WHITE paper

www.hcltech.com

Digital Healthcare for Rural India

TABLE OF CONTENTSAbstract

Abbreviations

Market Trends and Challenges

Solution

Solution Representation

Access Channels to Digital Healthcare

Automated Diagnosis/Treatment Plan/Prescriptions

Actionable Insights

Monetization

Case Study

Client / Access Channels Tier

Presentation Tier

Analytical Engine Tier

DB and KB Tier

Potential Adoption rate in TamilNadu

Common Issues

Lack of Contextual Insight / Emotional Intelligence

Word sense disambiguation

How to reach Rural India ?

How to sustain, continuously evolving Digital Healthcare ?

Best Practices

Electronic Health Record instead of Physical records

Success of m-Pesa in Rural Africa

Conclusion

Reference

Author Info

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This white paper explains how a quality health care infrastructure can be built for Rural India with the help of Digital technology. This “Digital” HealthCare would be a Low Cost - High Reach service. The main objective of this Digital HealthCare Service is to • Perform automated diagnosis and provide personalized treatment plan/ prescriptions for the patients with the help of Cognitive Computing & Natural Language Processing.• Provide both Preventive and Curative care• Deduce Actionable insights for Government, NGOs, HealthCare Providers and Insurance Companies• Ensure high adoption rate ,by overcoming the challenge of poor internet access in the Rural

Lack of Quality Healthcare infrastructure in Rural India resulting in• People dying due to preventable / curable diseases like diarrhea, measles and typhoid.• Government not able to quickly control epidemic outbreaks• Traveling more than 30 kms to seek healthcare in rural India by almost 31% of the population The key problem is lack of adequate health care providers in rural, as the cost of setting health care infrastruc ture is quite huge. In such a situation, introducing “Digital” instead of “Physical” Health Centers, would certainly ensure quality Healthcare, also at a lower cost. However, Digitizing Rural India is a humongous challenge considering poor literacy rate, week internet penetration, and meagre Teledensity.

Abstract

Primary Health CenterPHC

NGO

USSD

NPL

CDSS

UIMA

IVR

CHC

1

Sl. No. Acronyms Full form

2

3

4

5

6

7

8

Non - Government Organization

Unstructured Supplementary Service Data

Natural Language ProcessingClinical Decision Support Systems

Unstructured Information Management Architecture

Interactive Voice Response

Community Health Center

Market Trends and Challenges

Abbreviations

Patients

Mobile,wearable tech,IVR, TeleMedia

PHC/NGO at rural

Analyticalengine Goverment

Care Provider

Insurance

Paramedic

SOLUTION Digital healthcare ecosystem comprises of• Analytical engine, a cloud based System with the ability to understand Natural Language, process unstructured data, provide automated Diagnosis and Treatment Plans/Prescriptions and also learn dynamically.• Access Channels to enable Digital Healthcare such as Mobile apps (Smart Apps, USSD/SMS Apps), IVR, Telemedia [Telemedicine] , Wearable technology gadgets• Rural/Urban residents, Care Providers, Government, PHC/NGO and Insurance Companies

Solution Representation

1. Patients having access to any of the Access channels like Mobile/IVR/Telemedia/Wearable gadgets would be able to record their Disease Symptoms or Health Metrics on their own

2. Patients who do not have access to any devices can leverage help from nearest PHC / NGO

3. PHC/ NGO in turn would record the disease symptoms/ health metrics of the patients via the available Access Channels.4. Access Channels would send the feeds to Analytical engine

5. Analytical engine would performs the automated diagnosis and provide treatment plan & prescriptions to patients leveraging data mining of vast amount of historic data

6. For high-risk patients who need immediate attention, Analytical Engine would send the alert to Care Provider (nearest Nursing Homes /Hospitals).

