Digitalisation Of Healthcare - Towards A Better Future - Free Download E book

ISSUE 44 2019 www.asianhhm.com
DIGITALISATION
OF HEALTHCARE
Associate Partner
CoverStory
IT
Special
TOWARDS A BETTER FUTURE!
The Science of Healthcare Delivery
Cardiovascular AI Risk Score Programme

Foreword
Prasanthi Sadhu
Editor
Healthcare’s Digitalisation
Towards a better future!
Wearables have made patient tracking for
healthcare professionals more seamless and
effective. Tracking patient data and providing
timely medical advice becomes easier with these
applications. AI brings in chatbots, while robotics
is being leveraged to make patient care smooth
and safe. Meanwhile, big data is helping health-
care professionals identify potential risk factors
for the patients leading to offering preventive
medicine.
Implementation of virtual healthcare applica-
tions allows effective handling of patient care
through better services using the telemedicine
platform. This implementation will drive growth
of the AR and VR usage in healthcare. According
to Medgadget, AR & VR Healthcare Market val-
ued approximately US$748.3 million in 2017 is
anticipated to grow with a healthy growth rate of
more than 30.1 per cent over the forecast period
2018-2025 to reach US$6141.78 million by 2025.
Increasing use of AR and VR also helps reduce
medical training costs and simplifies surgical
procedures. Patient data stored on smart weara-
bles allows data to be accessed from anywhere.
Such advancements will enhance the develop-
ment of AR and VR market in healthcare during
the coming period.
The cover story of this issue is a collection
of articles related to digital technologies in
healthcare and commercialisation of the same.
Digital health has been around for quite some
time. Advancements in technology, rising
demand for better care, and governments' focus
on improved health economy have contributed
to the digital transformation in the healthcare
sector. Healthcare providers and professionals
are continuously challenged to come up with
innovative and cost-effective ways of providing
effective care and better patient outcomes.
In the past few years, digital technologies
have changed the healthcare landscape into
becoming more patient-centric, with care givers
focusing on engaging patients and improving
their experiences.
According a Deloitte report, global healthcare
spending is estimated to cross US$10 trillion by
2022. As the global healthcare market embrac-
es digitalisation, innovation has a major role to
play. Healthcare companies have been investing
heavily in digital technologies to drive innovation
and value-based care, while making care giving
more accessible and efficient. Digitalisation re-
sults in better usage of patient data by care giv-
ers enabling them to offer personalised health-
care to the patients.
With telemedicine, healthcare became more
accessible for patients even in the remotest of
areas. There are a host of digital innovations that
help accelerate drug development, high-quality
care, effective diagnosis & treatment: Artificial
Intelligence (AI), Robotics, Virtual health, Inter-
net of Medical Things (IoMT), Virtual Reality (VR)
and Augmented Reality (AR), and Blockchain.
These technologies have led to a disruption in
healthcare industry enabling high quality care
with speed and accuracy, thereby resulting in
improved patient outcomes.

2 ASIAN HOSPITAL & HEALTHCARE MANAGEMENT ISSUE - 44, 2019
COVER STORY - IT SPECIAL
DIGITALISATION
OF HEALTHCARE
39
TOWARDS A BETTER FUTURE!
CONTENTS
16
26
HEALTHCARE
MANAGEMENT
06 Advancing the Role of Entrepreneurship
Healthcare in developing countries
Soong-chul (Sam) Ro, Willy Jin Huang, Pradeep Kumar Ray
University of Michigan, Shanghai Jiao Tong University Joint Institute
12 The Science of Healthcare Delivery
Construct and its impact on service delivery
Gurrit Sethi, Strategic Advisor, Global Health Initiatives
16 Lean Management of Emergency Department
R B Smarta, MD, Interlink Marketing Consultancy
MEDICAL SCIENCES
22 Sleep Deprivation and Disease Risk
Pradeep Chowbey, Chairman, Max Institute of Minimal Access, Metabolic
& Bariatric Surgery, Max Superspeciality Hospital
26 Cardiovascular AI Risk Score Programme
Clinical AI for all
Sangita Reddy, Jt. Managing Director, Apollo Hospitals
34 Leading Infectious Diseases among Under-5
Children in Developing Countries
Md Moshiur Rahman, Associate Professor, Graduate School of Biomedical
and Health Sciences, Hiroshima University
Michiko Moriyama, Professor, Graduate School of Biomedical and
Health Sciences, Hiroshima University
Mohammad Habibur Rahman Sarker, Graduate School of Biomedical and
Health Sciences, Hiroshima University
INFORMATION
TECHNOLOGY
40 Digital is set to Change Healthcare Massively
Here is how
Sanjay Das, Founder and Managing Director, SD Global
44 Commercialisation of Digital Health
Yoshihiro Suwa, Partner, Roland Berger
52 The Seven Obstacles
Success Factors for Digital Transformation
in International Health Tourism and Global Health
Mohammed Yassin Blal, CEO & Founder, Caresocius.org
56 Delivering Healthcare Innovation in a Heartbeat
Chua Hock Leng, Managing Director, Pure Storage
59 News
60 Books

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EDITOR
Prasanthi Sadhu
EDITORIAL TEAM
Debi Jones
Grace Jones
ART DIRECTOR
M Abdul Hannan
PRODUCT MANAGER
Jeff Kenney
SENIOR PRODUCT ASSOCIATES
Peter Thomas
David Nelson
Susanne Vincent
PRODUCT ASSOCIATES
Austin Paul
John Milton
CIRCULATION TEAM
Naveen M
Sam Smith
SUBSCRIPTIONS IN-CHARGE
Vijay Kumar Gaddam
HEAD-OPERATIONS
S V Nageswara Rao
Gabe Rijpma
Sr. Director Health & Social Services for Asia
Microsoft, New Zealand
Peter Gross
Chair, Board of Managers
HackensackAlliance ACO, USA
Malcom J Underwood
Chief, Division of Cardiothoracic Surgery,
Department of Surgery,
The Chinese University of Hong Kong,
Prince of Wales Hospital, Hong Kong
David A Shore
Adjunct Professor, Organizational Development
Business School, University of Monterrey,
Mexico
John E Adler
Professor
Neurosurgery and Director Radiosurgery and
Stereotactic Surgery
Stanford University School of Medicine, USA
AdvisoryBoard
Pradeep Chowbey
Chairman
Minimal Access, Metabolic and Bariatric
Surgery Centre
Sir Ganga Ram Hospital, India
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Healthcare is probably the most important social
entrepreneurship sector that can benefit from the innovation
and zeal of young entrepreneurship and public-private
partnership both of which are being actively promoted in
healthcare worldwide. China’s Belt and Road Initiative (BRI)
can be leveraged in promoting technology entrepreneurship
in the social sector in general and in healthcare in particular.
This article discusses a new multi-country and multi-
disciplinary initiative called mHealth for Belt and Road
region (mHBR) led by the University of Michigan-Shanghai
Jiao Tong University Joint Institute. The project involves
the application of a range of mHealth technologies (e.g.,
mobile phones, drones, robots etc.) for Healthcare across
the BRI region involving China and neighbouring countries.
Soong-chul (Sam) Ro, Willy Jin Huang, Pradeep Kumar Ray
University of Michigan, Shanghai Jiao Tong University Joint Institute
HEALTHCARE MANAGEMENT
T
he United Nations (UN)
has recognised the need
for a holistic approach of
sustainable development where health,
environment and social wellbeing are
being targeted together through the
new global Sustainable Development
Goals (SDGs). In the healthcare
sector, Universal Health Coverage
(UHC) is the platform that seeks to
Advancing the Role
of Entrepreneurship
Healthcare in developing countries
overcome inequality in tackling the
gap in the service provision and finance
that populations face. The role of ICT
(Information and Communication
Technologies) to build the essential
building blocks of UHC has been
widely accepted. The proliferation of
mobile phones in developing countries,
in particular, has raised the expectation
for better access to quality healthcare
in a cost-effective manner. Widely
referred to as ‘mHealth’, ‘mobile
communication devices, in conjunction
with internet and social media, present
opportunities to enhance disease
prevention and management by
extending health interventions beyond
the reach of traditional care’ and the
World Health Organization (WHO)
has announced that m-health has the
‘‘potential to transform the face of
health service delivery across the globe”.
However, achieving UHC through
mHealth presents some challenges,
particularly from the perspective
of sustainability and management.
Entrepreneurship in mHealth services
provide some mechanisms to overcome
these challenges.

7w w w . a s i a n h h m . c o m
On the other hand, China has
undertaken a major initiative called
the Belt and Road Initiative (BRI) for
the development of the region from
the western and southern regions of
China through the adjacent countries
towards Europe and Africa. This initia-
tive involves developing regions (e.g.,
Yunnan and Guanxi provinces) of
China and other neighbouring coun-
tries (Pakistan, Bangladesh, Myanmar,
Kazhakastan, Uzbekistan etc.). The
BRI scheme mainly funds the infra-
structure development of the Belt and
Road region and countries through
public collaboration; however, once
the infrastructure projects are done, it
is important to build comprehensive
social development utilising increased
connectivity through people-to-people
collaboration along the BRI countries
and region. For this latter part, entre-
preneurship has important roles to play
in channeling the benefits of infrastruc-
ture and technology to the currently
under-developed regions. In view of
similarities in the problems for popula-
tions in this region, it may be possible
to share some cost-effective solutions as
well, making such collaboration all the
more significant. In addition, although
under-represented in the discussions
on health-care so far, entrepreneurship
has much potential in increasing its
significance in relation to healthcare in
general and mHealth in particular.
The University of Michigan (UM)-
Shanghai Jiao Tong University (SJTU)
Joint Institute (UMJI) Centre For
Entrepreneurship (CFE) is focusing
on social entrepreneurship through
its initiative on Technology Entrepre-
neurship for Sustainable Development
(TESD) by leading a new multi-disci-
plinary, multi-country (ten countries)
project called mHealth for Belt and
Road region (mHBR), as discussed in

