sought to repurpose private technologies as public utilities at key moments in its history. Communications technology was built and moulded into a public good by the American state. It was US law that enabled patent pooling by Bell Labs in the 19th century, leading to the creation of a “great new corporate power” in telephony. A few decades into the 20th century, American laws decreed telephone companies would be “common carriers”, to prevent price and service discrimination by AT&T. Meanwhile, both railroads and telecommunications providers were recognised as “interstate” services, subject to federal regulation. This classification allowed the US government to shape the terms under which these technologies grew. IT is precisely this template that Trump has now applied to telehealth technology in the US. Tele-medicine services could not previously be offered across state lines in the US, but the US government used its emergency powers last week to dissolve those boundaries. And on March 18, President Trump invoked the Defence Production Act, legislation adopted during the Korean War and occasionally invoked by American presidents, that would help him commandeer private production of nearly everything, from essential commodities to cutting-edge technologies. 

Invoking the law is one thing, executing it is another. Rather than strong-arming businesses, the Trump administration is now trying to bring together private actors to create multiple “playgrounds” with an underlying public interest. The Coronavirus Task Force was the first of its kind. The Task Force brought together Walmart, Google, CVS, Target, Walgreens, LabCorp and Roche, among others to perform singular responsibilities aimed at tackling the coronavirus pandemic. Walmart would open its parking lots for testing, Google would create a self-testing platform online, Roche would develop kits, LabCorp would perform high-throughput testing, and so on. The COVID-19 High-Performance Computing Consortium, created on March 23, is another such playground. It includes traditional, 20th-century actors such as the national laboratories but is doubtless front-ended by Microsoft, IBM, Amazon and Google Cloud. The Consortium aims to use its high computational capacity to create rapid breakthroughs in vaccine development. Proposals have been given an outer limit of three months to deliver. 

In some respects, the United States is turning to an approach that India has advanced. To be sure, we may not currently be in a position to develop such a playground for vaccine R&D and testing at scale. But India is well-positioned to create the “digital playgrounds” that can help manage the devastating economic consequences of the Covid-19 epidemic. There is a universal acknowledgement that India’s social safety nets need to be strengthened to mitigate the fallout. One analyst recommends “a direct cash transfer of ₹3,000 a month, for six months, to the 12 crores, bottom half of all Indian households. This will cost nearly ₹2.2-lakh crore and reach 60 crore beneficiaries, covering agricultural labourers, farmers, daily wage earners, informal sector workers and others.” The same estimate suggests “a budget of ₹1.5- lakh crore for testing and treating at least 20 crore Indians through the private sector.” 

The digital public goods India has created — Aadhaar, UPI and eKYC — offer the public infrastructure upon which these targeted transfers can be made. However, cash transfers alone will not be enough: lending has to be amplified in the months to come to kickstart small and medium businesses that would have been ravaged after weeks of lockdown. India’s enervated banking sector will have meagre resources, and neither enthusiasm or infrastructure to offer unsecured loans at scale. “Playgrounds” offers private actors the opportunity to re-align their businesses towards a public goal, and for other, new businesses to come up. Take the example of Target, which is an unusual addition to the Coronavirus Task Force, but one whose infrastructure and network makes it a valuable societal player. Or Amazon Web Services in the High-Performance Computing Consortium, which has been roped in for a task that is seemingly unrelated to the overall goal of vaccine development. 

If digital playgrounds are so obvious a solution, why has India not embraced it sooner? None of this is to discount the deficit of trust between startup founders and the public sector in India. Founders are reluctant to use public infrastructure. It is the proverbial Damocles’ sword: a platform or business’ association with the public sector brings it instant legitimacy before consumers who still place a great deal of trust in the state. On the other hand, reliance on, or utilisation of public infrastructure brings with it added responsibilities that are unpredictable and politically volatile. To illustrate, one need only look at the eleventh-hour crisis of migrating UPI handles from YES Bank in the light of a moratorium imposed on the latter earlier this month. On the other hand, the government retains a strong belief that the private sector is simply incapable of providing scalable solutions. In most markets where the India government is both player and regulator, this may seem a chicken-and-egg problem, but c’est la vie.

Nevertheless, there are milestones in history where seemingly insurmountable differences dissolve to reveal a convergence of goals. India is at one such milestone. A leading American scientist and university administrator have called the pandemic a “Dunkirk moment” for his country, requiring civic action to “step up and help”. By sheer chance and fortitude, India’s digital platforms are poised to play exactly the role that small British fishing boats played in rescuing stranded countrymen on the frontline of a great war: they must re-imagine their roles as digital platforms, and align themselves to strengthen the Indian economy in the weeks to come. 

Arun Mohan Sukumar is a PhD candidate at the Fletcher School, Tufts University, and a volunteer with the non-profit think-tank, iSPIRT. His book, Midnight’s Machines: A Political History of Technology in India, was recently published by Penguin RandomHouse.

#6 Healthstack session at LetsIgnite

We had the chance to conduct a discussion on the National Health Stack during the LetsIgnite event organized by the LetsVenture team on 15th June at the Leela Palace. The audience comprised of early stage healthcare startups along with angel investors and venture capitalists having keen interest in healthcare investments. Some notable attendees included Dr. Ramesh (senior cardiologist, MD Endiya Partners) and Mr. Mohan Kumar (Partners, Norwest Venture Partners).