7. Care Provider with the help of paramedics’ workforce, attends the high -risk patients directly.

8. On regular basis, Analytical Engine updates the Government with valuable actionable insights

9. Insurance companies having access to Analytical Engine, can effectively connect clinical data with claims data or even arrive at personalized premiums.

Access Channels to Digital Healthcare

Wearable Gadgets

Smart Phone

USSD/SMS

IVR / Telemedia

Below are various access channels to Digital HealthCare. Patients with Wearable Gadgets can avail the preventive care, while others mostly can avail only Curative care.

Smart Watch / Smart Clothing/ Smart Glasses etc. which has the ability to periodically collect the health metrics (such as heart beat rate, blood pressure, blood sugar level etc.,) and can communicate with Analytical Engine via Internet.

Mobile apps (in Smart Phones) which has the ability to take inputs on disease Symptoms/health metrics from patients and can communicate with Analytical Engine via Internet

USSD Apps / SMS short codes with which patients can input disease Symptoms/health metrics.USSD/SMS communicates with Analytical Engine via GSM network via Mobile Aggregators. Internet is not required at the subscriber mobile.

Patients can invoke IVR or call TeleMedia services and record their disease symptoms over phone orally.This oral communication would be automatically fed in to Natural Language Processor and then subsequently converted in to Structured Data. Based on which, Diagnosis would be conducted and Treatment Plan/ Prescription would be arrived & communicated back orally, leveraging Text to Speech conversion technology. This would help Patients to communicate their diseases and also receive the Treatment, in their native languag-es. This would result in faster adoption of Digital Healthcare.

Patients with no access to devices or are illiterate, can get help from PHC/NGO to feed the inputs to Analytical Engine. (PHC/NGO assumed to have the availability of any of the Access Channels)

Diagnosis would be based on automated interactive queries. For patients with wearable gadgets, Diagnosis could be performed with continuous feeds of health monitor statistics, originating from the gadget.Personalized Treatment plan/Prescriptions would be derived with the help of either • Data mining from earlier occurrences of similar symptoms/diseases (or) • Pre- derived Treatment plan / vaccination schedule, as recommended by care givers.Also, Treatment plans adhere to treatment guidelines such as avoiding known drug conflicts, dispensing the right medication to the right patients etc.

Based on Comprehensive analytics and reporting, actionable insights are derived for various parties. • Alerts the care provider about the high risk patient who requires immediate attention • When an outbreak occurs in a region, Analytical Engine would receive more requests with similar patterns. Based on which it can alert the Government about the Outbreak of Epidemics. • Insurance providers leveraging the Analytics data can provide tailored plan/premium for the Consumers.

Metering / Billing can be done for every actionable data provided by Analytical Engine. This way significant monetization can be realized from Digital Health Care System.

Case study explains the proposed tiers involved in the architecture and the implementation details of key components. It also discusses the potential adoption rate of Digital Health Care in TamilNadu based on various facts.

Wearable Gadgets, USSD/SMS/Smart Apps, IVR & Telemedia are all within the scope this Tier. The system would leverage on Android Wear Operating System for programming wearable gadgets.

PHC / NGO

ACTIONABLE INSIGHTS

MONETIZATION

CAse Study

CLIENT / ACCESS CHANNELS TIER

AUTOMATED DIAGNOSIS / TREATMENT PLAN / PRESCRIPTIONS

PRESENTAYION TIER

This is Auxiliary tier to the Analytical engine. Primarily it has Rest API Interfaces which are accessible by any of the Access Channels. This tier also does the “Natural Language processing” & “machine learning” for effective communication.

Oral

Written

To Analytical EngineSpeechSynthesizer

(eSpeak - openSource)

Smart AppScreen / USSD

Menu / SMS

Natural LanguageProcessing

(Apache openNLP)

Natural Language Processing

Patients can communicate their disease symptoms either orally (via Telemedia) or written (via USS-D/SMS/Smart Apps).Apache openNLP (Open Source) would be used for Natural Language Processing (Both Understanding and as well Generation). Also would be leveraging upon eSpeak (Open Source) for speech Synthesizer.

