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Healthcare Technology

Evolving Leadership in Healthcare: In discussion with Health Tech Leader Ravi Ramaswamy

Healthcare is at the cusp of change. To drive any change, we need an evolution in the way of thinking. This tone has to be set on the top hence we need a change in the thinking of the leaders.

In the first part of the series, I am talking to Health Tech leader Ravi Ramaswamy, CEO of RV Consultants. A veteran of the health tech industry, Ravi has lead global giants like GE Healthcare and Philips to market success. Here are the extracts from the conversation.

Dr Vikram Venkateswaran:  Dear Ravi, thank you for taking time out of your schedule, and talking to me on this very interesting series. So the first question is, you know because you’ve seen it all when you started healthcare was in a different state in the country. Now today we are talking about a lot of big things. Also, you always talk about how it’s an ecosystem play. We should not think in silos; can we work together today you’re trying to bring various parties together right that’s essentially what you’re trying to do. So why do you think that new, new thinking is required on leadership for healthcare today?

Ravi Ramaswamy: Thank you for inviting me and I think this is a very important question. I think we have to look at it from multiple aspects. There is a certain play, which the technology has brought in. There is a certain play, which the players have the providers of healthcare have brought it. There is a certain play which the consumers themselves have brought in, given the fact that the, the consumer centricity has gone quite a bit.

Let’s look at other industries, like telecom, mobile phone and the associated apps have brought in a very different social connect to what is actually happening. People like my mother at 85, she reaches out to her sister for comparing notes on medicines and doctor prescriptions. This is the creation of a healthcare ecosystem of referrals and sharing medical best practices amongst two individuals

So in that sense, what you’re trying to see is the type of a social Connect, which my mother does at 85. I didn’t see when she was maybe at 65, almost 20 years back. She never even wanted a mobile phone even when I offered to buy her one.

But now with the surrounding ecosystem has grown What is it is also putting the sort of pressure on her to try and see how do she be one with the surrounding. So that is one aspect.

So, the impact of a parallel development in another sector is trying to sort of push a certain amount of growth in the healthcare space itself.

Second one is the role of internet itself.

Almost 30 years ago my boss had asked me to check for the end suppliers to one of our suppliers for printer material. I remember going to the US embassy in Delhi and spending hours there looking through the books to see the name of the supplier for the printer material and finally found it. But today it is a click of a button.

So the power of networking the power of Internet has brought to for access to data in a very different form.

Now number three is the technology itself.

The technology is evolved considerably considering where we were to where we are today.

Take the manufacturing space SMT was being introduced, way back in the 1985. In fact, the first time when I saw in 1985 floppy drive in Japan, it was aha for me, because I had never seen that before. It was just about introduced and basically a three-and-a-half-inch drive storing one megabyte of data that was a big deal for us in those days.

But then if you look at what technology has done for us. It has sort of brought in a very different. There is so much of power that is being packed in fact, a simple mobile phone, that is almost as powerful as a supercomputer of what existed in the 80s. So that is the type of compute power that you bring in and along with that, the processing power has gone up, the algorithms are better and the decision support systems that are, that are driven, that has also gone up so technology has also played a substantial role in this evolution.

Number four is the commercial business innovation, people have started coming together they have felt the need that a siloed approach is not going to work. Because as data gains pre-eminence, you find that it is going at some point in time it is going to be device agnostic.

Ravi Ramaswamy , CEO RV Consultants, EX GE Healthcare, EX Philips

Dr Vikram Venkateswaran: Very interesting train of thought- Innovation in other industries, role of internet, technology and commercial business innovation are helping us build this ecosystem in India, but what about this last statement on being device agnostic, can you help me understand that as well?

Ravi Ramaswamy: The device is only going to give you the data the balance of the insights and the interpretation is done by the software piece, and the decision support systems which run well above the devices per se. We have seen significant growth in that space as well. If you look at the industry, healthcare has gone leaps and bounds in terms of its capability in diagnostics and getting into the realm of personalised medicine.

