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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

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NHS Open House Discussion #4: Doctor Registry, Enrollment APIs And PHR

On 13th June, iSPIRT hosted the fourth open house discussion on the National Health Stack (NHS). For anybody unfamiliar with the NHS, here are some introductory blog posts and videos.

In the session, our volunteer Vikram Srinivasan deep dived into the Enrollment APIs of the electronic doctor registry. These APIs are called when a new doctor is being added to the registry, or when a doctor’s information is being uploaded. 

Vikram also spoke about the attestation APIs, which come into play when an attesting institution (such as a state medical council, medical college, or hospital) confirms some data about a doctor. This is crucially important for building trust in the registry and preventing the proliferation of false profiles. With the release of these enrolment and attestation APIs, all the APIs pertaining to the electronic doctor registry are now available here.

After Vikram’s presentation, he and our other volunteer Siddharth Shetty answered some technical questions submitted by the community. Here are some of the questions they fielded:

  • Doctors have multiple identities (from different medical councils), how are these unique IDs handled by the electronic registry?
  • Can anybody access the doctor information in the registry, including phone numbers and photographs of doctors?
  • Who can healthcare companies partner with in the Health Stack Ecosystem?
  • How does the federated network architecture of the PHR system deal with downtimes, incorrect data, and other failure? Is this architecture scalable for a system with 1000s of participants?

As always, these were great questions. You can watch Sid and Vikram answer these questions and walk through their presentations below. Please keep the questions coming by sending them in through this form: https://bit.ly/NHS-QAForm.

If you would like to get involved with Health Stack, we encourage you to watch the recordings of the previous Health Stack open house discussions before reaching out.

Furthermore, if you are interested in the Health Stack and wish to build on top of it or contribute to the working groups being formed, you should reach out to [email protected]

Please note: The fifth open house on PHR Implementation was previously planned for 27th June. This has been postponed to 11:30 am on 4th July due to unavoidable circumstances.

To confirm your participation, continue to register on this form.

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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 

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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.

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#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]

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#5 What is the Federated PHR Component of the Health Stack?

PHR – Personal Health Record – is a mechanism to access a longitudinal view of a patient’s health history and be able to use it for different purposes. It is a component of the health stack:


It relies on two building blocks – (a) registries, to know the source of the data; and (b) health identifier, to know whom the data belongs to. Separating out the building blocks with each serving singular functions helps design a more scalable and sustainable system. We follow certain principles for both of these building blocks:

1. Registries are master databases with information about different entities in the healthcare ecosystem, for example, of hospitals, doctors, care beneficiaries, etc. There should be checks and balances built to ensure correctness of data (such as digital signatures, audit trails, etc.), and this information should be made accessible for different use cases (through open APIs, and consent). Opening access to this information will have a positive effect of increased demand, thus improving quality and leading to convergence towards singular sources.

2. Health identifier is a mechanism to integrate a patient’s health records. This identifier should incorporate the following features:

  • The identifier need not be unique. This means that a patient should have the ability to create multiple health identifiers for different health records – think of different digital folders for mental health cases and cancer cases (a common practice in the physical world).
  • The power to unify health records should lie with the patient. In the physical world, this would translate to the patient having the right to either keep two folders or merge them into one. The same should be allowed digitally.
  • Patients should be allowed to use any identifier to verify themselves. However, since we are creating an electronic system of health records, it is important that these be digitally verifiable – such as mobile number, email ID or Aadhaar.

3. Electronic consent, as specified by MeitY, is a mechanism to give consent electronically in a manner that follows the ORGANS Principles – Open, Revocable, Granular, Auditable, Notifiable, Secure.

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With these building blocks in place, we come to features of the PHR architecture:

1. Federated – instead of having a centralised repository of all health records, we propose a federated framework where data resides at the source of generation. This has many benefits – (i) ease of operations, as data is not stored with a single entity (ii) lower costs, as no additional repository is being built (iii) better security, as data is stored at different nodes; and (iv) patient empowerment, as data is being shared directly with the patient.