Sharad Sharma (co-founder, iSPIRT), Dr. Santanu Chatterjee (Founder, Nationwide Primary Care), Dr. Ajay Bakshi (Founder Buddhimed Technologies, ex-India CEO Parkway Pantai) and Arun Prabhu (Partner, Cyril Amarchand Mangaldas) had been invited to lead the session, which was moderated by Anukriti Chaudhari and Priya Karnik, both core volunteers at iSPIRT championing the health stack initiative.

The context was set by an interactive talk by Sharad who began by giving a glimpse of the underlying philosophy of the iSPIRT Foundation – the idea of building public goods as digital technology stacks which can be leveraged by private players to serve Bharat. . Sharad described societal change in India being a Jugalbandi between digital public infrastructure, market participants and policy makers to achieve the same. He mentioned how the India Stack was changing the face of fintech in India and that the Health Stack could do the same for healthcare. The audience was more than startled to hear that a day prior to the session, the number of UPI transaction in India were already one-sixth of what MasterCard had done worldwide. ( UPI has only been around for 33 months! ). Sharad then went on to explain the different layers of the Health Stack comprising National Registries, standardised health information flows, an insurance claims management software built upon a standard Policy Markup Language and a gamifier policy engine. He didn’t miss reminding the audience that the Health Stack was being built to solve for the healthcare needs of ‘Bharat’and not the privileged 30 million Indian families already being well-served by the healthcare conglomerates in urban areas.

With the context in place, Anukriti took over to give a background of the healthcare landscape in India. India struggles with a 1:1600 doctor to patient ratio with more than 60% of doctors and hospitals concentrated in urban regions. To add to that, the public expenditure for healthcare is just 3.9% of our annual GDP (compared to 18% in the US) and it’s not surprising that most deaths in public healthcare facilities happen because of poor quality of care. Health insurance penetration barely touches 20% with OOP expenditure dominating the healthcare spending in India. With a huge underserved population, the need of the hour is to leap-frog to scalable solutions that can reach the masses instead of incremental linear growth solutions to address the Indian healthcare challenges. The different layers of Health Stack make it much easier for innovators (both public and private) to develop radical solutions.. While funding in healthcare startups has increased over the last 5 years, it still significantly lags behind areas like fintech, e-commerce, ed-tech, etc. Moreover, the bulk of healthtech investments have been focused on the consumer tech sector. Anukriti ended her views with a futuristic optimism regarding the innovations that Health Stack could open, to make healthcare truly affordable, accessible and high quality.

We were fortunate to have Dr. Santanu and Dr. Bakshi give insights about the Health Stack with their on-ground experiences in healthcare spanning over decades. Dr. Santanu mentioned that for primary care, the national registry of care providers was very fundamental to ascertain ‘which stakeholder provides what’ given that almost every provider is somewhere involved in primary care. On top of that, he stressed about the need for Artificial Intelligence backed clinical support systems that seamlessly integrate with the doctor’s workflow. This is of particular relevance for rural healthcare settings wherein, despite various efforts, there aren’t enough doctors to setup shops in villages . A standardized health information layer, along with data transfer mechanisms, could be the driving force for this. He was, however, wary of how well standard insurance schemes would work for primary care as the insurance business model falls apart given that almost everyone needs access to primary care at some point or the other. Priya resonated with his views and further suggested that for ‘Bharat’, micro insurance policies could be the key mechanism to drive insurance adoption at the consumer level. Such a system could potentially be facilitated by a claims engine platform build upon a standard policy markup language to ‘almost-automate’ (auto-adjudicate) the claims addressal process.

Dr. Bakshi contended that for a stable society, healthcare and education are a must, as the former secures our ‘today’ while the latter secures our ‘tomorrow’. Having worked as the CEO of three major hospital chains in India, he accepted (without an iota of political correctness) that as a nation, we have failed miserably in providing either. Healthcare is a social good and nowhere in the world has it been solved by private players alone (given the way private incentives are aligned). The public sector in India hasn’t stepped up which is the reason that private players dominate the quality healthcare delivery which could lead us (or is perhaps already leading) to following the footsteps of the US. This is an alarming trend because in the short and medium term, India cannot afford to outsource the entire healthcare delivery to private players. Dr. Bakshi remarked that to set things on the correct track, the Health Stack is a very important initiative and congratulated the iSPIRT team for working ardently to make it happen. He however suggested all stakeholders to be privy of the fact that while fintech transactions are linear (involving the payer and the recipient), a healthcare ‘transaction’ involves multiple aspects like the doctor’s opinion, investigation, drugs, nurses, ward boys and many other layers. This underlying multidimensionality would make it difficult to replicate an India Stack kind of model for the healthcare setting. At the core of the healthcare transaction lies the ‘doctor-patient’ interaction and it is imperative to come but with some common accepted standards to translate the healthcare lingo into ‘ones and zeroes’. He lauded the health information flows  of the Health Stack for being a step in the right direction and mentioned that in his individual capacity, he is also trying to solve for the same via his newly launched startup Buddhimed Technologies.

With two stalwarts of healthcare sitting beside her, Anukriti grabbed the opportunity to put forth the controversial concept of ‘doctors being averse to technology’ which could possibly be a hindrance for Health Stack to take off. Dr. Santanu and Dr. Bakshi were quick to correct her with the simple example of doctors using highly technical machines in providing treatments. They coherently stated that doctors hated Information Technology as it was forced upon them and suggested that IT professionals could do a better job by understanding the workflows and practical issues of doctors and then develop technologies accordingly. This is an important takeaway – as various technologies are conceptualized and built, doctors should be made active participants in the co-creation process.