Earlier where they used to go the doctor would say, He will take an X ray of a liver or he will do an ultrasound of a lever, and he will look, do a, a CT of Oliver, but each of these were looked at as independent polarities today what the doctor says is, hey I want to look at it as a whole.

Therefore, give me a technology by which I’m able to fuse all this to reconstruct the liver in its true form, so that I can do a much better diagnosis, and he doesn’t stop there. He says, now what I want to do is to go to a tissue level. I want to go to a molecular level, and I want to go down to a genomic level, to see what is it,

The problem, that you’re trying to fix it at the root itself. So the depth to which medicine has gone is significant. Last but not the least, you find that the competition to the traditional healthcare companies like Siemens or GE or Philips is coming, not from the big guys alone, but also from the unconventional players like the Amazon and the Google and Microsoft, which in the earlier days was simply not there.

Microsoft was never into healthcare; neither was Google into healthcare neither was Amazon into healthcare. They were happy selling their own operating system, Amazon was happy with this bookstore. But, so basically what you see is there is a complete change in the environment. And that has resulted in a very different thinking that is needed in today’s world, which simply did not exist the past. In the past did not need it. today it just needed.

Another good example are the start-ups. Yesterday when he was talking to somebody saying that they are building an app store where medical applications are put on a Play Store. From where you download the application, use it for what you need and then pay it on an asset on a per use basis, without really owning the algorithm per se. So, the business model is also evolved and therefore you find that all the changes that we talked about, you find that the conventional old leadership will simply cannot work in today’s world, and therefore the new, therefore the need for a new world for the, for our leadership in the new world.

Dr Vikram Venkateswaran: There is interesting that you bring up Amazon because today they have invested in Apollo pharmacy, for example, and it is not a new thing for Amazon because they tried pharmacies in the past, during the 90s as well, and did not succeed but now they are back and we all know that Apple as well as Google as, as well as Microsoft is coming into the healthcare space primarily on the basis of data and technology. So, how do you think this new thinking will come in. Do you think it will come from a lot of relearning and learning from the traditional firms? Do you think it will come from the technology firms, or do you think this learning will come from our educational institutions where do you think this this new learning will come from?

Ravi Ramaswamy: Let’s look at the Med tech firms and in particular CT Scans.  Med Tech Firms always priced themselves saying, I am going to bring in a certain amount of capability within the device itself for diagnostics, you started with the 8 slice, then you went for a 16 slice CP then the 32, then a 64, then a 128 and the Toshiba came out the 256 Slice CT.

The same was the case in MRI you started off with the point to Tesla, then you had a one then you had a 1.5 Tesla, then somebody brought in a 3 Tesla and that people are also at some point in time we’re talking about 7 Tesla.

So, technology has also developed. Okay, but at some point in time, you ought to realise saying that it’s like a mobile, it’s like a mobile camera, whether you have anything more than a 10-megapixel camera whether it is 10 or 100, the image resolution that you’re going to see is the same. It doesn’t matter. Beyond that, what’s going to happen is, how am I going to take that 10 or that 100 megapixels and at that point 100 Megapexel can be a pain for you because of the data size that you need to transfer over the network without any added benefits for you.

Going back to the MRI for both applications or 1.5 Tesla is more than enough for you. You don’t require anything more than that. So, given that saturation has started to some point.

The stage is taking the data and interpreting meaningful insights out of it. And that is the job is predominantly done by the doctors. And so now if you have a doctor, who are able to look at this data, and then work with the Amazon and the Microsoft or the Google, who have phenomenal analytical capability in terms of driving analytics deep learning and what have you.

Then where is the need for the med tech companies then. So you will find that at some point in time technology, I can reduce exposure rate as then because the balance of it can be done by the software.

