Healthcare in India – still Miles from the Internet of Things Vision

My 81 year old dad has been having a rocky couple months.
It started with weakness and giddiness; then a feeling of numbness in his limbs; then incidences of blurred vision and slurred speech – classic stroke symptoms.
My brother and I started the usual merry go round that all caregivers of senior citizens go through – emergency-neurologist-cardiologist-nephorologist-endocrinologist-back to emergency-repeat cycle. Threw in sessions with a GP, and then a couple operations of the eye at the ophthalmologist.
Went to two hospitals, and 4 branches of one of them.

Was completely appalled at the isolated nature of patient information access and diagnostists available, even at the best hospitals, in the Silicon Valley of India. And this, when we are debating the use of Wearables, Internet of Things and Big data all the time!

Lets look at the possibilities for the Healthcare IoT first:

– At the individual/ patient level –

The ultimate beneficiaries, patients (both current and potential/ future), will basically create and consume larger amounts of data than ever before – due to wearables (e.g. Tempo from CarePredict) / implants/ other gadgets and devices owned.

This will enable better monitoring of behaviour, and, when coupled with context – facilitate hugely improved diagnostics. Diagnostics that are derived from integrated data – multi disciplinary, as well as omnichannel/ source. (So, no more – “your sodium is low, eat more salt – says nephrologist — uhhh, but BP is high, reduce salt says cardio”! )

These diagnostics will then not only treat any emergencies or negative incidences quicker/ more competently, but also act proactively – thus alerting users and discouraging them from harmful behaviours (too much smoking/ not enough walking/ too many carbs/ not enough sleep….)

This personalised patient care, is after all, the raison-d-etre of the wearables market, which, according to a recent IDC report, is set to reach 45.7 million units worldwide in 2015, and 126.1 million units in 2019.

The IoT approach can then be taken a step further – and use gamification techniques to reward compliant medical behaviour. (My constantly sudoku playing dada and candy crushing mom I’m sure will be very vulnerable to these approaches!)

– At the macro/ aggregated level –

Obviously, when taken as a large body of data, analytics organisations can develop and fine tune personas and segments, making them richer and more detailed. The way to do this would be to combine biomed research using life sciences databases with aggregated patient behaviour and symptoms. This should ideally ultimately result in predictive models, thus leading to better treatment. Basically, a higher emphasis on real time monitoring and intervention combined with traditional lab work becomes the new clinical research methodology! In long term vision, companies and nations get a jumpstart on reducing burden of disease in the overall population.

– At the enterprise level –

Many studies are saying that providers may be able to save up to a quarter of their business costs with the Internet of Things.  This would be done by integrating new technologies into their operational strategies. Think about it – a vast, dynamic mass of wearables, biometric sensors, smartphone add-ons, and other medical devices and implantables – all growing, shifting, and ripe for an IoT approach

– Miscellaneous –

The serious side of Healthcare IoT is only one side of the picture actually – the wearables landscape is fairly glamorous even from the early adopter tech consumer’s Point of View! Think Ping, a social networking garment developed by designer Jen Darmour; Smart socks that tell you when to change, and where the pair is; Electrozyme or Motorola digital tattoos (that always remind me of the Bourne Identity series); tweeting bras (to remind one of breast exam monthly); dream inducing headbands; Peekiboo, a cap that lets you see the world through your baby’s eyes; smart pajamas that help you with bedtime entertainment when your kids are ready for bed; i-Grow income hair growth helmet; Drumpants which is Multiple touch pads sewn into a pair of classy jeans give drummers a six-piece kit; and, the coolest of all, Necomimi, a set of feline-like ears that strap on to your head, supposedly measure brainwaves and then move and flick based on how you’re feeling at a given moment!

The Flip Side

But the real truth, atleast in India (as experienced by my dad and me) is a far cry from the vision. At the moment, there is NO healthcare Internet of Things – maybe just a random collection of medical devices and consumer monitoring technologies that don’t quite know what to do with each other! 

Treatment is isolated – diagnosis is gut and experience based (which actually is not necessarily a bad thing – since, given India’s huge population, doctors do get to practice a lot and so see a wide variety of patients); there is very little digitisation even in the best hospitals. (In fact, in the hospital where we treated our dad, even within the 3 buildings in the same health city campus, there are different degrees of digitisation – the newest, the Eyecare hospital introduced EMR maybe 3-4 years ago, and so it’s all modern; the next oldest Multi Specialty Hospital now scans the written prescriptions of the doctor after you come out of the treatment room, (so, atleast keeping some records – though I’m reasonably confident nothing is being done with those scans yet); and the oldest, the Cardio facility I think still does nothing digital)

To answer the question – “why” – I think it really has to do with a basic question of population – in our country, we are too busy solving the Maslow’s Hierarchy lowest rung questions of food, clothing and shelter to spend too much money and time on other stuff. Coupled with legacy systems and old habits dieing hard, it’s a tough combo to beat!