ANALYTICAL ENGINE TIER

Performs the thinking & decision making while performing Diagnosis/Treatment. Based entirely on Cognitive Computing, Machine Learning Algorithms. Analytical Engine has the ability to take unstructured data(from Telemedia via NLP) as input and convert the same to structured data and store in Database and Knowledgebase for easy retrieval.(Of course input can be semi-structured data as well, in the case of IVR/USSD/SMS/Mobile app/Wearable Gadgets).Design leverages upon UIMA.

UIMA Architechture

Data

(Video/Gmail/

Audio,Chat)

PayloadConsumer

PayloadConsumer

PayloadConsumer

Reader

Process Engine

Annotoar

Process Engine

Annotoar

Process Engine

Annotoar

Payload Payload KnowledgeBase

DataBase

DB and KB Tir

1. The Reader reads the Unstructured /Semi Structured Data

2. Converts the same into Payload. [Standard Container for information]

3. Payload fed in to Analytical Engine

4. Analytical Engine is comprised of one or more Processing Engines.

5. Each Processing Engine is comprised of one or more Annotators.

6. Each Annotator has a specific context and will accordingly analyze the text and fill the Payload with informa tion it has found relevant to its context.

7. After passing through all the Processing engines, structured data is achieved at the end.

8. Database stores the structured data in relational format

9. Knowledge Base is usually computed regularly from Database. (This helps achieve machine learning capabili ty of the system).

10. Finally, Diagnosis and Subsequent treatment plans/prescriptions are arrived based on data mining the Knowledge Base

Category

Population (as per census 2011)

Literacy Rate%

Rural Population%

Urban Population%

Rural Literacy Rate

Urban Literacy Rate

WireLine Teledensity

WireLine Teledensity

WireLess Teledensity

WireLess Teledensit

Total inhabited villages in India

connected via Village Public Telephones

Statistics

7,21,38,958

80%

51.55

48.45

73.8

87.24

1.71

5.92

72.31

132.24

99.19%

Sub-Center

PHC

CHC

7057

1173

293

Shortfall 1626

Shortfall 79

Surplus

2.08 KM

5.47 KM

10.05 KM

Toatal Numbers Shortfall / Surplus by Total RadialCoverage

• Mobile Teledensity (How many mobiles per 100 people?) in Rural Tamil Nadu is quite high 72.31. This indicates potentially high adoption of Mobile Access Channels to Digital health Care.

• Rural population without Mobile can also be accommodated in Digital Health Care System, via Wireline Telephones, Public Telephones and government facilities like Sub-Center/PHC/CHC or even NGO . This will ensure delivery of quality healthcare to rural areas even with basic infrastructure.

The Analytical Engine, lacks contextual insight/emotional intelligence and it cannot replace humans immediately. Hence initially it can be employed as Clinical Decision Support Systems and gradually over time it will accumulate the knowledge through its machine learning capability.

Lack of Contextual Insight / Emotional Intelligence

There is a challenge in extracting meaningful data from unstructured text. Oral communication from Patients (or) Clinical notes from PHC/NGO can often contain terms or phrases that have more than one meaning. For example, “cold” can refer to either disease or climate. The capability (with the help of advanced algorithms) to rightly infer the intended meaning of words based on the context is very critical for the success of Cognitive computing

Word sense disambiguation

COMMON ISSUES

Potential Adoption rate in TamilNadu

Electronic Health Record (EHR) for every patient helps in realizing streamlined/personalized healthcare, as it encapsulates medical/treatment history, lab results, etc. This is must in any Digital Healthcare Solution.