the Research Section of their website.1
As a part of this, a systematic survey was
carried out on the role of entrepreneur-
ship in mHealth in terms of four emerg-
ing major issues: sustainability, evalua-
tion, social media, and interoperability.
Sustainability in mHealth projects has
become an issue because there are many
pilot projects in mHealth without
leading to any large scale deployment
with the exception of some specialised
medical devices incorporating mHealth
features. There is also an issue of evalu-
ation surrounding the debate on the
suitability of expensive, time-consum-
ing randomised controlled trials, a gold
standard evaluation methodology for
healthcare intervention. Some research-
ers are questioning this gold standard
for mHealth project evaluation given
the rapid obsolescence on mHealth
technologies. The rapid proliferation
of mobile technologies in social media,
on the other hand, offers increasing
number of options for mHealth solu-
tions but since mHealth represents
a class of solutions based on multi-
disciplinary knowledge involving many
complex technologies, often mHealth
solutions do not work together, leading
to interoperability problems and hence
the lack of effective interventions. This
survey is an attempt to link the emerg-
ing issues on mHealth with the strong
interest amongst entrepreneurs on the
development of medical devices based
on mobile technology.
The Center For Entrepreneur-
ship (CFE) at UMJI has also brought
together the works in the interna-
tional initiative called mHealth for
Belt and Road Region (mHBR) and
led to a new program called Technol-
ogy Entrepreneurship for Sustainable
Development, which was initiated
with the Shanghai 1000-talent Distin-
guished Professor Award to Pradeep
Ray in 2017. Them HBR project
is based on ongoing collaborations
1 http://umji.sjtu.edu.cn/entrepreneurship/views/about.
html.
ince has been selected as a part of the
developing BRI Region in China. The
works in this mHBR project can be an
illustrative example of the multi-coun-
try, multi-stakeholder collaborative
approach to the development of BRI
region through entrepreneurship in a
popular technology (mobile) applica-
tion particularly in healthcare sector.
Other groups can use this as a model
for future development, especially in
social entrepreneurship (entrepreneur-
ship to help disadvantaged section of
the population, e.g., poor, disabled,
elderly etc.)
The OBOR mHBR Initiative is
Organised into Six Projects as
Follows:
1.Robots for elderly:
This project follows on from the EU
Victrory a home2
to help overcome the
loneliness of the elderly living inde-
pendently using telepresence robots
operated by family members using
the Internet and mobile devices (e.g.
laptop computers, tablets, mobile
phones etc.) from geographically
remote locations. The robot used in
Victoryahome project proof of concept
was too expensive for people in BRI
region. Hence the first objective of this
project is to first develop a low cost,
appropriate robot for Belt and Road
countries (mainly China and Bangla-
desh) involving entrepreneurs in the
region. The project will have the bene-
fit of the experience of related projects
in the EU, Australia,and China where
current partners are located.
2. Drones for disaster management:
Drones have been successfully used
for rescue missions and disaster relief
management in Asia, especially in
Japan. This project will develop some
of these cases applications in devel-
oping countries in the region. For
example, resource management in the
Sunderban region is of great interest to
both Bangladesh and India and project
2 www.victoryahome.eu
across several institutions in different
countries such as Australia (UNSW,
University of Sunshine Coast, UTS
and University of Wollongong), Bang-
ladesh (Dhaka University, Jessore
University of Science and Technol-
ogy, Yunus Centre, Grameen Shakti),
Denmark (Copenhagen Business
School), Norway (NTNU, KUC),
Japan (Kyushu University, Redcross),
Spain (Universidad Politechnica de
Madrid), Thailand (Asian Institute
of Technology), Shanghai (Shanghai
Jiao Tong University) and other BRI
Region in China (Guangxi Univer-
sity). The project encompasses multi-
ple disciplines including Software,
healthcare, mobile communications,
entrepreneurship, business, and social
development. Students, faculty, and
researchers, in these different institu-
tions and disciplines, are cooperatively
investigating the technical and entre-
preneurship aspects of mobile technol-
ogies (such as phones, robots, drones
etc.) for healthcare development in
the specified BRI regions and coun-
tries. Bangladesh has been selected as
a major partner in this project because
of its pioneering status in commer-
cialising mHealth (healthcare using
mobile phones) through services, such
as Health Hotline 789. Guangxi prov-
In the healthcare sector,
Universal Health Coverage
(UHC) is the platform
that seeks to overcome
inequality in tackling
the gap in the service
provision and finance that
populations face.

partners are from Bangladesh, China,
India, and Japan.
3. Portable Health Clinic (PHC):
The idea is to use mobile phones for
primary healthcare in remote areas in
developing countries where the doctor
remotely assesses a patient remotely
using a mobile phone. Such systems
have undergone pilot trials in several
countries including Bangladesh, China
and Australia This is a well-known
project with strong involvement
from several countries. The project
name PHC evolved from Grameen
Communications and Yunus Centre
work called ‘Doctor in a Box’. This
project will leverage entrepreneurship
amongst village health workers across
the OBOR borders (China and Bang-
ladesh) for healthcare applications
using mHealth. Project partners are
from Bangladesh, China, Japan, Paki-
stan, and Thailand.
4. Blockchain for social business:
This project deals with various aspects
of the blockchain technology to help
the social services sector (including
NGOs) to gain the trust of the donors
at minimal cost thanks to blockchain
technology in mobile services. Partners
include organisations from Australia,
China, Denmark, Korea, and Norway.
5. mHealth for parkinsons disease:
This project focuses on the applica-
tion of mobile and wearable technolo-
gies for major global chronic diseases

(e.g., Parkinsons Disease-PD) that is
of great importance to China as almost
50 per cent of global PD patients are
from China. Researchers are working
on using wearable mobile technolo-
gies to treat PD patients in very early
stages. This project will focus on the use
of mHealth for reducing the cost and
improving the quality of life of chronic
illness patients. The partners are from
Australia, China, Japan, and Norway.
6. Global challenge:
While all the above projects relate to
the application and deployment of a
type of mobile technology, this project
will deal with the development of
entrepreneurship for the social devel-
opment integrating above technologies
in a developing country. This project
acts as an umbrella for the develop-
ment, deployment and evaluation of
the mHealth technologies involved
in the above projects. The project will
carry out relevant case studies across
the borders of OBOR region (e.g.,
China and Bangladesh) to share infor-
mation (e.g., success stories and know-
how) related to the deployment of these
technologies for healthcare from the
perspectives of government policies,
regulatory environment, entrepreneur-
ial / business support, cross-cultural
collaboration and related funding
mechanisms. Partners are from Bang-
ladesh, China, Pakistan and Thailand.
These technology entrepreneur-
ship projects study the feasibility and
deployment of various mobile technol-
ogies for the sustainable development
of healthcare in developing regions,
such as Belt and Road provinces of
China and neighbouring countries.
Each project will involve academics
and entrepreneurs from China and at
least one Belt and Road country (e.g.,
Bangladesh) to collaborate and learn
various aspects of the deployment of
mobile technologies in healthcare.
The whole project came to a
concrete footing in September 2018
through the Entrepreneurship Week
event organised by UMJI. As a first
such event, it was attended by about
120 participants from 14 countries,
and discussed the way forward for
them HBR projects. This event led to
the initial plan of mHBR in consulta-
tion with multi-national partners in
academia, business, and the govern-
ment and consolidated the organisa-
tion of mHBR project into six projects
mentioned above, led by experts and
members from ten countries including
Australia, Bangladesh, China, Japan,
Korea and several European countries.
This mHBR group will meet again in
Sept. 2019 in Asian Institute of Tech-
nology to discuss the progress of all
projects and their future strategies.
References are available at
www.asianhhm.com
AUTHORBIO
Pradeep Kumar Ray is a 1000-talent Distinguished Professor in
the University of Michigan-Shanghai Jiao Tong University Joint
Institute and is currently leading a major collaborative project called
mHealth for Belt and Road Region involving seven countries. He
is the founder of the WHO Collaborating Centre on eHealth in the
University of New South Wales (UNSW)-Australia.
Dr. Soong-chul (Sam) Ro has been teaching political economy,
and sustainable development at the University of Michigan–
Shanghai Jiao Tong University Joint Institute. He also works for the
Center for Entrepreneurship of the Joint Institute, taking an active
part in the mobile Health for Belt and Road Region project.
Willy Jin Huang is currently an active member of the UM - SJTU
Joint Institute Center for Entrepreneurship (CFE), assisting the
various activities listed at the web site of CFE http://umji.sjtu.
edu.cn/entrepreneurship/. He is also an aspiring entrepreneur
who possesses previous experience of working for multinational
companies on various projects.

The science of service delivery is a
skill that can only be mastered by
understanding the requirements and
the needs of the service consumer:
patients and their attendants / family in
our context. While the medical talent
provides for the requirements, the need
is fulfilled by the overall experience
through the patient journey. Since we
deal with people and lives, the personal
touch is critical, alongside expectation
setting for medical conditions, outcomes
as well as patient movement, all
along reflecting empathy and care.
Gurrit Sethi, Strategic Advisor, Global Health Initiatives
The Science of
Healthcare Delivery
Construct and its impact on
service delivery
T
here are many aspects to healthcare delivery: the
spread, aided by market factors, government
policy and regulations, the enablers like
IT, digitisation, connected health etc., the support
ecosystem like pharma and device etc., and, the delivery
construct at the organisational level. All of these aspects
come together at the delivery Segment, aiding the very
construct of the services offered.
In my last article I touched upon the spread; in this,
let us talk about the delivery construct. Also, because
I have had the pleasure of working on this area with
hospitals, IT as well as medical devices, segment over the
last few years. A very recent incident of hospitalisation of
a close family member also exposed me to experience the
work flows from the other side of the table—as a patient’s
attendant, and have interesting insights to share.
So let me start with my experience as a service
consumer. My kin was wheeled into a hospital
emergency. As I finished the registration, I looked on in

anticipation to get some insight on the patients’ condition.
Blood samples were taken, different doctors came in and
went out and I kept waiting. As I went to complete the
admission procedure I felt as lost as any other patient
attendant, forgotten were my years of experience of working
in hospitals. It was a great experience though from a
professional perspective. While there was no lack of courtesy
as I badgered everyone with my questions, which were
politely answered, I still felt lost not only from an emotional
perspective, but also from a procedural / information / what-
do-I-do next perspective. And this, when I had no financial
worries because of the insurance privilege that offered total
financial security.
Ever since, I have wondered about the missing link.
Being handed some papers and told to go to the admission
desk, I couldn’t find the way–—the sign boards were either too
small or confusing or tucked away in a corner so I had to look
hard and my brain refused to remember the path instructions
given. Of course I finally found another attendant who walked
me across. When I walked back, I was as confused—whom
do I hand over the document, who will explain what next?
I walked up to the doctor who said it’s a cardiac emergency,
the respective team is looking into it. I chided myself to be
patient as my kin was put into hospital clothing. And then I
realised they were shifting him elsewhere, I quickly ran to ask
where and was told to walk along.