And then there’s the question of reliability – many medical practitioners suspect non manual devices and gadgets – I have met with scepticism on the results of digital BP monitors from all doctors and nurses! (and my 10-times-a-day-BP-measuring dad’s experience shows significance differences between same time readings of manual/ analog BP monitors and the digital ones. Despite repeated calibrations!). So, reliability is suspect.

And, as yet, I’m not even stepping into the whole compliance/ medico-legal/ security aspect of the data

I think this is a bit like the “obvious” steps in customer centricity across functions and kind of business that are visible to everyone now with Big Data, but the fact is that no one is exploiting them – due to lack of vision, corporate lethargy, or even mal-intent in the form of vested interests! (watch out for the next blog on that topic in a few days). The good news – In a PwC study, 95% of healthcare CEOs said they were exploring better ways to harness and manage big data. The bad news – this is not confined to India alone – Read this article on how this state of affairs sadly seems true globally :(.

Maybe it’s just a matter of time – the question is how much time! Meanwhile, for my dad and me, it’s onwards and upwards to the next “o-logist” – this time the ENT specialist for new hearing aids! Yawwwnnnn….

The Internet Of Things: State of Maturity in India

With all the hype about Digital India, and Prime Minister Modi’s Smart City initiative, one question that keeps getting asked is the state of maturity of the Internet of Things in India.

Well, first of all, let me give you my take on the state of maturity of the IoT in the world – like most revolutionary waves that arise because of supply and not demand, at this stage a lot of the work on the IoT is more conceptual/ background building than application oriented. As a corollary of this, the real benefits haven’t trickled down to the end consumer – mainly also as the last mile connectivity applications are still being built. Early devices that purported to be based on the IoT were more bought than used (it is said 70% of fitness trackers bought are not used now); Google Glass is currently resting in a graveyard; IoT revenues are growing at 20-25% for even the top players in the space/ the facebook’s internet.org is getting into all kinds of hot water.

The eco system of companies in the IoT is still hyper fragmented and interoperability is still an issue (standards and protocols are still being worked upon – in fact, that’s where a large body of work is being done).

One of the big roadblocks to progress is miniaturization – specially of batteries. For ultra small sensing devices, either fitted into large industrial buildings, or on small wearable devices, the level of miniaturization requiredd of batteries is not funny – our smallest batteries are still how big

Having said that, there are many heartening examples of work that has been done – after all, ever since 2008, there have been more connected “things” than people in this world! Not the least of this is evident in Smart Cities. Songdo in South Korea has been one of the oldest cities to get ‘smart” – they have a smart energy grid which matches power supply and demand. They have no garbage – their waste gets automatically sucked into Sewage Treatment Centres.

Glasgow has recently announced a budget of 37 mil $ for its project. Their street lights will automatically switch off; they will map routes for easing traffic congestion; footfalls can be monitored, noise and air pollution levels are monitored; Delivery services are prioritized per criticality; there is CCTV coverage of the whole city to ensure higher safety levels.

When it comes to India though, 100 smart cities at a Rs. 7060 crores investment plan notwithstanding, there are a few further hurdles to quick penetration of the Internet of Things.

First of all, we need indigineous/ low cost hardware. Even now, some 65% of hardware that India uses is imported. Then, our bandwidths need to improve significantly. With a $ 12 – 15 billion IoT market revenues expected by 2020, we cannot make it happen with the current pathetic internet speeds. We need low cost/ low power devices that are pluggable into wi-fi. We need the basic infrastructure required for any technology to work. And finally, we need a thriving eco system of vendors building off the Internet of Things.

But maybe the biggest issue facing IoT development in India is that of usability – essentially, the Big problem to be solved/ prioritized still needs to be defined!

I think the first few areas that need/ will see IoT solutions, much like the rest of the world, will be: Utilities/ Smart cities; Agriculture and Healthcare. On the business front, it could be logistics and supply chain – with a newly booming e-commerce industry driving usage.