In the Indian market scenario, where the penetration of smart phones is relatively low and use of internet on mobile is primarily limited to key cities, many users are excluded from accessing the Digital healthcare via smart phones. The need for an omnipresent access mechanism is a growing necessity. We expect USSD/SMS based apps to help reach majority of the rural users, as GSM telephony is available widely in rural India. [“Currently there are over 300.63 million Rural subscribers for GSM telephony”] With the Natural Language processing, we can further expand the reach of Digital Healthcare (via IVR and Telemedia access channels.)

In future, we believe internet should reach deep in rural India, so that rural can tap the fullest potential of Digital Healthcare. For instance, Wearable technology for the rural India will be needed in future, where chronic diseases are quite prevalent and that remote monitoring & tracking is essential. “Google’s Project Loon, Microsoft’s White Spaces and Facebook’s Internet.org are working on providing free internet for all across the world. This would surely benefit Digital Healthcare to spread rapidly across Rural”

m-Pesa (M for mobile, pesa is Swahili for money) is a mobile phone- USSD based money transfer and micro financing service, launched by Vodafone for Safaricom and Vodacom, the mobile network operators in Kenya and Tanzania. M-Pesa operates on GSM network without the need of internet. “Over 17 million active users reap benefit from this service in Kenya and another 5 million in Tanzania”This success of USSD can be analyzed and applied for Digital healthcare initiatives as well.

The world will be short of 12.9 million health-care workers by 2035; today, that figure stands at 7.2 million. A WHO report released warning that the findings – if not addressed now – will have serious implications for the health of billions of people across all regions of the world. India would be the most impacted due to its humongous population. Healthcare organizations & Government need to plan for the future where they can leverage these new technologies and services to optimize their care services delivery in the safest, highest-quality and most cost-effective ways possible.

Best Practices

ELECTRONIC HEALTH RECORD INSTEAD OF PHYSICAL RECORDS

How to reach Rural India?

How to sustain, continuously evolving Digital Healthcare?

SUCCESS OF M-PESA IN RURAL AFRICA

CONCLUSION

REFERENCE[1] http://articles.economictimes.india-times.com/2013-07-22/news/40727949_1_rural-areas-providers-healthcare-informatics[2]https://www.ibm.com/developerworks/community/blogs/Inside-SystemStorage/entry/ibm_watson_how_to_build_your_own_wa tson_jr_in_your_basement7?lang=en[3] http://www.who.int/mediacentre/news/releases/2013/health-workforce-shortage/en/[4] http://www.research.ibm.com/cognitive-computing/#fbid=bufjU1dLTzM[5] http://www.information-age.com/it-management/strategy-and-inn-ovation/123458811/intelligent-enterprise-how-businesses-will-use-cognitive-computing-2015[6] http://www.healthit.gov/providers-professionals/faqs/what-electronic-health-record-ehr[7] http://www.ibm.com/developerworks/library/os-ind-watson/[8] http://censusindia.gov.in/2011-prov-results/paper2/data_-files/tamilnadu/Tamil%20Nadu_PPT2_Volume1_2011.pdf[9] http://www.trai.gov.in/WriteReadData/PIRReport/Documents/Indicator%20Reports%20-%20Mar-14.pdf[10]http://en.wikipedia.org/wiki/M-Pesa[11]http://www.informationweek.in/informationweek/-case-study/298608/indian-hospital-mobility-improve-healthcare-rural[12]http://en.wikipedia.org/wiki/Watson_%28computer%29

A digital healthcare solution equipped with automated diagnosis/treatment plan is the need of the hour to attain Healthy Rural India at a lower cost.

BALAMURUGAN SELVARAJUHCL Engineering and R&D Services

TM

Hello there! I am an Ideapreneur. I believe that sustainable business outcomes are driven by relationships nurtured through values like trust, transparency and flexibility. I respect the contract, but believe in going beyond through collaboration, applied innovation and new generation partnership models that put your interest above everything else. Right now 110,000 Ideapreneurs are in a Relationship Beyond the Contract™ with 500 customers in 31 countries. How can I help you?

Author Info