2. Schema level standardisation – we believe that only standardising the schema without enforcing codification standards (which require a significant behavioural shift) should be sufficient for a number of use cases. Since this standardisation is at an IT systems level, it only requires a one-time mapping and does not require any change in clinical workflows.

3. Health data access fiduciaries – these would be entities that would route the consent and data requests between information users and information providers. In doing so, they would play the role of privacy protection, consent management and user education.

4. Health data vault – this is an option for the patient to store his/ her records in a personal storage space. While most hospitals that capture data continue to store it for a long period of time,  an individual might still choose to store this information separately (for long-term access, trust-deficit between patient and provider, etc.). In such a case, the patient can request a copy of the record to be pushed to his/her health data vault.

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Proposed architecture:

Workflow:

Patient goes to a healthcare provider. At the time of issuance:

Option 1: patient shares mobile number/ email id/ aadhaar no.
1. Provider authenticates user using one of the digital identifiers
2. (a) Provider sends a link to patient for downloading the report. Patient can later link these records with his/ her HDAF; or
2. (b) Patient can sign up with HDAF and search for provider to link records

Option 2: patient shares HDAF ID
1. Provider links patient records to the HDAF

Post linkage, patient can approve requests from data consumers through the HDAF for different use cases.

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We believe that building PHR as a public good will enable interesting use cases to come to life, that would together improve the healthcare ecosystem. While we will continue our quest for these, we would love to receive feedback on our thinking! If you work in this space and have comments, or would like to understand how this could help your product, please drop me a line at [email protected].

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#4 Reimagining Cancer Care

In the last few months, I have had the opportunity to work closely with the National Cancer Grid – a network of 150+ cancer centres in India – and in the process, better understand the workflows involved in different medical processes and the requirements of medical professionals. I have closely observed care delivery, interviewed cancer patients and oncologists, learnt about current challenges and about initiatives being undertaken by NCG and other organisations to tackle them.

This blog post is an evolved version of an earlier post, where I had talked about the use cases of health data and the implementation of a PHR (Personal Health Record). Of these, I believe that the biggest use of health data will be in improving the quality of care in complex medical cases (either acute like surgical procedures, or chronic like cancer). In this post, I will use cancer care to exemplify this.

Core idea
Let us visualise a specific application for cancer care, with oncologists as its primary users. There are only around 1000 trained oncologists in India, so let’s assume that all of them are users of this application. Let us also assume that clinical data of all patients treated by these oncologists is conveniently accessible through this application (with due privacy and security measures). What will these users do now?

Expert consultation
I attended a Virtual Tumour Board run by the National Cancer Grid – a weekly remote consultation program run on Saturday mornings where teams of doctors voluntarily join to discuss well-documented cases and their potential treatment plans. VTBs are run separately for each speciality (like head & neck tumour, gynaecology, neurology, etc.), which means that it takes up to 4-6 weeks for one’s turn. Doctors usually do not have the luxury of such long waiting periods, and therefore turn to individual consultations which are often not documented, depend on informal connects and are sometimes made with incomplete data. Formalising this process and making it asynchronous can be of huge benefit to all medical professionals.

Care team collaboration

Complex medical procedures often involve a team of doctors and other medical professionals, working responsibly for a given patient. A significant percentage of all deaths due to medical negligence is caused by lack of communication between the care team members. The communication process today is paper-based and unstructured, leading to accidents that can, in fact, be prevented – especially with the growing use of IoT devices and voice-based inputs. (I saw one such application at Narayana Health being used by their ICU teams).

Performance evaluation

Lack of organised data, changing patient care-providers and long feedback loops make it difficult for medical professionals to monitor their performance. Can we empower them with tools to do so? Doctors today lack visibility on the outcome of the treatment given and rely on intuition, experience or techniques tested in developed countries for care delivery. Such a tool would not only help doctors improve their performance, but also improve the trust equation with their patients.

User Experience
There are three crucial elements for enabling a good user experience:

Data input – Most EHR systems require text input to be typed in by doctors. This makes it difficult to use. Other input techniques for automated data transcription like touch, voice, or other innovative methods for data capture will need to be explored. Additionally, interoperability across all systems and devices will be key in enabling access to all data.