Take for example Phillips’s MRI. On a 3 Tesla machine. It takes about 40 minutes for a head scan for a brain scan. You do one thing you under us under sample that 20 minutes. And the balance of the image reconstruction which is done by the software. So what do you go and claim to the world I am able to do a scan in 20 minutes.

Okay, so the same story, can also be done by the Amazons and the Googles of the world, in conjunction with the clinical knowledge, which the hospital provides. And therefore, you will find that unless the med tech companies themselves don’t keep pace with this sort of AI, Data Science, ML and Deep Learning and what have you, you will find that they will be left behind by the Amazons and the Googles of the world, surely because of the intelligent, the analytical the analytics processing power, that these guys otherwise have.

Dr Vikram Venkateswaran: So the next wave of leadership, you’re saying will mostly either will be technology firms like Google and Amazon or, it also might be traditional healthcare firms trying to react to this new situation and bringing in some leadership in this area?

Ravi Ramaswamy: What I expect to see going forward is issues like interoperability that have always been a question.

Now we might see a situation where even the biggies collaborating between themselves. So then the data becomes portable, otherwise they have a challenge in hand. Okay, so there is going to be a collaboration of sort between the biggies, and it is in their interest that they come up with standardised protocols

And that is because again from the customer perspective, the hospital is still telling the manufacturer that I see guys. I don’t care whether you give me an MRI or a CT, you give me a solution for a care continuum. And the moment that happens, you would want to look for the best in class equipment across the segment.

For all you know it could be a Philips cath lab, it could be a MRI from Siemens and a CT from GE. And when you want to fuse all this. The provider is going to ask for a certain amount of interoperability between these devices otherwise you’re going to put pressure on you saying I don’t need your machine. So, the very fact that the world is now headed towards a solutions play rather than a modality play is also going to put sufficient pressure on the manufacturers from an interoperability perspective, and that once it happens, will also drive data integration data portability and what have you in the future. So, there is a big sequence of events that is being sort of lined up

Dr Vikram Venkateswaran: Now a kind of counter question. Do you see any role for educational institutions in this, even the medical institutions do you see any leadership coming out of them?

Ravi Ramaswamy: Whenever I go to these campuses or wherever I sort of speak to some of these, Vice Chancellors and others a lot of people have asked me saying what are the difference between an American ecosystem and an Indian ecosystem.

One thing for sure, is the amount of interaction that a Stanford has with it’s with the ecosystem of the industry, which includes the payer, the provider and the med tech companies, you don’t get to see that in India.

Number two, the educational institutions they follow a system, or an academic system of SOP, which is more based on creating papers. Whereas, the, the latest and greatest of what the industry needs are, is never thought. And that’s possibly the reason when a new graduate joins the industry, It takes about nine months for him to even get his hands and feet wet. So from that perspective, one piece of advice that I’ve been giving these institutions is keep tab on what the industry needs are and try and see how you can build your syllabus to address that need so that when the student leaves the college he hits the ground and starts running.

Take for example security, privacy. How many of the colonists teach that year, there is hardly any, you can count.

Take Intellectual Property (IP), for example, how many people. How many colleges have even a course on IP, or even bring in a certain representation as to what an IP is intellectual property is all about data even more serious quality and regulatory hyperreal medical industry is a hyper regulated industry.

When I talk about the CDC, and FDA people turn around and ask what’s the full form. Now, that that ought to be and therefore, there is a certain amount of leadership that the educational institutions have to deliver.

There was one incident I remember when I was talking about MRI and CT, one of the professors came to me and asked me the difference between them. Now the professor himself has not seen one. So what do you expect the professor to teach the students on. So there ought to be a certain amount of sabbatical for the professor to come in, spend time in the medtech world, so that he is able to understand what the industry is heading towards he gets to absorb that portion of it so that he can go and impart it to his students. I think you really need to change the education as well.

Dr Vikram Venkateswaran: Very fascinating and great insights, then one last question what does the future healthcare leader look like, like what are the attributes he or she should have?