The overall/ global perceived risks of security threats still exist – as much in India as anyplace else, but I think at an overall level, this fear is becoming slowly marginalized. A higher risk is a more social one – on the one hand, tha of “de-humanization” – machines talking to machines/ robots and AI devices will slowly delimit human contact even more than the current whatsap culture is doing. On the other hand, there is a real “social apartheid” risk – these technologies, atleast till the time they focus high end customer acquisition, may just polarize the haves and have nots even more.

All in all, though, the IoT is coming – earlier in some places than in others, but the advance is real! One statistic said that by 2017, 50% of IoT solutions will come from companies that are less than 3 years old. So, get ready all, action stations!

The IoT Ecosystem – A Beginner’s Guide for Benefiting from It

Last month I was at a panel discussion. The Topic was – “The Internet of Things; Leveraging Technologies in Business”. As I was thinking about what I would say to a room full of entrepreneurs, I came across a startling statistic – 87% of people in this world have not heard of the IoT!!! There bursts our collective IT/ Valley type bubble, which gets so wound up in the latest tech thing that it forgets to demystify even really applicable stuff to the real beneficiary!

I decided therefore to begin my talk with a very simple eco system clarification graphic – one that would explain to each of us our place in the Internet of Everything / Internet of Nouns whatever you want to call it. Here it is:

CONSUMER BENEFITS IN THREE WAYS:

What it means is basically, that as Consumers, of course, our lives will be made easier due to the Internet of Things. But that happens in essentially 3 ways:

a) The environment becoming more efficient/ optimised/ user friendly and hopefully cheaper. Think smart cities; urban lighting i.e. street lights auto switch off; transport management including traffic congestion easing and smart parking; smart energy grids; city and waste management; agriculture produce optimisation…..in effect, the Gotham city of the future without Batman! 🙂

b) Better Health and Welfare – All the fitness meters and wearables will enable better quality healthcare for most of us; things like remote tracking for senior citizens; and better compliance and adherence in treatment administration. Not only that, security for kids/ adults/ everyone in fact will be much better with tracking devices and sensors.

c) Customization – What the plethora of things stuck on any and every monitor-able membrane will do, is enable micro modules of data – every action, behaviour, and even possibly thoughts and emotions will be tracked for everyone. This will enable better mapping of individuals (not just segments or clusters), thus making daily lives more efficient and easier. This is where the standard use cases of the thermostat enabled warm home before you enter from office (Google’s Nest acquisition); the pre-ordering fridge when eggs stock gets depleted (Whirlpool, Electrolux); the erstwhile Google Glass, and the pre determined shopping selections at retail play. This is also where much of the glamour and hype around the IoT exists – after all, the early adopters consumers will really be looking at these ‘cool/ quirky” gadgets to show their “with-it-ness”.

ENTERPRISE ECO SYSTEM COULD BE AS IoT VENDORS; OR USERS OF IoT FOR CUSTOMER ENGAGEMENT

But when it comes to businesses, the interplay changes a bit.

Most of the thought leadership coming currently on this space is from businesses participating directly in the Internet of Things – these are (largely) technology or data type firms – and they could be either manufacturing devices (the last mile therefore); or operating in the standards and protocols arena – therefore providing the platforms for all to operate; or working on applications on and around the IoT; or be working with the data arising out of the petabytes of data (erstwhile BI/ Big Data processors).

In all these avatars, the companies are providing products and services directed related to creating, harnessing and delivering the Internet of Things – whether to other businesses, or to end consumers. Also, as in most modern technological playing grounds, everyone is collaborating with everyone else (or, well, should be!). There are large interdependencies, and companies have realized that it is better to work on their chunk of the whole. Cisco, IBM, Intel, Google, Facebook, Salesforce, Amazon, Samsung and GE with their Industrial Internet are the primary large names that pop up when this category is discussed.

The balance of the businesses, will essentially participate in the Internet of Things to harness and derive the benefits it delivers. Hence, this is about exponentially bettered customer centricity – about really hyper personalized, context driven products and solutions. The insights gleaned from processing the oodles of data generated by all the sensors will enable one to one customer dialogue in a multi channel environment, and therefore real time, event based marketing and service to customers.

But also overall, the Internet of Things will create a smarter, more efficient Enterprise Eco System (that both kinds of businesses will benefit from).

Think more predictable weather conditions bettering disaster prevention; better Industrial Automation, Logistics, shop floor management and supply chains (including traffic/ fleet management); better utilities; better buying procedures; better infrastructure at lower costs!

What this really implies is that, beyond the hype, there is something in the IoT for everyone, the only thing to do is to figure out your place in that sun, and to be able to monetize it (if you are a business), or use it (as a consumer).

Viva IoT!