Well the senior physician under
whom the patient was admitted,
didn’t come along as he was not in
the hospital. Of course the treatment
went fine through his team and they
answered my questions to the point.
But this stood out in my mind that the
admitting doctor hasn’t come, hasn’t
contacted. I raised my concern to one
of the doctors on duty who seemed to
be senior amongst those present. I first
requested for his name and then asked
him next steps. He told me another
name (again not the admitting doctor)
as the person who will do the angiogram
and any further procedure. I politely
asked him to introduce me to him on
arrival. The nursing staff and a junior
doctor got a consent form signed.
When I saw a seemingly important
person walk by I ran behind to be told
that he is the guy I was looking for as he
would do the procedure. The meeting
was brief—information about the
procedure and then told to wait outside
the cathlab. The procedure went fine.
I asked the nurse and duty doctor on
what I needed to do next—wait? If
so, where? Did they need me around?
What are the visiting hours? Etc.,
Next day the patient was posted
for discharge. Having being told in the
morning that he would be going home
by noon, there was much elation in his
eyes. Well, noon came by and went by.
I went up and down—the nurses said
they had sent all the documents to
billing, billing said they hadn’t received
it. Then someone told me to go to the
OT to see if they had done their bit of
clearance and posting of implants used.
And then the billing system stopped
working. The staff was inpatient now
with all the questions from the many
waiting people.
Slowly I was able to regain my
composure, and know how from
experience started kicking in. I calmly
called in the supervisor, told him how
and where to get the information he
needed regarding the amount I needed
to pay so that I could go home while his
‘system’ was down. I promised to return
the next day to sign the documents
and get a copy of the bill. Two days
later, I went to ask for the bill—it
wasn’t ready. They didn’t remember!
And once I reminded them, they are
finally following me around to get
my signatures on it as only then can
they submit the bill to the payor for
payment—an interesting role reversal!
While the Treatment was Good and
Very Satisfactory, what was the
Missing Link?
The big C&I all the way—Commu-
nication and Information, flow of
communication, method of commu-
nication, the how of communication,
the missing pro-activeness of commu-
nication, the level of detailing expected
in the communication, who needs to
communicate what and when, how
does the communication flow, when
and where does it flow, what and where
are the interconnects with the patient’s
family and attendants. And what infor-
mation flows with this communication.
It is these processes that finally define
how the service consumers come out of
that experience. And irrespective of the
medical outcomes (there will always be
terminal cases), if we get it right we will
have the patient and family walk out
our doors with a good and satisfactory
experience. And when they do, they
will come back again as well.
The delivery at the organisational
level revolves around the design and
construct of the organisation itself, the
way it is wired, what tools are used;
which in turn defines the information
flow and who does what. Those who
have mastered the art, also take care to
define the how and when. The current
that flows through this wiring is our big
C&I—communication and informa-
tion—that enables good service deliv-
ery. This current is also the culture, the

A U T H O R B I O
Gurrit K Sethi, Hospital Chief Operating Officer, Care Hospitals; Strategic Advisor
for Global Health Services, Global Strategic Analysis, contributes to healthcare by
helping providers build and better business efficiencies and concept development,
also strives to contribute socially through the Swiss Foundation, Global Challenges
Forum as Strategic Advisor, through conception of sustainable health initiatives. She
started her career from the shop floor working her way up to lead and set up different
healthcare businesses. In her words, her significant achievements have been in
bringing to life different SMEs and SBUs signifying a change in the Indian healthcare
scenarios, as the opportunity paved the way along the healthcare growth curve in the
country. With over 18 years in healthcare under her belt, across different healthcare
verticals, she has carried transformational changes in the projects she has led, four
of those being early stage start-ups. Gurrit is an avid traveller and voracious reader
of varied genres, attributes which she says, provide her with incisive insights about
people and systems and what drives them.
capability and the motivation of the
people and the team and carry this
delivery to the last mile.
There is a growing focus on
culture building within organisations
these days. It is people who deliver
the services. It is the front end staff
that finally manage the moments of
truth on our floors and not the senior
management. However, it is the senior
management that drives the environ-
ment in which the team members
operate. It is finally the environment
and the EQ that motivates these front
end teams to do what they need to do
and how. Therefore, the last mile deliv-
ery is so badly dependent and corre-
spondent with the culture / environ-
ment of the organisation.
It’s also a common misnomer to
read the organisation structure as a
hierarchy archetype. By my experi-
ence, the organisation structure lays
out the basis of the operations—who
is required to do what, definition of
the what, and the details of the how,
the required skill sets and the capabil-
ity build that forms the basis of the
culture. This in turn defines the plugins
of the various to dos across the depart-
ment structures and layers. Informa-
tion flows through this construct and
is relayed by way of communication—
across the patient journey and through
this system.
I have also come across various
organisations that simply ape the struc-
tures of other organisations as they
come up. It is important to understand
the model first before an organisation
structure gets defined. Because it is this
model that will give shape to the end
delivery and how this is to be done. It
is advisable to use the requirements of
this model to build an org structure
that works rather than a copy paste.
As I look through the various
service delivery organisations in
healthcare—we have miles to go before
we sleep, but maybe we need to put
this through a sleep study to be able to
drive it more scientifically!!

Lean management could prove to be an essential tool
for solving a key issue of the emergency department:
overcrowding. Lean management works towards reducing
the non-required items/ processes/ activities commonly
known as ‘waste’ and streamlining the system towards
qualitative services. Applying lean management would result
in sustainable growth due to realignment of services and
processes towards patients and staffs satisfaction. It further
reduces unnecessary cost burdens on patients, staff, and the
environment while also facilitating continuous improvement for
innovative services leading to patient benefits and profitability.
R B Smarta, MD, Interlink Marketing Consultancy
LEAN
MANAGEMENT
OFEMERGENCY
DEPARTMENT G
lobally, healthcare
systems are under
pressure to improve
qualityandpatientoutcomesusing
evidence-based interventions.
Many healthcare organisations
are turning to industrial
improvement approaches, such as
the lean management system, 5-S
model, Six sigma, etc., to enhance
quality and safety. The critical
part of emergency department
is the 24* 7 working hours
during which it is almost always
overcrowded. Thus, minimising
thenon-relevantandnon-required
items/ activities from the system
and reducing waste would prove
to be beneficial, and this is what
lean management aims towards.

Lean thinking is a visual state of
mind, whereby the focus is on the task
and nothing else is encouraged. Lean
management in healthcare systems
was first applied way back in 2004 at
the Mason Hospital, Virginia,USA, to
improve their process methodology. A
study also reveals that some hospitals in
USA in 2009 implemented lean system
to improve the quality of healthcare
services, out of which 60 per cent
applied in emergency department.
Essence of Emergency Department
The emergency department is
characterised as a critical department
in hospital setting and is occupied by
varied patient types. Various countries
have applied National Emergency
Department Inventories (NEDI)
survey as a standardised method to
benchmark the characteristics of
emergency department.
Overcrowding in emergency
departments is a global problem and
has been recognised as a national
crisis in some countries as it hampers
the objective of service to the patient.
The improvement, in terms of cost of
care, the quickness of service, handling
of crowds, swiftness in triage process,
and most importantly, patient safety
are now widely accepted by means of
patient-centricity. The workflow of
the emergency department should
be planned in such a way that the
staff could attend immediately to
unscheduled and unexpected patient
inflow.
One survey showed that a varied
number of emergency departments
has high annual visit volumes and long
length-of-stay, and most of them are
over loaded.
There is no doubt that the
emergency department is the most
complex clinical department in
modern hospital infrastructure. It is
always intended to have well designed
infrastructure and depending on the
condition of the patient and whether
the patient is with occupier or not
priority of formalities and treatment
needs to be decided. Nothing is more
crucial than saving lives!
Emergency Department Process
Flow
Many a times, disparity between
capacities of the emergency department,
requirement of triage process,
diagnostic tests and consultation with
doctor affects the patient flow to a
greater extent in. In addition, some
studies have recognised overcrowding
as the major reason for adverse patient
outcome, delayed treatment, prolonged
length of stay and hospital readmission.
Well, to solve those issues revisiting
the workflow of the entire process
of the emergency department isa
prerequisite and needs to be integrated
along with collaborative support from
all healthcare professionals involved in
the emergency department.
Not only does lean management
reorganise services and systems for
patients, it also indirectly affects
employees. Streamlining the work
processes directly affects the staff
and helps them in managing their
work pressure accordingly. Lean is
implemented in particular contexts and
success is dependent on how it fits into
the system.
Let's look at the principles of lean
management that help understand the
basic concept of lean.
5 Lean Management Principles:
Define value
The first stage is to define the value
of your products and services as per
customer requirements which is
directly proportional to beneficiary
in terms of footfalls. It is supreme to
determine the actual or latent needs
of the customer. To better understand
the Lean management principles
we should start with defining
“customer value”. Value is what the
customer is keen to pay for. Sometimes
customers may also be unable to
express it. This is particularly observed
when it comes to novel products
or technologies. Applying to recent
trends, Artificial Intelligence (AI)
and machine learning are some that
need to be perceived by patients.
There are various ways like focus
group interviews, surveys, footfall
analysis, demographic information
and web analytics that can lead you
to know your customers preferences.
Source: Overcrowding in emergency departments:
A review of strategies to decrease future challenges
Figure 1 Emergency department process flow
Triage
Registartion Early
Treatment
Zone
Resuscitation
/ Trauma Home
Acute Inpatient ward
Sub-Acute
Rehabilitation
unit for chronic
condition
Fast track
Emergency
Department
Short stay unit
Urgent care
Unit
2 Hours 1-2 Hours