Ravi Ramaswamy: I see the future leader of healthcare as an interdisciplinary person who is adept in technology, as much as much as commercial innovation. He ought to be sort of embracing the start-up ecosystem and not believe on the fact that everything needs to be done in house. So, it ought to be a lot more collaborative with the ecosystem. You need to understand. You need to understand the fact that the competition for you is not coming from the traditional players but from the sort of niche and focused technology companies, and therefore we adapt and hands on in terms of playing around with technology.

So the era of people managers in healthcare is over we would need but more like a techno functional leader who is able to sort of roll, roll up his sleeves and get into the depth of it, to understand what the hell is going on, and at the same time be savvy, be smart enough to understand that certain commercial innovations have to be baked into the design process itself as it is never going to hit the road. So you need to have a well-rounded personality, and it’s going to be. It’s going to be very different than the traditional people managers whom you have seen are just sort of one functional expert coming to the top, I think that won’t work anymore.

Dr. Vikram Venkateswaran: Dear Ravi Thank you for your time

Categories
Healthcare Technology

The Virtual Blockchain in Healthcare Summit

Blockchain in healthcare has been an area of immense interest to me. I believe that a system of records available real-time would solve a lot of the issues that we see in healthcare today. As part of my efforts to build consensus and understand how Blockchain can solve some of the issues in the healthcare ecosystem, I regularly connect with healthcare leaders through events, conferences, and forums. 

Virtual Blockchain in Healthcare Symposium #VBIHS2020 is poised to be a platform where people related to the healthcare industry can gain in-depth knowledge on how blockchain can leverage the healthcare industry in present & future pandemics. It also convenes the necessary resources to drive systemic transformation and unleash the full potential of blockchain in the healthcare industry.

I am anticipating meeting around 10-15 healthcare leaders as part of the event, interacting across 4 sessions and ability to talk to more than 20 solution providers and influencers. 

I am speaking on a panel on Healthcare ecosystem and how it can leverage Blockchain, but the other topics being discussed include 

–          Blockchain & Artificial intelligence,

–          E-Health & M-Health

–          Healthcare Data Exchange

–          Pharma Supply chain

–          Blockchain Applications

Below are some additional links for the event and I’m looking forward to meeting you all there.

Social Media Links,

Event Register Link: http://www.blockchaininhealthcare.net/register.php

Categories
Healthcare Technology

Blockchain in Healthcare

Healthcare today has been adopting new technology like never before. As a result of this we have many significant developments in recent days. Let’s take for instance the adoption of telemedicine by both patients and care providers alike during the Covid 19 pandemic. It is significant to note how quickly the ecosystem moved ahead and adopted the new standards and today we have multiple consultations on telemedicine.

Similarly, the development of the Covid19 vaccine has been possible partially due to the increased collaboration between the scientific community made possible by digital technologies.

Blockchain has become a game changer in the healthcare industry. It is a foundational technology with capabilities that go way beyond the traditional IT stack. With features like immutability, digital identity, encryption and real time updates, Blockchain has many of the features that would help the industry evolve to the next level. 

Last year Priyank Jani and I wrote a paper on Blockchain where we discussed how it could be implemented in the healthcare industry. Here is the link of the paper. 

But before we go forward let me quickly discuss what is Blockchain. 

Blockchain is a continuously growing list of records, called blocks, which are linked and secured using cryptography.  Each block contains, typically, a link to a previous block, a timestamp and transaction data. Transactions have to be approved by all users of the Blockchain to be stored and modifying an older block of data is impossible. Only updating of future records is permissible making the system secure (relatively speaking) and therefore reliable. This also means an entire Blockchain can serve as a secure ledger that records transactions, negating the need for multiple disparate trails of information.