Data interpretation – Sorting through a patient’s health records takes up a substantial amount of time of a physician, especially when the data is unstructured. Developing intelligence to sort the relevant records as per the case in question will significantly enhance the user experience of the product.

Safety and Privacy– All solutions should ensure complete privacy of patients. This could mean access controls, electronic consent, digital signatures, digital logs, tools for data anonymisation, etc. it might also be important to perform basic verification of users of the platform.

Value Discovery
The value of the platform will increase as more and more physicians become a part of it. For example, an endocrinologist might need to consult a cardiologist in a case of disease progression, or an ENT specialist might need to consult an oncologist to confirm a diagnosis. More importantly, the platform will also drive innovation, i.e., other use cases can be developed on top of it. For example, the expert opinions mentioned above can also be used for consulting patient remotely, pre-authorising claims, forming medical peer review groups, etc. Similarly, working care groups can also simultaneously enrol staff for upskilling (as practised today in an offline setting), and information about treatment outcomes can help guide better research.

Next steps
We remain on a quest to find use-cases for PHR since we believe technology pilots alone would not be enough to drive its adoption. In that context, we are looking for partners to experiment with this in different healthcare domains. If you are interested, please reach out to me at [email protected]!

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#3 What does the Health Stack mean for you?

The National Health Stack is a set of foundational building blocks which will be built as shared digital infrastructure, usable by both public sector and private sector players. In our third post on the Health Stack (the first two can be found here and here), we explain how it can be leveraged to build solutions that benefit different stakeholders in the ecosystem.

Healthcare Providers

  • Faster settlement of claims: Especially in cases of social insurance schemes, delay in settlement of claims causes significant cash-flow issues for healthcare providers, impacting their day-to-day operations. The claims and coverage platform of the health stack is meant to alleviate this problem through better fraud detection and faster adjudication of claims by insurers.
  • Easier empanelment: The role of facility and provider registry is to act as verified sources of truth for different purposes. This means a convenient, one-step process for providers when empanelling for different insurance schemes or providers.
  • Quality of care: The use of personal health records can enable better clinical decision making, remote caregiving and second opinions for both patients and medical professionals.

Insurers

  • Faster and cheaper settlement of claims: claims and coverage platform, as described above
  • Easier empanelment of healthcare providers: registries, as described above
  • Diverse insurance policies: In addition to the above benefits, the policy engine of the healthstack also seeks to empower regulators with tools to experiment with different types of policies and identify the most optimum ones

Researchers and Policymakers

  • Epidemiology: the analytics engine of the healthstack can be helpful in identifying disease incidence, treatment outcomes as well as performance evaluation of medical professionals and facilities
  • Clinical trials: a combined use of analytics and PHR can help in identifying requirements and potential participants, and then carrying out randomised controlled trials

How can it be leveraged?

While the healthstack provides the underlying infrastructure, its vision can be achieved only if products benefitting the end consumer are built using the stack. This means building solutions like remote second opinions using health data from healthcare systems, as well as developing standard interfaces that allow existing systems to share this data. In the diagram below, we elaborate on potential components of both of these layers to explain where innovators can pitch in.

If you are building solutions using the health stack, please reach out to me at [email protected]!

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#2 Federated Personal Health Records – The Quest For Use Cases

Last week we wrote about India’s Health Leapfrog and the role of Health Stack in enabling that (you can read it here). Today, we talk about one component of the National Health Stack – Federated Personal Health Records: its design, the role of policy and potential use cases.

Overview

A federated personal health record refers to an individual’s ability to access and share her longitudinal health history without centralised storage of data. This means that if she has visited different healthcare providers in the past (which is often the case in a real life scenario), she should be able to fetch her records from all these sources, view them and present them when and where needed. Today, this objective is achieved by a paper-based ‘patient file’ which is used when seeking healthcare. However, with increasing adoption of digital infrastructure in the healthcare ecosystem, it should now be possible to do the same electronically. This has many benefits – patients need not remember to carry their files, hospitals can better manage patient data using IT systems, patients can seek remote consultations with complete information, insurance claims can be settled faster, and so on. This post is an attempt to look at the factors that would help make this a reality.