Map the value stream
In this step, the objective is to use the
customer’s value as a reference point
and to identify all the other factors
those contribute to these values. Those
activities that do not add value to
the patient are considered waste and
should be eliminated. The waste can
be differentiated into two categories:
non-value added but necessary and
non-value but unnecessary. The latter
is pure waste and should be eliminated
while the former should be reduced
as much as possible depending on the
patient preferences and reducing the
cost of production of that particular
product or service.
Make the process flow
Once elimination of non-value added
services or products is done, ensure
that the rest of the process is smooth.
Strategies to ensure that process runs
smoothly, measures that can be taken
include breaking down the major
stages into two three subsequent steps,
levelling out the workload amongst
the staff, creating cross-functional
departments, and training employees to
Leadership
Support
Educate entire staff
Encouragement of
Continuous improvement
Figure 2 Pyramid of enabling Lean management Source: Interlink Marketing Consultancy

be multi-skilled, talented and adaptive
to environmental changes.
Pull from the customer
The aim of applying a pull-based system
is to limit the inventory to required
things and work in progress. Also,
assurance of the availability of required
materials and data at appropriate
time for a seamless process of work
is necessary, as it enforces ‘In-time’
delivery. Pull-based systems are always
prioritised based on the needs of the
end customers.
Work towards perfection
Once the process is set in order by
implementing the first four steps,
the fifth step of chasing perfection is
of utmost importance. It makes lean
management thinking an integral part
of the organisation and lends a continu-
ous process of upgrading accuracy and
precision in organisational culture.
Every employee should endeavour to
exactness while providing service to the
patient. One should always remember
there is no limitation to learning, and it
is a steady process.
The 5 Lean management prin-
ciples create a background for well-
organised and active organisation. It
allows managers to reduce inefficien-
cies, deliver better value to customers,
create efficient workflow, and develop a
continuous improvement culture. This
will encourage competitive environ-
ment, increased value, decreased cost
to run business, and indirectly increase
profitability.
Implementing lean in the emer-
gency department should start with
cleaning up cluttered spaces by remov-
ing or replacing unnecessary items.
This would free-up the space across the
overcrowded department and facilitate
smooth movement.
A small study conducted in a hospi-
tal showed that the average length of
stay is approximately 1 hour and 41
minutes. Various factors govern the
length of stay starting from the time
required for the registration process,
time invested by patient’s kin in taking
decisions, making financial arrange-
ments, and to submit documents.
Furthermore time taken by consultant
to attend the patient, even the wait-
ing time for radiology investigations
or other laboratory reports are time
consuming and stressful.
Following is the observation of
time required for various processes (in
minutes) from experience of lean in
Emergency department: [1]
Environmental Issues in the
Emergency Department
The main issue and concern for any
emergency department is overcrowding.
Hospital managers need to examine
their operational procedures to resolve
this concern. Once the reason for
overcrowding is known, then tackling
it won’t take much time. The standard
time an individual spends in emergency
department is 5-6 hours. The care
provided to in-patient and emergency
department should be the same and
the processes should ensure safe and
qualitative care.
The staff plays a major role in the
up-gradation of the organisation.
Taking into account the operational
realities, techniques, and relatively
inflexible culture make it challenging
to implement lean management. Many
a times hospitals are not aware of the
lack of resources or training of soft skills
which may reduce time required for
interaction. The in-patient department
Figure 3 5 Lean management principles Source: Interlink Marketing Consultancy
A study reveals that some
hospitals in USA in 2009
implemented lean system
to improve the quality
of healthcare services,
out of which 60 per cent
applied in emergency
department.

R B Smarta has designed management
agendas for profitable growth, relevant
expansion, launching new concepts,
ideas and projects for National and
Global clients in Pharmaceuticals,
Nutraceuticals and Wellness. Being in
the industry for more than
4 decades & amp; in consulting as a
pioneer for 3 decades, he has a perfect
blend of industry and consulting best
practices. He has added value and
impact on performance of wide variety of
clients, inclusive of start-ups to national
and multinational corporate. His firm
Interlink has created valuable insights
and depth of knowledge in its knowledge
bank, along with its consultants and
associates.
is often trained for usage of new devices,
but the emergency department tends
to get overlooked as a different entity,
although the emergency department
staff may benefit from it. Empowering
the staff with proper training and
resources can eventually contribute to
other efforts such as improved services
and reduced waiting times.
Unique Culture of Hospitals
Althoughmanyhospitalssharecommon
problems such as overcrowding, it
is important to remember that each
hospital has its own environmental
issues depending upon the culture.
Morality of employee may seem to be a
minor issue, but if staff is unhappy then
this could hamper services and may
escalate to staff inefficiencies that could
badly affect the image the of hospital.
In this case, the management leadership
should be firm enough to take decisions
toward establishing processes and
improving inefficient practices.
Way Forward
Lean management through the use of
the following initiatives can prove to be
an effective way forward:
1. Replacing traditional nurse-based
triage with a team of triage including
physicians has proved to be beneficial
as it could discharge more patients that
too without admission.
2. Depending on the patient flow,
high/low flow strategies can be imple-
mented when there is overcrowding and
some of them may get treated in initial
care unit.
3. Another way to tackle overcrowding
is to employ a waiting room that
allows treatment by the time primary
diagnostic tests results are revealed.
A continuous improvement
mindset is essential to reach the
company's goals. The term ‘continuous
improvement’ means incremental
improvement of products, processes,
or services over time, with the goal of
reducing waste to improve workplace
functionality, customer service, or
product performance. Lean is founded
on the concept of continuous and
incremental improvements on product
and processes while eliminating
redundant activities. "The value of
adding activities are simply only those
things the customer is willing to pay
for, everything else is termed as waste,
and should be eliminated, simplified,
reduced, or integrated".
References:
1. Lean thinking in emergency department,
Taraknath Taraphdar, presentation at EMCON,
Jaipur, November 2017.
2. Overcrowding in emergency departments: A
review of strategies to decrease future challenges,
Mohammad H Yarmohammadian, Fatemeh
Rezaei, Abbas Haghshenas, and Nahid Tavakoli;J
Res Med Sci. 2017.
Table 1 Source: Lean thinking in emergency department, TaraknathTaraphdar,
presentation at EMCON, Jaipur, November 2017.
Process
Before
(Time in mins.)
After
(Time in mins.)
Consultant waiting time 21 16
Final waiting time 29 19
Blood sample result time 69 28
Radiological investigating result time 32 15
Admission waiting time 30 20
Length of stay 123 72
Patient satisfaction 86% 98%

Sleep is a restorative process which plays a very
crucial role in our physical, mental and emotional
health. It has profound consequences on one’s
overall health and well being. There is a lot of
literature established which points towards a direct
correlation between sleep deprivation and a number
of chronic health diseases like obesity, diabetes,
hypertension and cardiovascular diseases.
Pradeep Chowbey, Chairman, Max Institute of Minimal Access, Metabolic &
Bariatric Surgery, Max Superspeciality Hospital
SLEEP
DEPRIVATION
AND DISEASE
RISK
MEDICAL SCIENCES
T
he cost of sleep debt is much heavier
than one may comprehend. Sleep
is a restorative process which plays
a very crucial role in our physical, mental
and emotional health. It has profound
consequences on one’s overall health and well
being. There is a lot of literature established
which points towards a direct correlation
between sleep deprivation and a number of
chronic health diseases like obesity, diabetes,
hypertension and cardiovascular diseases.
Sleep debt may result from insomnia
or other underlying conditions that require
medical attention. But most sleep debt is
due to burning the candle at both ends —
consistently failing to get to bed on time and
waking up late the next day disrupting the
sleep pattern.

The hormonal imbalance
Leptin and ghrelin are two peripheral
hormones that regulate energy balance
and food uptake.
Leptin is the appetite suppressor
hormone which is released by fat cells.
It sends signals of satiety to the brain-
and instructs to stop eating. During
sleep, leptin levels in the body increase,
signifying that the body has enough
energy and does not need any food.
MEDICAL SCIENCES
Understanding the Body’s Internal
Clock
The body clock or sleep / wake cycle is
also termed as the Circadian rhythm.
It is a twenty four hour internal
clock of the body which cycles
between sleepiness and alertness at
regular intervals. The body clock is
controlled by an area of the brain
that responds to light, which is why
humans are most alert while the sun
is shining and are ready to sleep when
it's dark outside.
The circadian rhythm causes
the level of alertness to rise and dip
throughout the day. Most people
feel less alert between 1:00pm and
3:00pm and then late night between
2:00am and 4:00am, but this can
vary from person to person. This
body clock also changes with age.
If one follows the body’s natural
cues regarding when to go to sleep
and wake up, the circadian rhythm
should stay balanced, but a change in
the schedule like staying up late can
disrupt the body clock.
Relationship between Sleep Habits
and Chronic Diseases
Short-term ill-effects of sleep depri-
vation include fatigue / tiredness
throughout the day, bad mood and
inability to focus on task at hand.
However, if one is sleep deprived on
a regular basis, it can lead to develop-
ment of chronic diseases.
1.Obesity
Short sleep duration has been
documented to be closely linked to
elevated Body Mass Index (BMI).
Recent studies suggest that less than 7
hours of sleep can reduce or even undo
the benefits of diet and exercise. Sleep
deprivation in turn makes one crave
food and even calorie dense food. It
is well understood that during sleep,
the secretion of various hormones
varies, contributing to the metabolism
and energy balance of the body. Sleep
deprivation may disturb this balance
leading to weight gain.
This hormone significantly decreases
with sleep deprivation which results in a
constant feeling of hunger and a general
slow-down of metabolism.
‘Ghrelin’ is the appetite stimulator
or hunger hormone which has the exact
opposite purpose of leptin. It is released
by the stomach and its function is to
stimulate appetite. While sleeping, the
levels of ghrelin decrease; however if one
is sleep-deprived, it results in an increase
It is scientifically proven
and published in many
leading journals that
even one night of sleep-
deprivation can cause
insulin sensitivity to drop
which impairs glucose
metabolism.