The idea of a common public infrastructure for healthcare definitely caught the attention of both investors and startup founders. But amidst the euphoria emerged expected murmurs over privacy issues. That was when Arun Prabhu, the lawyer-in-chief for the session, took the lead. He reiterated Dr. Bakshi’s point of the doctor-patient relationship being at the core of the healthcare transactions. Such a relationship is built upon an element of trust, with personal health data being a very sensitive information for an individual. Thus, whatever framework is built for collating and sharing health information, it needs to be breach proof. Arun cited the Justice Srikrishna report to invoke the idea of consent and fiduciaries – a system wherein individuals exercise their right to autonomy with respect to their personal data not by means of ownership (which in itself is an ambiguous term), nor by regimes of negligence or liability but by the concept of a coherent consent mechanism spread across different stakeholders of the healthcare value chain. Moreover, the consent system should be straight-forward and not expressed via lengthy fifty page documents which would make it meaningless, especially for the India 2 and India 3 population. Lastly, he mentioned that just like physical and tangible assets have certain boundaries, even data privacy can have certain realistic limitations. If an information point cannot be specifically identified or associated with a particular individual but can have various societal benefits, it should be made accessible to relevant and responsible stakeholders. Thus, while it is imperative to protect individual health data privacy, there should be a mechanism to access aggregated anonymized health data. There is tremendous value in aggregating large volumes of such data which can be used for purposes like regional analysis of disease outbreaks, development of artificial intelligence based algorithms or for clinical research. Priya added that such a system was inherent in the Health Stack via the Population Health Analytics Engine and the framework for democratisation of aggregate data.

Overall, the session amalgamated various schools of thought by bringing together practitioners, CEOs, CIOs, lawyers, startups and investors on one common discussion platform. This was perhaps an example of the much-needed Jugalbandi that Sharad had mentioned about. A public good is conceptually ‘by the stakeholders, for the stakeholders and of the stakeholders’. This necessitates its active co-creation instead of isolated development. Needless to say, multi-way dialogue is the DNA of such a process. Staying true to that philosophy, we look forward to conducting many such interactive sessions in the future.

Ravish Ratnam is part of the LetsVenture Team – a platform for angel investing and startup fundraising.

He can be reached on [email protected]

#1 India’s Health Leapfrog – Towards A Holistic Healthcare Ecosystem

In July 2018, NITI Aayog published a Strategy and Approach document on the National Health Stack. The document underscored the need for Universal Health Coverage (UHC) and laid down the technology framework for implementing the Ayushman Bharat programme which is meant to provide UHC to the bottom 500 million of the country. While the Health Stack provides a technological backbone for delivering affordable healthcare to all Indians, we, at iSPIRT, believe that it has the potential to go beyond that and to completely transform the healthcare ecosystem in the country. We are indeed headed for a health leapfrog in India! Over the last few months, we have worked extensively to understand the current challenges in the industry as well as the role and design of individual components of the Health Stack. In this post, we elaborate on the leapfrog that will be enabled by blending this technology with care delivery.

What is the health leapfrog?

Healthcare delivery in India faces multiple challenges today. The doctor-patient ratio in the country is extremely poor, a problem that is further exacerbated by their skewed distribution. Insurance penetration remains low leading to out-of-pocket expenses of over 80% (something that is being addressed by the Ayushman Bharat program). Additionally, the current view on healthcare amongst citizens as well as policymakers is largely around curative care. Preventive care, which is equally important for the health of individuals, is generally overlooked.  

The leapfrog we envision is that of public, precision healthcare. This means that not only would every citizen have access to affordable healthcare, but the care delivered would be holistic (as opposed to symptomatic) and preventive (and not just curative) in nature. This will require a complete redesign of operations, regulations and incentives – a transformation that, we believe, can be enabled by the Health Stack.

How will this leapfrog be enabled by the Health Stack?

At the first level, the Health Stack will enable a seamless flow of information across all stakeholders in the ecosystem, which will help in enhancing trust and decision-making. For example, access to an individual’s claims history helps in better claims management, a patient’s longitudinal health record aids clinical decision-making while information about disease incidence enables better policymaking. This is the role of some of the fundamental Health Stack components, namely, the health registries, personal health records (PHR) and the analytics framework. Of course, it is essential to maintain strict data security and privacy boundaries, which is already considered in the design of the stack, through features like non-repudiable audit logs and electronic consent.

At the second level, the Health Stack will improve cost efficiency of healthcare. For out-of-pocket expenditures to come down, we have to enable healthcare financing (via insurance or assurance schemes) to become more efficient and in particular, the costs of health claims management to reduce. The main costs around claims management relate to eligibility determination, claims processing and fraud detection. An open source coverage and claims platform, a key component of the Health Stack, is meant to deal with these inefficiencies. This component will not only bring down the cost of processing a claim but along with increased access to information about an individual’s health and claims history (level 1), will also enable the creation of personalised, sachet-sized insurance policies.

At the final level, the Health Stack will leverage information and cost efficiencies to make care delivery more holistic in nature. For this, we need a policy engine that creates care policies that are not only personalized in nature but that also incentivize good healthcare practices amongst consumers and providers. We have coined a new term for such policies – “gamifier” policies – since they will be used to gamify health decision-making amongst different stakeholders.

Gamifier policies, if implemented well, can have a transformative impact on the healthcare landscape of the country. We present our first proposal on the design of gamifier policies, We suggest the use of techniques from microeconomics to manage incentives for care providers, and those from behavioural economics to incentivise consumers. We also give examples of policies created by combining different techniques.