What does it take?

There are fundamentally three steps involved in making a PHR happen:

  1. Capture of information – Even though a large part of health data remains in paper format, records such as diagnostic reports are often generated digitally. Moreover, hospitals have started adopting EMR systems to generate and store clinical records such as discharge summaries electronically. These can act as starting points to build a PHR.
  2. Flow of information- In order to make information flow between different entities, it is important to have the right technical and regulatory framework. On the regulatory front, the Personal Data Protection Bill which was published by MeitY in August last year clearly classifies health records as sensitive personal data, allows individuals to have control over their data, and establishes the right to data portability. On the technical front, the Data Empowerment and Protection Architecture allows individuals to access and share their data using electronic consent and data access fiduciaries. (We are working closely with the National Cancer Grid to pilot this effort in the healthcare domain. A detailed approach along with the technical standards can be found here.)
  3. Use of information – With the technical and regulatory frameworks in place, we are now looking to understand use cases of a PHR. Indeed, a technology becomes meaningless without a true application of it! Especially in the case of PHR, the “build it and they will come” approach has not worked in the past. The world is replete with technology pilots that don’t translate into good health outcomes. We, in iSPIRT,  don’t want to go down this path. Our view is that only pilots that emerge from a clear focus on human-centred design thinking have a chance of success.

Use cases of Personal Health Records

Clinical Decision Making

Description: Patient health records are primarily used by doctors to improve quality of care. Information about past history, prior conditions, diagnoses and medications can significantly alter the treatment prescribed by a medical professional. Today, this information is captured from any paper records that a patient might carry (which are often not complete), with an over-reliance on oral histories – electronic health records can ensure decisions about a patient’s health are made based on complete information. This can prove to be especially beneficial in emergency cases and systemic illnesses.

Problem: The current fee-for-service model of healthcare delivery does not tie patient outcomes to care delivery. Therefore, in the absence of healthcare professionals being penalised for incorrect treatment, it is unclear who would pay for such a service; since patients often do not possess the know-how to realise the importance of health history.

Chronic Disease Management

Description: Chronic conditions such as diabetes, hypertension, cardiovascular diseases, etc. require regular monitoring, strict treatment adherence, lifestyle management and routine follow-ups. Some complex conditions even require second opinions and joint decision-making by a team of doctors. By having access to a patient’s entire health history, services that facilitate remote consultations, follow-ups and improve adherence can be enabled in a more precise manner.

Problem: Services such as treatment adherence or lifestyle management require self-input data by the patient, which might not work with the majority. Other services such as remote consultations can still be achieved through emails or scanned copies of reports. The true value of a PHR is in providing complete information (which might be missed in cases of manual emails/ uploads, especially in chronic cases where the volume and variety of reports are huge) – this too requires the patient to understand its importance.

Insurance

Description: One problem that can be resolved through patient records is incorrect declaration of pre-existing conditions, which causes post-purchase dissonance. Another area of benefit is claims settlement, where instant access to patient records can enable faster and seamless settlement of claims. Both of these can be use cases of a patient’s health records.

Problem: Claim settlement in most cases is based on pre-authorisation and does not depend solely on health records. Information about pre-existing conditions can be obtained from diagnostic tests conducted at the time of purchase. Since alternatives for both exist, it is unclear if these use cases are strong enough to push for a PHR.

Research

Description: Clinical trials often require identifying the right pool of participants for a study and tracking their progress over time. Today, this process is conducted in a closed-door setting, with select healthcare providers taking on the onus of identifying the right set of patients. With electronic health records, identification, as well as monitoring, become frictionless.

Problem: Participants in clinical trials represent a very niche segment of the population. It is unclear how this would expand into a mainstream use of PHR.

Next steps

We are looking for partners to brainstorm for more use cases, build prototypes, test and implement them. If you work or wish to volunteer in the Healthtech domain and are passionate about improving healthcare delivery in India, please reach out to me at [email protected].