of ghrelin which results in increased
hunger and appetite, more so for the
carbohydrate rich, starchy and calorie
dense foods.
So, sleep debt causes this combi-
nation of a decrease in leptin and an
increase in ghrelin which results in an
increased calorie intake and weight
gain. Various studies have established
that sleep deprivation leads to increased
levels of stress hormones and resistance
to insulin, both of which also contribute
to weight gain.
Vicious cycle
Following the biological clock is the key
to good health and well being. Altered
sleep patterns contribute to eating at
wrong times, thus disturbing metabo-
lism. Seven to nine hours of daily
sleep at the right time is imperative.
Odd timings of sleep encourage
midnight binging which is mostly junk
processed food that is high in calories.
Moreover, no physical activity after
that causes everything to be deposited
as fat in the body during sleep. The next
morning, the person obviously wakes
up late and feels lethargic throughout
the day with poor energy and concen-
tration levels due to which there is
no exercise in the day time as well.
This slows down the metabolism even
further and contributes to weight gain.
Poor metabolism
Adequate sleep plays a vital role in
regulating metabolism and appetite.
With irregular sleep patterns which
causes, sleep deprivation, individuals
have a decreased ability to manage
blood sugar levels and also may end up
being hungrier.
Lack of sleep is also responsible for
high stress levels, lower productivity
in work and increased likelihood of
metabolic disorders.
2. Insulin resistance and Type 2
Diabetes
It is scientifically proven and published
in many leading journals that even one
night of sleep-deprivation can cause
insulin sensitivity to drop which impairs
glucose metabolism. Few consecutive
sleep deprived nights through the body
metabolism into complete disarray
putting the body in a state of insulin
resistance—a common precursor of
weight gain, diabetes and other serious
health problems.
In a healthy body, sugar is
metabolised by the insulin released
by pancreas. When the body develops
insulin resistance, cells are less
responsive to that signal, and glucose
levels rise in the bloodstream. That can
lead to diabetes
3. Hypertension and heart diseases
Sleep deprivation results in an increase
in blood pressure and causes changes
in the lining of arteries. This leads to
an increased risk of heart disease due to
weight gain and also adverse changes in
the arteries. Studies suggest that even
a single night of inadequate sleep in
people with existing hypertension can
cause elevated blood pressure through
the next day
4. Psychological disorders
A single disturbed night of sleep reflects
on the working of an individual the
next day. The person is fatigued, sleepy,
confused and not focused throughout
the day. Long term sleep deprivation
can lead to chronic long term disorders
like depression, anxiety and memory
issues.
5. Gastrointestinal issues
Sleep deprivation has been associated
with Gastrointestinal issues. Both
Inflammatory Bowel Disease (IBD) and
inflammatory bowel syndrome, have
been linked to lack of sleep. Patients
suffering from Crohn's disease are twice
as likely to experience a relapse when
they are sleep deprived.
People always find themselves
struggling to lose weight despite
moderateexerciseanddietmanagement,
recent studies suggest that less than 7
hours of sleep can reduce or even undo
the benefits of diet and exercise. Sleep
deprivation in turn makes one crave
food. The millennial lifestyle does not
always allow us to follow the right sleep
patterns; however, here are few things
to do for a good night’s sleep:
1. Try and maintain regularity
Maintaining more or less the same time
to go to sleep and waking up is vital.
This helps to set the body’s internal
clock and optimise the quality of sleep.
MEDICAL SCIENCES

Pradeep Chowbey belongs to the cadre of the pioneer
laparoscopic surgeons in India. He has graphed his career with
singular determination to develop, evaluate and propagate Minimal
Access, Metabolic & Bariatric Surgery in India. The advent of
Laparoscopic surgery with his hands became a point in India's
medical history.
Chowbey established the Minimal Access and Bariatric Surgery
Centre, Sir Ganga Ram Hospital, New Delhi in 1996, which was the
first of its kind in the Asian subcontinent.
2. Control exposure to light
Melatonin is a naturally occurring
hormone controlled by light exposure
which helps to regulate the sleep-
wake cycle. The brain secretes more
melatonin when it’s dark—triggering
sleep—and less when it’s bright—
making one more alert.
• Avoid bright screens within 1-2 hours
of bedtime
• Don’t read with backlit devices
• At the time of sleep, the room should
be dark.
3. Keep the room cool
A temperature of around 18° C with
adequate ventilation is considered ideal
for a good sleep. A room that is too hot
or too cold can interfere with quality of
sleep.
4. Be Smart about what you
drink & Eat
• Limit caffeine and nicotine
• Avoid alcohol before bed.
5. Don’t stay in the bed awake
If one is unable to sleep and has been
awake for more than 15 minutes, it is
best to step out of bed and do a quiet,
non-stimulating activity, like reading a
book. The lights must be kept absolutely
dim and screens must be avoided.
Key Messages:
1. Various epidemiological studies
have established a strong association
between short sleep duration and
overweight and/ or obesity.
2. The third leg in the tripod of weight
management is adequate sleep at
appropriate time; the other two being
healthy diet and exercise.
3. The use of multimedia has
emerged as the most common factor
contributing to sleep deprivation (for
example, television, smartphones, and
computers) which aggravates sedentary
behaviour and increases caloric intake.
4. Sleep deprivation results in
metabolic and endocrine alterations
which are
• Increased levels of ghrelin, the
hunger hormone
• Decreased levels of leptin, the
appetite suppressor hormone
• These two in combination contribute
to increased food intake, high caloric
snacking and poor diet quality.
• Decreased glucose tolerance
• Decreased insulin sensitivity
• Increased production of stress
hormone ‘Cortisol’ .
MEDICAL SCIENCES

Cardiovascular Diseases have grown to epidemic proportions in India
leading to high mortality. Apollo Hospitals and Microsoft have come together
to develop and implement a model using Artificial Intelligence (AI) and
Big Data to help us define risk prediction, create stratified populations and
build targeted therapies and treatment, thereby avoiding preventable deaths.
Sangita Reddy, Jt. Managing Director, Apollo Hospitals
Cardiovascular AI
Risk Score Programme
Clinical AI for all
MEDICAL SCIENCES

Apollo Hospitals and Microsoft
have joined hands to develop the
Standard Cardiovascular Risk Score
in Indian population based on the
available data at Apollo Hospitals using
AI and Machine Learning (ML). The
basic objective of this unique initiative
is in developing a more accurate risk
prediction model so that in conjunction
with screening, diseases can be averted
in high risk groups.
Risk Factor Selection and Modelling:
Building the Tech Capability
The study started with the analysis of
over 400,000 individual health check
records that were collected between
2010 to 2017 from six centres of
Apollo Hospitals and matching them
with 60,000 patients with discharge
summaries of cardiovascular events.
All the records were anonymised by
removing patient name and unique
identification number. Following the
data hygiene and curation, the initial
model was built on approximately
7,000 patients with cardiovascular Event
discharges and a previous health check
record (Cases) with 25,000 individuals
who had two or more health checks
done in the same period without any
cardiovascular event (Controls).
Health check data yields more
than 100 clinical parameters for each
individuals. The initial step was to filter
and identify the applicable risk factors.
As the next step, Spearman’s correlation
coefficient was used to correlate risk
factors to a cardiovascular event. The
data was filtered with respect to all the
parameters and were further grouped
and normalised. After the clinical
validation process, around 21 clinical
risk factor was selected for further study
and validation.
MEDICAL SCIENCES
C
ardiovascular diseases have
grown to epidemic proportions
in developing countries such
as India, where lifestyle patterns have
changed significantly due to growing
urbanisation, dietary habits, reduced
physical activity, and associated
psychological stress. Currently,
cardiovascular diseases contribute
to more than 29 per cent of deaths,
while Coronary Heart Disease alone
contributes to around 15 per cent of
deaths in India. Though, there have
been multiple studies on cardiovascular
disease risk factors since early 1940s,
they were not specifically applied to
Indian population with high accuracy.
Further, most of these studies had
selection bias in terms of choosing
the risk factors and wouldn’t provide a
prospective feedback loop to account
for a Cardiovascular event in an
individual on a future date.

Hazard models were used to predict time to event;
these models were built to have unique advantage over
regression model to further improve accuracy. Applying the
recent advances on Deep Learning on Survival Analysis, we
could create an integrated model which provided improved
inferencing of co-variate (Hazard Model) while giving better
prediction score (Deep Learning).
Initial Results
The accuracy of the model looking at the 21 clinical risk
factors stands at the AUC 0.83 which is significantly higher
than Framingham Risk Score for the same population at
AUC 0.47. One of the significant outcomes was about
determining the cardiovascular risk in younger (below 40
years) population (16.6 per cent).Secondly, the interplay of
multiple factors were more significant than any one individual
factor. For example, the study yielded higher correlation
between hypertension and diabetes as risk factors for
cardiovascular event than any one of the factors individually.
The study also highlighted that the higher diastolic blood
pressure is a better indicator of cardiovascular disease than
higher Systolic Blood Pressure, particularly in a younger
population. Specific to Indian population, chewing tobacco
is more harmful than smoking for cardiovascular disease
(around 7 percentage point more). Lastly, higher BMI (> 27)
with either smoking or chewing tobacco increases heart risk
by 14 per cent percentage point.
The results of the study were next validated retrospectively
with blinded data set from 2 other (larger) centres of Apollo
Hospitals with AUC scores of 0.844 (n = 2389) and 0.92
(n=857). During this validation process, another significant
inference came out in the form of frequency of health check
to the accuracy of prediction. The study concluded that when
the health checks are done more frequently, the accuracy of
the prediction improves providing a better predictability for
cardiovascular event.
Figure 1 Showing the complete synopsis of the Methodology from Data Collection, Processing, Analysis and Creation of Novel API Tool for Operational Roll Out
MEDICAL SCIENCES