What’s next?

The success of the policy engine rests on real-world experiments around policies and in the document we lay down the contours of an experimentation framework for driving these experiments. The role of the regulator will be key in implementing this experimentation framework: in standardizing the policy language, in auditing policies and in ensuring the privacy-preserving exchange of data derived from different policy experiments. Creating the framework is an extensive exercise and requires engagement with economists as well as computer scientists. We invite people with expertise in either of these areas to join us on this journey and help us sharpen our thinking around it.

Do you wish to volunteer?

Please read our volunteer handbook and fill out this Google form if you’re interested in joining us in our effort to develop the design of Health Stack further and to take us closer to the goal of achieving universal and holistic healthcare in India!

Update: Our volunteer, Saurabh Panjawani, author of gamifier policies, recently gave a talk at ACM (Association for Computing Machinery)/MSR (Microsoft Research) India’s AI Summit in IIT Madras! Please view the talk here: https://www.microsoft.com/en-us/research/video/gamifier-policies-a-tool-for-creating-a-holistic-healthcare-ecosystem/

Data Privacy and Empowerment in Healthcare

Technology has been a boon to healthcare. Minimally-invasive procedures have significantly increased safety and recovery time of surgeries. Global collaboration between doctors has improved diagnosis and treatment. Rise in awareness of patients has increased the demand for good quality healthcare services. These improvements, coupled with the growing penetration of IT infrastructure, are generating huge volumes of digital health data in the country.

However, healthcare in India is diverse and fragmented. During an entire life cycle, an individual is served by numerous healthcare providers, of different sizes, geographies, and constitutions. The IT systems of different providers are often developed independently of each other, without adherence to common standards. This fragmentation has the undesirable consequence of the systems communicating poorly, fostering redundant data collection across systems, inadequate patient identification, and, in many cases, privacy violations.

We believe that this can be addressed through two major steps. Firstly, open standards have to be established for health data collection, storage, sharing and aggregation in a safe and standardised manner to keep the privacy of patients intact. Secondly, patients should be given complete control over their data. This places them at the centre of their healthcare and empowers them to use their data for value-based services of their choice. As the next wave of services is built atop digital health data, data protection and empowerment will be key to transforming healthcare.

Numerous primary health care services are already shifting to smartphones and other electronic devices. There are apps and websites for diagnosing various common illnesses. This not only increases coverage but also takes the burden away from existing infrastructures which can then cater to secondary and tertiary services. Data shared from devices that track steps, measure heartbeats, count calories or analyse sleeping patterns can be used to monitor behavioural and lifestyle changes – a key enabler for digital therapeutic services. Moreover, this data can not only be used for monitoring but also for predicting the onset of diseases! For example, an irregular heartbeat pattern can be flagged by such a device, prompting immediate corrective measures. Thus, we see that as more and more people generate digital health data, control it and utilise it for their own care, we will gradually transition to a better, broader and preventive healthcare delivery system.

In this context, we welcome the proposed DISHA Act that seeks to Protect and Empower individuals in regards to their electronic health data. We have provided our feedback on the DISHA Act and have also proposed technological approaches in our response. This blog post lays out a broad overview of our response.

As our previous blog post articulates the principles underlying our Data Empowerment and Protection Architecture, we have framed our response keeping these core principles in mind. We believe that individuals should have complete control of their data and should be able to use it for their empowerment. This requires laying out clear definitions for use of data, strict laws to ensure accountability and agile regulators; thus, enabling a framework that addresses privacy, security and confidentiality while simultaneously improving transparency and interoperability.

While the proposed DISHA Act aligns broadly with our core principles, we have offered recommendations to expand certain aspects of the proposal. These include a comprehensive definition of consent (open standards, revocable, granular, auditable, notifiable, secure), distinction between different forms of health data (anonymization, deidentification, pseudonymous), commercial use of data (allowed for benefit but restricted for harm) and types and penalties in cases of breach (evaluation based on extent of compliance).

Additionally, we have outlined the technological aspects for implementation of the Act. We have used learnings from the Digital Locker Framework and Electronic Consent Framework (adopted by RBI’s Account Aggregator), previously published by MeitY. This involves the role of Data Fiduciaries – entities that not only manage consent but also ensure that it aligns with the interests of the user (and not with those of the data consumer or data provider). Data Fiduciaries only act as messengers of encrypted data without having access to the data – thus their prime task remains managing the Electronic Data Consent. Furthermore, we have highlighted the need to use open and set standards for accessing and maintaining health records (open APIs), consented sharing (consent framework) and maintaining accountability and traceability through digitally verified documents. We have also underscored the need for standardisation of data through health data dictionaries, which will open up the data for further use cases. Lastly, we have alluded to the need to create aggregated anonymised datasets to enable advanced analytics which would drive data-driven policy making.

We look forward to the announcement and implementation of the DISHA Act. As we move towards a future with an exponential rise in digital health data, it is critical that we build the right set of protections and empowerments for users, thus enabling them to become engaged participants and better managers of their health care.

We have submitted our response. You can find the detailed document of our response to DISHA Act below

The best way to predict the future is to invent it!

India is interestingly poised today. About half of India’s 1.25billion people are under the age of 25 and by 2020, India will be the world’s youngest country with an average age of 29. According to the World Bank, India’s will overtake China to become the world’s fastest growing big economy by 2017-18. The scale of opportunity – and of course the challenge – in India is unprecedented. Millions of jobs have to be created in the coming years. Wealth has to be created. At an increasing pace and in   an ever changing world.