data is collected in the EMR which
would auto populate the cardiac risk
score user interface. On clicking the
‘Get Prediction’ button, the Cardiac
Risk Score is generated with the
following features: (Figure 3) –
• The risk score of the patient with the
optimal score for his / her age.
• The top three modifiable risk
contributors, which the patient
should work on moving forward to
reduce the risk of the cardiovascular
disease.
• The patient’s historical risk score that
has been generated from the earlier
health checks done in the system,
which predicts the risk trend.
• The clinical decision support system
which provides what the physician
should direct the patient towards
next lab investigations, Diagnostic
imaging, referral to cardiologists,
medications, patient and family
education and repeat visit timelines.
• Alegaldisclaimersuchas:Thisclinical
Steps to Tech Adoption
With the technology capability
developed and promising initial results
of the retrospective study, the Apollo
Hospital: Microsoft Team next focused
on deploying the AI model into the
organisational Electronic Medical
Records (EMR) for improved adoption.
A roadshow programme for eight
Apollo Hospitals and a prospective
longitudinal study with ten Indian
Hospitals (including reputed academic
institutions) were subsequently
designed. The next objective was to
focus on empowering physicians to
determine risk factors in patients with
more holistic way and provide insights
to them for lifestyle modification and
timely interventions.
a)Integrating the AI model as an API
to the organisational EMR :
The programme was built through novel
ideas and designing of the operational
processes. The API tool is built for
the EMR, where the patient’s current
risks are determined and methods to
reduce risk were provided during the
discussion with the physician. There
are currently no existing tool based on
computation on deep neural networks
available to predict cardiovascular risks.
Next step in the workflow was to
define the inclusion and exclusion
criteria as under what clinical condition
a physician can choose to generate the
risk score of an individual or a patient.
Following the development of the
inclusion criteria, the team designed
the work flow required to implement
the process and integrating the API at
personalised health check clinics in the
hospitals and Apollo Clinics; Specialty
Clinics like Apollo Sugar and Healthy
Heart Clinics; Physician OP Clinics
in Internal Medicine, Cardiology etc;
and finally, developing an App for
Peripheral Public Camps and Remote
Care – Apollo TeleHealth.
In all of the above situations, the
patient- / individual-related clinical
Figure 2 Flowchart of the Inclusion / Exclusion Criteria for Cardiovascular Risk Scoring with the 21 Risk Factors
MEDICAL SCIENCES

One of the key imperatives
for any clinical AI
programme is to provide
a link between the AI–ML
research and integrate
this with core clinical
functionality for a better
adoption of clinicians.
algorithm is a general guideline for
physicians using the cardiac risk
score. Any additional laboratory
investigations, diagnostic imaging,
treatment or patient education
related to lifestyle management is
under the physician’s or cardiologist’s
discretion.
b) Clinical Decision Support
Systems
One of the key imperatives for any
clinical AI programme is to provide
a link between the AI–ML research
and integrate this with core clinical
functionality for a better adoption of
clinicians. The clinical algorithm was
developed to support the patient’s risk
score and channelise them through
appropriate care processes as described
above. Figure 4 shows the process. The
benefit of the clinical algorithm were
two-fold:
helping the physicians to guide their
patients better
• Prospective Study & Roadshows
with Clinicians
For the prospective use of the
cardiac risk score API tool, the team
designed an observational prospective
study with appropriate layers of
informed consent, data security
&confidentiality and applied to 10
institutional ethics committees across
the country. Currently, approvals have
been obtained for the prospective
studies which are underway for further
validation and calibration. Similarly,
premier healthcare institutions outside
India in USA, Europe and Canada
are being brought in to make an
international data consortium to take
the cardiac AI risk score, for global
population with multi-ethnic and cross-
geographic boundaries. Technically,
the opportunity remains to comply
MEDICAL SCIENCES
• It provided an immediate and handy
guideline for the next course of
action for the patients with high risk
to seek next level of intervention
• It standardised the process of the
investigations and referral thereby
Figure 3

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MEDICAL SCIENCES

with national and international
data privacy laws and integrate the
API with translatable interoperable
EMR / EHR systems.
In the context of rolling this out
to clinicians during the roadshows,
the team adopted three fundamental
principles:
1. Algorithm + Clinician: AI
algorithms are not replacements
for clinicians, but rather are
complementary to clinician
decision–making
2. Risk Identification and
Prevention: – This tool does not
diagnose coronary artery disease;it
provides a risk computation for
mitigation and prevention only.
3. For Outpatient and Health
Check Clinics: The tool has been
prepared for use at preventive
cardiology screening programmes at
the outpatient clinics and for health
check clinics.
The roadshows in August 2018
and January 2019 covered 600
Physicians and 100 cardiologists at
eight Apollo locations.
Conclusion
Beginning with an unmet need to
standardise a cardiovascular risk
score for Indian population, this
endeavour looks forward to involve
healthcare institutions, public and
private health services, corporate
wellness programmes, e–Health
portals etc., across geographies and
multiple ethnicities to use the risk
score API. The personalised output
and recommendations of the risk
score algorithm will benefit both the
physicians and the people to prevent
cardiovascular events in the long-run.
AUTHORBIO
Sangita Reddy is the Joint Managing Director of the pioneering Apollo
Hospitals Group, a proponent of integrated healthcare delivery. In addition
to her operational responsibilities, Sangita led the group’s retail and primary
healthcare endeavours. Recently, in partnership with the National Skill
Development Corporation; she initiated a unique PPP purpose-designed to skill
half a million individuals before 2020.
An ardent champion advocating the benefits of a global delivery model through
rural hospitals, outreach camps and telemedicine, Sangita is continuously
engaged with the governments to deliver innovative health services harnessing
digital platforms.
MEDICAL SCIENCES

Although disease patterns change constantly, infectious diseases remain the
leading cause of mortality and morbidity in the developing countries; especially,
among under-5 children. In the current global context, it is important to
understand how international aid agencies and donors prioritise their funding
allocations for the prevention, control and treatment of infectious diseases.
Md Moshiur Rahman, Associate Professor, Graduate School of Biomedical and Health Sciences, Hiroshima University
Michiko Moriyama, Professor, Graduate School of Biomedical and Health Sciences, Hiroshima University
Mohammad Habibur Rahman Sarker, Graduate School of Biomedical and Health Sciences, Hiroshima University
Leading Infectious
Diseases among
Under-5 Children in
Developing Countries
MEDICAL SCIENCES
G
lobal child mortality has decreased
substantially since 2000 due to
vaccinations, adequate nutrition
and health education; however, mortality and
morbidity remain high among the developing
countries. Infectious diseases are the leading causes
of death worldwide, particularly in low-income
countries, caused by usually microscopic size
organisms, such as bacteria, viruses, fungi, or
parasites. In developing countries, top five
infectious diseases that are responsible for
under-5 mortality and morbidity are pneumonia,
diarrhoea, HIV/AIDS, malaria and tuberculosis.
Pneumonia
Pneumonia is the foremost cause of death from
infectious diseases in under-five year old children
worldwide. It accounts for 16 per cent of all deaths,
killing 920,136 children in 2015. Pneumonia is
caused by a number of infectious agents, including
viruses, bacteria and fungi; streptococcus
pneumoniae – the most common cause of bacterial

by trained community health workers;
hospitalisation is recommended only
for severe cases of pneumonia.
Preventing pneumonia in children is
an essential component of a strategy to
reduce child mortality. Immunisation
against Hib, pneumococcus, measles
and whooping cough (pertussis) is
the most effective way to prevent
pneumonia. Furthermore, adequate
nutrition, exclusive breastfeeding,
avoidance of indoor air pollution and
encouraging good hygiene in crowded
homes are useful measures.
Diarrhoea
Diarrhoea is the second leading cause
of death in children under five years
old, and is responsible for killing
around 525,000 children every year.
Considering the etiology, rotavirus
is the most common cause of acute
watery diarrhoea with about 39 per
cent of diarrhoea hospitalisations and
199,000 deaths each year, mostly in
children; unfortunately, 85 per cent of
them occur in low-income countries.
Next to rotavirus, enterotoxigenic
Escherichia coli (ETEC) is estimated
42,000 deaths of children under five
years of age in 2013. On the other
hand, Vibrio cholerae causes an
estimated 3–5 million cholera cases
and 100,000–120,000 deaths every
year with a higher incidence among
children. The other responsible
pathogens for diarrhoea are salmonella,
shigella, campylobacter, etc. Now,
other causes such as septic bacterial
infections are likely to account
for an increasing proportion of all
diarrhoea-associated deaths. Children
who are malnourished or have
impaired immunity and people living
with HIV are most at risk of life-
threatening diarrhoea. These diarrhoea-
related infections are mainly caused by
unclean drinking water, contaminated
food or person-to-person contact and
poor hygiene.
Diarrhoea is defined as the passage
of three or more loose or liquid stools
per day (or more frequent passage
than is normal for the individual).
Frequent passing of formed stools is
not diarrhoea, nor is the passing of
loose, ‘pasty’ stools by breastfed babies.
Diarrhoea is usually a symptom of an
infection in the intestinal tract, which
can be caused by a variety of bacterial,
viral and parasitic organisms.
There are three clinical types of
diarrhoea: acute watery diarrhoea –
lasts several hours or days, and includes
cholera; acute bloody diarrhoea –
also called dysentery; and persistent
diarrhoea – lasts 14 days or longer. The
most severe threat posed by diarrhoea
is dehydration. During a diarrhoeal
episode, water and electrolytes
(sodium, chloride, potassium and
bicarbonate) are lost through liquid
stools, vomit, sweat, urine, and
breathing. Dehydration occurs when
these losses are not replaced properly.
Treatment includes: rehydration
with Oral Rehydration Salts (ORS)
solution or with intravenous fluids
(severe dehydration or shock), zinc
supplements, nutrient-rich foods:
antibiotics for specific pathogens. Key
preventive measures include: access to
safe drinking-water; use of improved
sanitation; hand washing with soap;
exclusive breastfeeding for the first six
months of life; good personal and food
hygiene; health education about how
infections spread; and vaccination.
MEDICAL SCIENCES
pneumonia in children; Haemophilus
influenzae type b (Hib) – is the second
most common cause of bacterial
pneumonia; respiratory syncytial virus
is the most common viral cause of
pneumonia; in infants infected with
HIV, Pneumocystis jiroveciis one of the
most common causes, responsible for
at least one-quarter of all pneumonia
deaths in HIV-infected infants. The
viruses and bacteria that are commonly
found in a child's nose or throat, can
infect the lungs if they are inhaled. They
may also spread via air-borne droplets
from a cough or sneeze. In addition, it
may spread through blood, especially
during and shortly after birth.
Pneumonia occurs when the air
sacks in the lungs, the alveoli, are filled
with pus and/or fluid. This makes
breathing difficult, and does not allow
the infected person to intake enough
oxygen. The presenting features of
viral and bacterial pneumonia are
similar. However, the symptoms
of viral pneumonia may be more
numerous than bacterial pneumonia.
In children under 5 years of age, who
have cough and/or difficult breathing,
with or without fever, pneumonia is
diagnosed by the presence of either
fast breathing or lower chest wall in
drawing where their chest moves in or
retracts during inhalation. Wheezing is
more common in viral infections. Very
severely ill infants may be unable to
feed or drink and may also experience
unconsciousness, hypothermia and/or
convulsions.
The risk factors related to the host
and the environment in developing
countries include malnutrition, low
birth weight (≤ 2500 g), non-exclusive
breast feeding, lack of measles
immunisation, indoor air pollution,
crowding, etc. The antibiotic of choice
for treatment is amoxicillin dispersible
tablets. Most cases of them require oral
antibiotics, which are often prescribed
at a health centre. These cases can also be
diagnosed and treated with inexpensive
oral antibiotics at the community level
In developing countries,
top five infectious diseases
that are esponsible for
under-5 mortality and
morbidity are pneumonia,
diarrhoea, HIV/AIDS,
malaria and tuberculosis.