It is clear to all, including the government, that technology will play an ever more important role in the future. The inevitability of that fact is slowly but surely seeping into the consciousness of all decision makers at all levels. That technology needs to be embraced and leveraged in improving the lives of Indians.

New technologies and platforms are rapidly emerging – e.g., IoT, Mobile/Smart phones, Cloud, Aadhar, Payments – that can and will have profound impact on how we as a country think about the next 5-10years. Our future.

It is clear that continuing to do what we’ve done since 1947 isn’t going to get us far into the future.

“The best way to predict the future is to invent it” and “Change is the only constant” are two popular adages usually bandied about in seminars, corporate-speak, by VC s and successful entrepreneurs! What’s left unsaid are – how do I invent the future? How do I deal with change? And from there on to, what are the possible futures? What are the possible changes? What’s causing them? How will different industries like Financial Services, Retail, Healthcare be likely impacted?

These are the tough questions. Successful entrepreneurs, investors, corporations, academics and governments spend – or, need to spend – a lot of time thinking about such issues.

What are new ways of framing the potential and overcoming these challenges? What is unique about India and what solutions and resources can be shared from around the world? How can India utilize the enormous, young and entrepreneurial energy to craft scalable solutions to impact lives? What are the emerging global megatrends that can be harnessed that will enable India to leapfrog decades of inefficiency and empower people?

We have done this before: From mainframe computing to client-server. From land line to mobile. From paper based to digital identity.

Can we do this again across multiple areas? What will it take?

Answers will be found through debate and discussion by various stakeholders invested in the India of a new India– government, thought leaders, practitioners, entrepreneurs, executives among others. A forum for learning, discussing, debating, sharing of ideas of a future impacted by technology would be very impactful. To catalyse conversations, connections and collaborations that would help provide the answers to the questions.

A journey of a million miles begins with a single step. It is time for that 1st meaningful step to be taken!

LeapFrogTIE LEAPFROG. AUGUST 21ST 2015. ITC GARDENIA BANGALORE. http://www.tieleapfrog.in/

IT: Enhancing Healthcare for a Better Quality of Life

Information Technology has successfully reshaped our lives in ways unimaginable even a decade or two ago. The era of the telegram is now officially over and access to information is not just at our doorsteps but at our finger tips, due to the availability of communication tools like cellular phones, computers and the internet. It is no wonder then that technology has played a key role in healthcare as well and has the potential to completely change the way we deal with a disease at various stages.

The current government rightly focuses on using technology to improve the dismal standards of basic healthcare, not just for the urban population but also for people living in rural settings in remotest corners of ‘Bharat’ which is home to almost 70 percent of our country’s population. Evidence from national and international data clearly shows that the effective use of ICT in healthcare can improve access to better quality services, reduce costs, and empower doctors as well as patients. India has been aggressively experimenting with IT in healthcare, with notable progress in ‘m-health’, ‘tele-medicine’ and ‘e-health’. Many of these services are ready to take the next step and be scaled up to achieve their true potential. The use of IT in healthcare can be the first big step in improving the primary healthcare network in the country.

Simultaneously, it is also important to tap the energy of the private providers of healthcare services in India. Some estimates suggest that by 2012, private sector comprised 80 percent of the healthcare providers in India as against 8 percent at the time of independence. Traditionally, the private and public healthcare sectors in India have viewed each other with mistrust, and to get them to work in tandem is not an easy task. Efforts need to be made towards building confidence and fostering cooperation. This is where the true advantage of IT lies. Technology is available to doctors in both the sectors and can be used for notifying, reporting and following up on medical cases.

Take the issue of Tuberculosis in India, which accounts for more than 25 percent of the new TB cases worldwide. This contagious airborne disease kills almost 2.4 lakh Indians every year and is among the top four causes of death in adults. The Revised National TB Control Program (RNTCP) provides mechanisms to ensure treatment adherence monitoring and support, but these currently reach patients treated by the public sector. Inappropriate, inadequate and unmonitored care could lead to treatment failure, recurrent TB, and most devastatingly the development of drug resistant TB. Hence, proper mechanisms for awareness and monitoring for all TB patients, whether publicly or privately-treated, become all the more important.

In 2012, RNTCP launched e-NIKSHAY, a case-based and web-based reporting and recording system that would act as a centralized avenue for data collection of TB cases; aiding state and local systems to track the progress of patients and keep all the stakeholders in the loop. Over the last 6 months, in the Mehsana, Mumbai and Patna pilot Urban-TB projects, such IT- based systems have helped issue over 10,000 drug vouchers for privately-treated TB patients, and linked those patients to improved treatment monitoring and support. Total TB case notification in these districts, including public and private, has improved significantly demonstrating its success and importance. Increased transparency and monitoring leads to better planning and accountability.

The main reason behind the success of any IT application is its user friendly attribute. It is time to reach out to private practitioners with easy-to-use applications that take minimum time, and yield maximum value to providers and their patients. The most basic yet powerful communication device, the mobile phone, which is used by over 70 percent of Indians, will help us penetrate in the remotest corners of the country. This device can help extensively in increasing the reporting of cases and keeping a close watch on patient who often skip medicine. The Union Government’s recent launch of an initiative to maintain an electronic treatment record of TB patients by encouraging them to send a missed call notification on a number printed behind the strip of the drug is a classic example of how reporting and follow up can be done without involving significant extra cost and effort. This will help the treatment provider to intervene at the right time in case the patient misses a dose.

Training and education in e-healthcare plays the most crucial role in the implementation of these projects. For this purpose the Indian Council of Medical Research has made an open access online bibliography and there are hospitals which have collaborated with universities to teach certificate courses in telemedicine.

India is a leader in innovation, research and IT. It is important that this innovation potential and its resources are harnessed to combat India’s healthcare challenges. If we truly want to improve access to healthcare and sustain it, we need to scale up such innovative new practices by providing adequate resources and encouraging the appropriate skill-development. It’s time for us to move beyond working for IT and start making IT work for us.

Just Imagine

Today is India’s 66th Independence Day and the environment around, seems, to be generally shorn of excitement, energy and optimism. However, as is customary on such occasions, a call to the people – all of us – is, well, called for: to galvanise us all to action, to put our shoulders to the wheel of policy making that will make economic activity explode.  Such calls for action and indeed, the action, itself require us all to imagine an India that is radically different from the one that we see and experience each day around us.

Nandan Nilekani wrote “Imagining India” in 2008 and one of the things he imagined has since been actualised in the form of the Aadhar / UID project that provides an Identity card and number to every resident of India. Over 600million people would be recipients of this card by next year, 2014. In and as of itself, this would have been a gargantuan exercise, amongst the very largest in the world. But that by itself wouldn’t be as interesting as what the prevalence of the Aadhar infrastructure can enable.  Identity is a fundamental pre-requisite for any kind of financial transaction and the Aadhar project enables that.  “Know your customer” ( KYC) norms can now be easily done for all kinds of activities eg. From opening a bank account to applying for a gas connection to a phone to availing a loan to purchasing insurance. Hundreds of millions of people who operated in the informal or extra-legal financial services market will now come under the more benign, formal, organised and recognised regime.

Much earlier in the 1980s, Sam Pitroda imagined an India transformed with the creation and establishment of a nationwide telecom infrastructure.  Today, we all are witness to the remarkable benefits that this imagination has brought about. Over 900 million phone subscribers in just over two decades.

Even earlier, in the 1960s Dr Verghese Kurien imagined a young country that would be self-sufficient in milk. Operation Flood made India, formerly a milk deficient country, the world’s largest producer of milk accounting for over 17% of global output with an entire infrastructure, from rural to urban, tradition and technology to markets and branding.

Each of the above examples showcases the huge long term national benefits of creating big platforms – Unique Identity, Telecom, Milk Production and Distribution – through the sheer power of imagination, entrepreneurial energy, policy making, political will and savvy marketing. Platforms are soft and hard infrastructure – policy, rules of engagement and collaboration, co-opting of existing stakeholders, creation and harnessing of technology, innovative processes and business models. Such platforms while usually created and established by the government to serve public good, interest and national security, it is the subsequent entry of private entrepreneurs that enables the proliferation and development of additional technologies and services. For example, the mother of all platforms today, the internet, had its origins in the US Department of Defence Advanced Project Network.

So as we enter our 67th year as a nation, what is it that we can imagine? Indeed, what should we imagine? Very briefly,

i)               Education: In the age of MOOCs and Wikis, why cannot India have a national programme for education using and deploying the latest technologies? Video based learning, local languages with local examples, with the best teachers, with online testing? This will require the creation of a massive technology backbone, co-opting of existing institutions, training, establishment of processes and rules, financial incentives, payment and collection mechanisms for the entry and exit of private entities.

ii)              Healthcare is another area that requires enormous intervention along the lines being discussed. Telemedicine, remote diagnostics, new innovative low cost devices for self testing and medication, education and awareness, mobile clinics, logistics for moving patients and equipment, innovative payment systems, policy, regulation and oversight are areas that have to come together.

iii)            A marketplace for logistics providers – air, land and sea – across the value chain, integrated with warehouses, C&F agents, insurance providers, payments and settlements, processes for transparent pricing. Can be very useful for agriculture and industry.

There obviously are many more possibilities (viz. defence and space) and initiatives that can be imagined that will help all of us Indians and India. Can we set the ball rolling and start the process of engagement with various stakeholders – government, industry bodies, entrepreneurs and others – to help create platforms that can create a new India? Can we create and curate ideas for platforms that have the immense potential to fundamentally transform India.  Just Imagine.

The day Zest.Md picked on smartest brain for inputs at #PNMeetup

I met Avinash a few weeks back to share details about zest.md, and to discuss some of the challenges which we are facing. Avinash, helped me to understand a lot of issues better, and invited me to be a part of the #PNMeetup to discuss it with a larger group. To be honest, I was apprehensive initially, but seeing the conviction with which Avinash said that it would help us, I agreed and I am so glad that we did go and share our challenges at the #PNMeetup! 

Zest.Md is a SaaS platform which provides with medical practitioners with a solution to get started with online consultation process, using their own website. One of the key challenges which we shared with the group was on how to drive initial engagement with the medical practitioners who sign up. Another aspect which we discussed was around pricing. Currently we have a single price solution, and we were in the process of considering Freemium model – what should we keep in mind while designing Freemium so that we don’t end up losing paying clients. 

#PNMeetup was a great experience it was very refreshing to be amongst people who have been involved with various stages of product development, themselves. It was a very different space than the other entrepreneurship events that I have been in, almost everybody here was currently running an online product company, and they understood dilemma and the criticality of the decision around such questions. 