HIV/AIDS
Human Immunodeficiency Virus
(HIV) continues to be a major global
public health issue, having claimed
more than 35 million lives so far. About
940,000 people died from HIV-related
causes globally in 2017. Africa is the
most affected region, with 25.7 million
people living with HIV in 2017.
Although HIV and Acquired
Immune Deficiency Syndrome (AIDS)
originally emerged as adult health prob-
lems, they have become a major killer
of under-5-year-old children, especially
in developing countries. Children of
HIV-seropositive mothers can acquire
the virus directly through vertical trans-
mission; about 25–30 per cent of chil-
dren born to infected mothers become
infected with HIV and almost all of
them die before turning five. Thus, the
under-5 mortality rates among children
of HIV-infected mothers are two to five
times higher than those among children
of HIV-negative mothers. According to
the Joint United Nations Programme
on HIV and AIDS (UNAIDS) esti-
mates, about 14 million women of
child bearing age currently live with
HIV/AIDS in the world, giving birth
to children with an elevated risk of HIV
infection and death before the age of
5 years. Even among children who are
not infected, many will die because
the resources needed to ensure their
survival and health are used to care for
HIV-seropositive adults.
The symptoms of HIV vary
depending on the stage of infection.
The initial infection, individuals may
experience no symptoms or an influ-
enza-like illness including fever, head-
ache, rash, or sore throat. Afterwards,
patients develop other signs and symp-
toms, such as swollen lymph nodes,
weight loss, fever, diarrhoea and cough.
Further more, they also attract severe
illnesses such as tuberculosis, cryp-
tococcal meningitis, severe bacterial
infections and cancers such as lympho-
mas, etc. HIV can be transmitted via
blood, breast milk, semen and vaginal
secretions. Individuals cannot become
infected through ordinary day-to-day
MEDICAL SCIENCES
Tuberculosis (TB) is caused by a type of bacterium called Mycobacterium tuberculosis.
It's spread when a person with active pulmonary TB, coughs or sneezes and someone
else inhales the expelled droplets, which contain TB bacteria. In 2017, about 10 million
people were infected, and 1.6 million died (including 0.3 million among people with
HIV). Among them, an estimated 1 million children became ill with TB, and 230,000
children died of TB (including children with HIV associated TB).
Children can equally be affected by resistant strains of Mycobacterium tuberculosis,
with an estimated 25,000 children developing multidrug-resistant (MDR) tuberculosis
and 1,200 developing extensively drug-resistant (XDR) tuberculosis in 2014 alone.
Peadiatric tuberculosis requires specific considerations in clinical, public health, and
research aspects. Signs and symptoms of active TB include: coughing that lasts two
or more weeks, coughing up blood, chest pain, or pain with breathing or coughing,
unintentional weight loss, low grade fever, etc.
Treatment for TB usually involves taking antibiotics combination for several months.
The usual treatment is two antibiotics (isoniazid and rifampicin) for six months and two
additional antibiotics (pyrazinamide and ethambutol) for the first two months of the
six-month treatment period. Preventive measures include: Bacillus Calmette-Guerin
(or BCG) vaccine, early diagnosis and prompt effective treatment of infectious cases,
good infection control, Isoniazid preventive therapy, and Antiretroviral Therapy (ART)
for people with HIV.
contact such as kissing, hugging, shak-
ing hands, or sharing personal objects,
food or water.
Childhood risks of contracting
HIV include: sharing contaminated
needles, syringes and other injecting
equipment and drug solutions when
injecting drugs; receiving unsafe injec-
tions, blood transfusions, tissue trans-
plantation, medical procedures that
involve unsterile cutting or piercing;
and experiencing accidental needle
stick injuries. HIV infection is often
identified through Rapid Diagnostic
Tests (RDTs), which detect the presence
or absence of HIV antibodies. Most
often, these tests provide same-day test
results, which are essential for same-day
diagnosis and early treatment and care.
HIV can be suppressed by the combina-
tion of Antiretroviral Therapy1
(ART)
consisting of 3 or more AntiretroViral
1 https://www.google.com/url?sa=t&rct=j&q=&esrc=s&s
ource=web&cd=3&ved=2ahUKEwj04uWL8sXhAhWEf
d4KHVWTCTQQFjACegQIAxAB&url=http%253A%
252F%252Fwww.aidsinfonet.org%252Ffact_sheets%2
52Fview%252F403&usg=AOvVaw0BrC9O7iDnxpX4
MLWlT7r6
TUBERCULOSIS

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dose of information and knowledge – filled with
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best brains in hospital and healthcare industry,
the magazine offers timely business insights and
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Malaria, an ancient threat to human
health, remains a primary cause of
morbidity and mortality globally. The
2016 World Malaria Report indicated
that 212 million cases and 429,000
deaths were recorded in 2015.
Two-third of these deaths occurred
among under-5 year old children in
developing countries mainly in Africa.
The World malaria report 2018 summa-
rises global progress in the fight
against malaria up to the end of 2017.
The report reinforces the message
from the previous year's report that
the world is off track to achieve two
critical targets of the reducing malaria
deaths and disease by at least 40 per
cent by 2020, although there has been
a substantial reduction in the burden
of malaria since 2010. In 2017, there
were an estimated 219 million malaria
cases globally, compared with 214
million cases in 2015 and 239 million
cases in 2010. The reduced or reversed
progress in countries with the high-
est malaria burden is one of the main
contributors to the stalling of the global
progress. For example, in Africa, there
were an estimated additional 3.5 million
malaria cases in 2017 compared
with 2016. In comparing the trends in
cases and deaths, it is important to
understand that mortality is estimated
through a process that first quantifies
all-cause mortality in children aged
under-5 years. Overall this approach,
results in malaria mortality trends that
follow those of children aged under 5
years, and is often insensitive to year
on year change in malaria case burden.
Malaria is caused by the Plasmodium
parasite and spread to humans through
the bites of infected mosquitoes. There
are many different types of Plasmodium
parasite, but only 5 cause malaria
in humans; Plasmodium falciparum
(mainly found in Africa), Plasmodium
vivax (Asia and South America),
Plasmodium ovale (West Africa),
Plasmodium malariae (Africa) and
Plasmodium knowlesi (very rare, south-
east Asia). Most often, patients present
with non-specific symptoms, such as
fever, rigors, and chills. Severe malaria
develops mainly among children and
may manifest as extreme weakness,
impaired consciousness, severe
anaemia, respiratory distress, convul-
sions, and hypoglycaemia, among
other symptoms. The occurrence of
long-term neurological sequelae from
severe malaria, subtle developmental
and cognitive impairments as a result
of both severe and uncomplicated
episodes have been reported in chil-
dren. Moreover, anaemia is one of the
complications that accompany malaria
infections, and it plays a significant
role in its morbidity and mortality.
Malaria is a preventable and treat-
able disease. The primary objective of
treatment is to ensure complete cure,
that is the rapid and full elimination
of the Plasmodium parasite from the
patient’s blood, in order to prevent
progression of uncomplicated malaria
to severe disease or death, and to
prevent chronic infection that leads
to malaria-related anaemia. From a
public health perspective, the goal of
treatment is to reduce transmission of
the infection to others, by reducing the
infectious reservoir, and to prevent the
emergence and spread of resistance to
antimalarial medicines.
MALARIA
AUTHORBIO
Mohammad Habibur Rahman Sarker is a doctoral student at the
Graduate School of Biomedical and Health Sciences in Hiroshima
University. He completed his Master (MPH) and Bachelor (MD)
degrees from Bangladesh. He is also working at International
Centre for Diarrhoeal Disease Research, Bangladesh (icddr,b) as
a researcher and clinical trainer. His major field of interests are
epidemiology, infectious diseases, childhood malnutrition, chronic
diseases, etc.
Md Moshiur Rahman is an Associate Professor of International
Health and Medical Care, Hiroshima University, Japan. He has
outstanding academic credentials combined with experiences
in public health, population and health science, research,
administration, and leadership. He has more than 15-year
experiences in health-related programs and researches in
Bangladesh, Africa, and Japan.
Michiko Moriyama is a Professor of Division of Nursing Science
under the Graduate School of Biomedical and Health Sciences
in Hiroshima University, Japan. She has been involved in various
types of research activities such as Chronic Care and Disease
Management, Family Nursing, and Population Sciences. She has
multidisciplinary collaboration in different countries for sustainable
development.
(ARV) drugs. Antiretroviral drug
also uses for prevention and elimina-
tion of mother-to-child transmission
of HIV.
Infectious diseases in developing
countries can hold people into
poverty and have devastating
consequences for the population's
health and development. As many of
theinfectiousdiseasesarepreventable,
each country in the developing
world needs to construct evidence-
based strategies and lead effective
interventions for the management of
childhood infectious diseases.
References are available at
www.asianhhm.com
MEDICAL SCIENCES