I had attended along with two other members of my team, and the one of the greatest reaffirmation was that, there is no single answer or a single point of view when it comes to even simple questions pertaining to a product. Many a times we, as young start-ups, tend to get bogged down or keep changing paths based on feedback from a single person. Being at #PNMeetup gave a reassurance that it is justified that we were so concerned about our decisions on these questions as they are not so straightforward, and at the same time the forum was a great place for us to take feedback from a group as a whole, and it helped us to identify the range of possible solutions from which we could chart out our own solution. 🙂

Thanks Amit, Devendra & Avinash for helping me in the presentation and briefing you provided and for the opportunity.  I really liked the venue and seating arrangement, and I feel that the ambience was instrumental in creating an informal atmosphere where people could exchange frank and honest opinions.  

P.S.: The highlight of the day was meeting up with Amit Ranjan, co-founder Slideshare and to see him share his thoughts candidly! 🙂

My name is Vinayak and I’m the Founder & CEO at Zest.md. 

Does India provide a supportive environment for getting value out of innovation?

When we talk about supporting innovation in India, the first things that come to mind are the availability of capital and people with the right skills. But, the efforts and risks involved in innovation don’t make sense unless inventors and firms can get value out of their innovative activity.

When will innovation make money for inventors? That depends on issues like: Are users willing to try out new products and services? Do the capital markets place a premium on companies that are more innovative? Can an inventor protect his innovation from being copied by others, i.e., can he be sure that he (and he alone) will be able to capture the value from the innovation he creates? The right hand side of the framework below captures these “demand-side” factors.

In this article, I will focus on the last question – the issue of value appropriation – and ask a broad question: Does India provide a supportive environment for appropriating value from Innovation?

Appropriating Value from Innovation

To answer this question, I will investigate whether the Indian system for protecting intellectual property provides an effective mechanism for protecting inventor rights. Please remember that there is an exchange relationship at the bottom of the intellectual property system: the State gives an inventor a limited time monopoly to exploit her idea in return for the inventor sharing her knowledge or idea with society. So, a good intellectual property system has to balance the needs of both inventors and society at large.

Of course, I must add that from a firm-strategy perspective, appropriating value does not depend on intellectual property alone. As the graphic below (adapted from VK Narayanan’s book Managing Technology and Innovation for Competitive Advantage) shows, a firm’s ability to appropriate value from innovation also depends on its product market actions as well as its ability to innovate continuously and stay ahead of competitors. But, the intellectual property environment, and IP strategies followed by the firm form an important third prong, and these are the focus of this post.

A Historical Perspective

Independent India started off with a fairly strong intellectual property protection system. This should not surprise us because this was intended to protect the rights of British inventors under the colonial regime. However, there was growing disquiet about this system in the first two decades after independence, particularly in the area of pharmaceuticals where strong patent protection was seen as enabling multinational drug companies to extract monopoly profits from a poor country. As is well known, this culminated in our making important amendments to the Patents Act including removal of provisions to patent new molecules, and providing relatively short periods of patent protection in all cases. The new legislation – the Indian Patents Act of 1970 – is commonly credited with the growth of India’s generic pharmaceutical industry (based on an ability to create new processes for known drugs and scale them up effectively) and some of the lowest priced drugs in the world.

By the 1990s, many things had changed. Globalization was the order of the day, and India had climbed on the globalization bandwagon. International talks were on to provide a supportive environment for global trade. These talks expanded in scope to incorporate intellectual property protection. In 1995, India signed up for the GATT treaty and promised to put in place stronger intellectual property laws by January 1, 2005. India kept its promise, though not everyone is happy about this! But, the timing was right – by 2005, many Indian companies were taking innovation more seriously, and were therefore looking for stronger intellectual property protection for their inventions.

Where do we stand today?

Information

While the law changed, the procedural aspects of patenting have taken time to catch up. One of the important characteristics of a good patent system is easy availability of information about what patents have been issued. For several years this was a major bottleneck in India with such information not available online, and available only through a set of CDs compiled by TIFAC in Delhi. Even now, though there is an online database, it is nowhere as powerful or as comprehensive as the US PTO’s website. I would have thought that with all our software and IT prowess we should have been able to build something better than what the US PTO offers but…

Procedures and Process

Another important procedural issue is the speed with which the Patent Office considers applications, and the quality of the examination process. The importance of this dimension was recognized some years ago and a drive to hire and train patent examiners was launched. But, I saw a recent advertisement of the Controller General of Patents, Designs & Trademarks calling for applications for trademark examiner positions in which they are offering a consolidated salary of Rs. 25,000 per month to people with a degree in law and 3 years experience. I am sure it will be a challenge to get well qualified people at that level of compensation.

In an alternate effort to speed up the process, there was a proposal to involve the CSIR in preliminary screening and evaluation. But this was objected to by many as the CSIR itself is an active player in the intellectual property space and is, in fact, the Indian entity with the largest number of US patents.

While it’s difficult to judge the quality of patent examination, what we do know is that after an initial spurt in the speed of examination and grants, the process has slowed down again at a time when the number of applications is on the increase. Mint newspaper carried a useful graphic recently summarizing the challenge:

The Law Itself

As far as I can make out, there has been reasonably widespread acceptance of the amendments to the Patents Act made in 2004, 2005 and 2006 except for a couple of issues. The first issue is the now infamous Section 3 (d) that seeks to prevent evergreening by pharmaceutical companies by requiring a major inventive step as reflected in enhanced therapeutic value for a molecule to be awarded a patent. This has been a contentious issue almost since Day 1 of the new patents legislation, and a series of refused / cancelled patents to big name pharmaceutical companies has shown that the law has bite.

The second issue has been the issue of compulsory licensing. On March 9, 2012, the Controller General of Patents issued the first post – 2005 compulsory licence to Natco Pharma to manufacture its equivalent of Bayer’s Nexavar, a drug for treatment of kidney cancer. This has raised a hornet’s nest, as it has raised contentious issues like (1) what is a reasonable price for a drug? (2) what constitutes “working” a patent? and (3) what is the appropriate royalty to be paid to the inventor company in the event of compulsory licensing?

It’s fascinating to note that most of the controversies regarding the new patent law in India have centered around the pharmaceutical space. Globally, the big debates on intellectual property in recent times have been in the smart phone space involving companies like Apple, Samsung, and Google (Motorola Mobility). It’s almost as though we live on two separate planets! I suppose the reason for this is that India is still not a big market for high end smartphones and therefore the patent and design wars of this industry have not spilt over into India. But this is also another indication that India has failed to find a place at the high table of the most active innovation domains (see my earlier post on the areas in which India has the most active researchers).

In our obsession with the healthcare domain, we might be missing out on developments in other sectors that call for changes in our intellectual property protection laws. A new generation of software product companies is emerging from India (see my recent article in Outlook Business), and large companies like TCS and Infosys are embracing products and platforms in their quest for “non-linear” growth. But we continue to deny software products patent protection and limit their intellectual property protection to the Copyrights Act.

Awards & Enforcement

Consistent with their position in other matters, Indian courts tend to be conservative in penalties and awards for intellectual property violations unlike the multi-million dollar (or even multi-billion dollar) awards of American courts. In a way that’s good because it prevents intellectual property from becoming a separate game of corporate strategy. But the flip side of this is that there is the distinct possibility that an inventor may not receive adequate compensation for infringement of his intellectual property rights.

This become particularly critical in the case of the small inventor who anyway fights a David vs Goliath battle if the infringer is a large company with the ability to exploit all the procedural opportunities for delay available in the Indian legal system. In fact, if I were an inventor in India that would be my main fear – I may be able to obtain a patent and other forms of intellectual property protection, but will I be able to enforce my patent rights in a meaningful and timely way? Even in the US, the inventor of the intermittent windshield wiper, Robert Kearns had to struggle for years in his battle with large US auto companies (see the graphic below); I shudder to think what would happen to an equivalent inventor in India!

As we go forward, there will also be a need to ensure greater consistency in judicial decisions in the intellectual property domain. Without any disrespect meant to our honourable judges, I can see that in some of the recent judgements they have struggled to cope with the technicalities involved. Not too far in the future, when we have a critical mass of intellectual property cases, it will help to have a single court at the appellate level as has been done in the US.

Conclusion

In the 1950s and 1960s, we saw companies like Xerox and Pilkington Glass that established monopolies in their respective industries based on technologies which had strong patent protection. Today, the pace of innovation in most industries has hastened to the extent that companies need to innovate continually to derive maximum benefit from their innovations. But, intellectual property rights continue to provide the first-level protection for innovator companies.

As India develops a modern industrial economy, and more companies depend on innovation for their competitive advantage, our need to provide an appropriate level of legal support to enable innovative companies to capture the benefit of their innovations will grow. In this, our priority should be on improving IPR-related information flows, better processes and procedures, and enforceability, and on shifting our attention beyond the healthcare industry.

Original article can also be accessed here(from Juggad to Systematic Innovation).

Start the revolution in Healthcare at StartupWeekend, New Delhi

Until the dawn of this decade not many people would have thought of transforming the way dismal healthcare system works in India let alone doing it over the course of 2 days but this is about to change as the Startup Weekend comes to Delhi on 7 Dec with a sole focus of encouraging entrepreneurs who are passionate about revolutionizing the healthcare system in India. The event will provide an excellent platform where business people, doctors, designers and awesome developers can come together and take first steps towards developing the next big thing in healthcare!

The agenda for the weekend is jam packed with keynote addresses from eminent speakers, exciting pitch sessions, intensive coaching from renowned mentors and enjoyable networking sessions. The event will be attended by leaders from health and start-up fraternity including Chavvi Gupta (Co-founder YoPharma), Subinder Khurana (Mentor, NASSCOM Emerge Forum), Paul Singh (Partner, 500 Startups), Maniraj Singh Juneja (Co-founder of MadeInHealth), Zachary Jones (CEO of Portea Medical) and Maninder Singh Grewal (MD at Religare Technologies).

Here’s an idea of what Start-up Weekend Delhi Health is going to look like from 7th December to 9th December 2012 at the American Center on KG Marg. All attendees will have an opportunity to pitch at least one idea in 60 seconds.

Please make your arrangements to be at the venue late into the night on Friday and Saturday. If you need a couch to crash on, start talking to other participants when you get to the venue. We will provide dinner on Friday evening, Breakfast/Lunch/Dinner on Saturday and Breakfast/Lunch/Snacks on Sunday.

Whether entrepreneurs found companies, find a cofounder, meet someone new, or learn a skill far outside their usual 9-to-5, everyone is guaranteed to leave the event better prepared to navigate the chaotic but fun world of start-ups. If you want to put yourself in the shoes of an entrepreneur, register now for the best weekend of your life!

Post Contributed by Abhimanyu Godara