DIGITALISATION
OFHEALTHCARE
2
1
3
4
Digital is Set to Change Healthcare Massively
Here is how
Commercialisation of
Digital Health
The Seven Obstacles
Success Factors for Digital Transformation
in International Health Tourism & Global Health
Delivering Healthcare Innovation
in a Heartbeat
CoverStory
IT Special

Today, ‘Value’, ‘Patient Outcomes’ and ‘Quality’
are key watchwords for the healthcare sector. The
stakeholders of healthcare are on a continuous
drive to discover innovative and cost-effective
ways to make this environment more patient-
centric, secure and efficient. Here is how digital
is transforming the dynamic health economy.
Sanjay Das, Founder and Managing Director, SD Global
DIGITAL
IS SET TO
CHANGE
HEALTHCARE
MASSIVELY
Here is how
INFORMATION TECHNOLOGY
V
alue’, ‘patient outcomes’ and
‘quality’ are key watchwords
for the healthcare sector
today. Stakeholders of this ecosystem
are on a continuous drive to discover
innovative and cost-effective ways to
make this environment more patient-
centric, secure and efficient. The
stakeholders of healthcare are being
pushed to identify ways to move from

move into an age that is decentralised,
democratised and smart, helping both
patients and healthcare professionals.
Some of the obvious advantages of
leveraging digital technologies can be
summed up as follows:
• Smooth, seamless and transparent
communication between doctors
and patients that eliminates tradi-
tional hierarchies (attendants, assis-
tants, etc.)
• Bandwidth to respond to policy
changes and complex regulations
• Proactive health management
• Increased system efficiencies by reor-
ganising how services are organised
and delivered
• Improved clinical effectiveness and
greater bandwidth to focus on popu-
lation health management
• Shift from the traditional ‘break-fix’
model of health care to preventive
healthcare
• Greater healthcare access that defeats
geographical tyranny and improves
rural and remote community access
• Improved coordination of care
between multiple teams and stake-
holders by providing the caregivers
with up-to-date information
• Timely,accurateandbetter-informed
diagnostic based on data that leads
to positive patient outcomes
• Better management of chronic
conditions and improved life expec-
tancy.
So, what are the key technologies
that are making the healthcare sector
fitter?
Wearables and IoT
Wearables and the Internet of Things
(IoT) are two technologies that promise
to solve many healthcare challenges.
• Wearable devices can proactively
track patient health and provide
timely alarms based on defined
triggers
• The IoT ecosystem helps in providing
the entire patient experience by
enabling seamless communication
between devices and sensors
CoverStory
IT Special
‘volume’ to ‘value’, engage with patients
and improve experiences, increase
access, and improve care. Creating a
positive margin, improving financial
performance and operating margins
become other areas of concern in a
changing and dynamic health economy.
We are moving into a world where
information abounds, and patients
are no longer passive receivers of care.
Driven by their experiences in other
industries, the consumers of healthcare,
i.e. the patients, want similar, if not
better, healthcare experiences.
The Benefits of Digital Technologies
in Healthcare
The good news here is that technology
and the innovations arising from the use
of technology are helping the industry

We are moving
into a world
where information
abounds, and
patients are no
longer passive
receivers of care.
• The location-based-real-time services
provided by IoT also increases
patient safety and helps in making
the patient experience smarter in the
hospital environment
• Wireless parking sensors can make
the parking experience more patient-
friendly
• Smart registration systems help in
simplifying the patient registration
process, enable self-service and
ensure that all key patient-related
information is present in one place.
• RFID sensors can help in increasing
patient safety. These sensors also help
in smarter asset management
• We are also witnessing the rise of
Neurotechnology or Brain Sensors
that help in monitoring brain activity
• Along with this, IoT and wearables
also enable smart building technology
to ensure that the entire hospital
ecosystem functions optimally,
reduces waste and improves
environmental performance.
Augmented Reality and Virtual
Reality
Augmented Reality (AR) and Virtual
Reality (VR) are two technologies that
have moved out of the gaming sector
and are providing serious value to
healthcare.
• These technologies can give the
operating rooms the extra edge
by giving surgeons high-level
visualisation capabilities, enhancing
3D mapping, lowering risks and
improving outcomes
• AR and VR add intelligence to
departments such as radiology and
give the doctors the capability to
view a patients’ anatomy in a three-
dimensional image
• These technologies can also be
implemented to study how tumours
evolve, change the size and compare
in their overall size, shapes, and
margins
• Virtual simulations can be effectively
employed to improve learning
outcomes and improve patient
experience. Interactive technologies
such as these are being employed
to provide clear visualisations to
patients to help them understand
their health conditions
• 360-degree interactive guides and
games are being employed to help in
pain management and also manage
phantom-limb syndrome.
Artificial Intelligence
The applications of Artificial
Intelligence (AI) are expected to go
beyond treatment and touch everything
starting from service delivery to supply-
chain management.
• With AI, doctors get the bandwidth
to tap into data orders of great
magnitude in less time thereby
positively impacting diagnosis and
treatment decision-making
• AI-powered chatbots, virtual
assistants and robotics are ushering
in the new age of patient experience
making patient care safer and easier
• These technologies also ensure that
caregivers spend more time providing
care and less time in documentation
• AI algorithms help hospitals identify
ways to best manage expensive
constrained resources, decrease wait
times, improve patient access and
reduce the healthcare delivery costs
• AI is also poised to give Genomics a
huge push that could vastly improve
patient outcomes for a myriad of
diseases.
Big Data
Data is the new oil in healthcare as well.
• Big data analysis is helping the entire
hospital environment become more
efficient by identifying resource
challenges
• It is ushering in the age of preventive
medicine by helping doctors
identify risk factors faster and more
comprehensively
• Population health data is being
leveraged to predict health care
trends for different cultures and
communities
• From advanced patient care,
improved operational efficiency and
giving healthcare providers stronger
capabilities to discover unknown
correlations, hidden patterns, and
insights, Big Data is changing the
entire healthcare delivery model and
making it more proactive.
Cloud and Mobility
Mobility and cloud have made
healthcare more accessible. These
two technologies are responsible for
enabling telemedicine and ensuring that

AUTHORBIO
Sanjay has spent over two decades in the IT industry in Malaysia.
He is passionate about how IT can transform the healthcare industry.
Under Sanjay’s able leadership, SD Global has established itself as
a leader in Smart Hospital solutions in ASEAN countries - it has the
breadth of vision, depth of technology understanding and ready
frameworks to make the smart hospitals journey a guaranteed
success for healthcare institutes. Sanjay is the winner of various
awards including 100 Most Influential Young Entrepreneurs in
Malaysia, Emerging Youth Entrepreneur Excellence award given
by the ASEAN India Business Summit, and Perdana Young Indian
Entrepreneur Award.
patients even in the remotest of areas
can receive high-quality care. These
two transformative technologies have
also ensured greater democratisation of
patient health data. Owing to the cloud
and mobile, patients and caregivers
can access comprehensive health
records anywhere, anytime. These
technologies also play a key role in
improving patient experience by giving
the doctors capabilities to improve care
coordination, enhance respond rates,
amplify data access and communication
and reduce health care complexity.
Digital technologies have made
a profound impact on a myriad of
industries. The healthcare sector,
though technology-driven, has until
now been able to resist the charm
of digital technologies. However, as
digital becomes more mainstream and
healthcare organisations battle several
challenges, the transformative benefits
of the technologies at play become
hard to ignore. These technologies are
now helping us deliver the hospital
of tomorrow, the Smart Hospital –
one where technology and human
interactions co-exist to redefine
care delivery, improve operational
efficiencies, reduce waste, and promote
well -being, both of the patients and the
hospital staff.
CoverStory
IT Special

Digital Health refers to innovative initiatives that leverage
digital technology to achieve a desired outcome in the
healthcare industry. Currently, there is a mainstream
shift of investment from maturing technologies such
as telehealth and mHealth to new fields such as AI
and VR. The process of commercialising digital health
should begin from identifying the end objectives.
Yoshihiro Suwa, Partner, Roland Berger
M
any market research reports
estimate the global digital
health market in 2018 to
be worth around US$200 to US$300
billion. Supposing these estimates are
correct, the size of digital health market
was between 20 per cent to 40 per cent
of the size of the global pharmaceutical
market (US$800 billion) in that same
year. Yet, one would be hard-pressed
to readily name a business that best
represents this enormous market. Has
the digital health industry produced a
world-class business in the same vein as
Pfizer or Novartis? Or is digital health a
house of cards?
Red-hot digital technologies such
as telehealth, mHealth, AI, VR, the
blockchain are strong candidates
with the potential to bring further
innovation to the healthcare industry.
Indeed, countless long-standing
players are going through gradual
process of trial and error in their bid to
identify and define the roles that these
technologies will serve in the market.
The commercialisation of digital health
technology should begin from each
company defining a desired outcome
that it wants to achieve, followed by a
consideration of how and which digital
technologies to best leverage.
Digital Therapies
In 2017, the US Food & Drugs
Administration (FDA) gave its
approval for the first Prescription
Digital Therapeutic toreSETdigital
therapy, developed by Pear
Therapeutics as a single treatment for
dependency on alcohol, narcotics,
cocaine, and stimulant drugs. Aimed at
treating addiction, reSET encourages
modification to a patient’s behaviour
through communication with the
patient via an app. As a follow-up to
reSET, Pear Therapeutics has applied
for, and is awaiting approval on,
reSET-O, a combined therapy for
opioid dependence. Furthermore,
clinical trials are underway on other
digital therapies such as Virta Health’s
treatment aimed at diabetes patients
and Propeller Health’s treatment for
asthma and Chronic Obstructive
Pulmonary Diseases (COPD) patients.
Commercialisation
of Digital Health

Digitalisation Of Healthcare - Towards A Better Future - Free Download E book

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