We believe Indian healthcare has most to gain from the adoption of Blockchain technology. For starters, Blockchain allows all types of data to be integrated into the chain. This means one can add not just doctor prescriptions and treatment records but also nutrition information, fitness data, and recordings from medical devices (such as for blood pressure and diabetes patients) by patients themselves. Over time the presence of such longitudinal patient data means caregivers can better interpret disease symptoms and prescribe effective treatment that is customized to work for the patient. Currently, doctors rely on data from treating different patients to prescribe medication. The chances of success for such medication are about 50%. In many cases, doctors wait for feedback from patients to change the medication. With the availability of longitudinal patient data, doctors would know in advance what treatments are more likely to suit a patient in line with his/her health history.

If implemented over a large scale, Blockchain could help significantly lower healthcare costs in India. In addition, it can give multiple parties selective access to patient records ensuring data is not compromised. A survey report by IBM outlines the following healthcare areas benefiting from Blockchain: clinical trial records, patient health records, regulatory compliance, medical device data integration, treatment records, billing and claims, asset management (for hospital assets such as beds/ equipment available), and contract management (for hospitals).

I am really looking forward to the virtual Blockchain summit that is taking place on the 9h of December 2020. I plan to discuss with the various global leaders how Blockchain can be incorporated into the healthcare ecosystem. Do register if you are interested in discussing Blockchain and building a consensus in this area. The link for registration is here- Register | BlockChain in HealthCare

Categories
Public Health

Diabetes levels drop marginally in India as per Novo Nordisk Foundation Study

Diabetes is a cause for greatest concern in India. The reason for that is many fold. But the most prominent among them is that diabetes is the foundation on which many other diseases come into play. As you know, diabetes is a condition and not a disease, and usually starts with the body’s inability to maintain the insulin level in the blood. As you know, diabetes is a condition and not a disease and usually starts with the body’s inability to maintain the sugar levels in the blood.

This could be a result of genetic makeup or also from the pancreas inability to produce insulin. But the most common co factor is stress. In 2018 Novo Nordisk had launched a diabetes impact challenge, in which they wanted to maintain a diabetes index to measure the HPA one c levels in the body.

HbA1C measures the Association of the glucose molecule with the red blood cell. As a red blood cell has a life of 120 days. This measure gives us an average of the sugar levels in the body for 120 days, and it’s a much better, and reliable measure of the sugar levels as compared to fasting, and post prandial blood sugar levels that were used earlier. In its recent finding the Novo Nordisk Foundation which produces this result figured out that from October 2019 to September 2020. The HbA1C levels have marginally dropped in India. Currently they are at 8.48 per cent. They ideally should be below 6.

By, the average HbA1C once he level was recorded at 8.48% for the year from October 2019 to 20. But this collection happened over 30 Indian cities with a vast average respondent rate of 55 years, or which of the 57% were men and 43% were women. Again you can see the testing levels among women are less and this is another area of concern.

The Indian diabetes care index which was also launched in 2018, to improve the diabetes care in the country has been providing a real time view of the average HbA1C levels in India.

According to the Novo Nordisk foundation, there are more than 77 million diabetics in the country. And the country, the total spend on diabetes is around INR 64,000 crores.

The second issue that comes up is that with COVID-19, it is clearly proven that anybody with comorbidity or with underlying conditions like diabetes, was more predisposed to, you know, to health issues. And it is clearly established that diabetes affects a lot of body parts, especially extremities like hands and feet, heart, circulatory system, and your kidneys. Your eyes, and overall suppresses your immune system.

I have written about diabetes and its implications on health, many times earlier, including these articles which you can refer to help you get a better understanding of what can be done.

What does this mean for you?

1)      Monitor-  I think 55 is a bit too late to check what your sugar levels are. The most important thing is to start monitoring it from the mid-30’s onwards. If India has risen to 71 million diabetics overnight. It is primarily because the awareness has increased. And the constant checking is possible.

2)      Detect- Get a blood sugar monitor machine. I think it’s very important, a very good investment, along with a Blood Pressure machine. I think these are solid investments that you should make, whether you have an HDTV or the latest Apple gadget. It doesn’t matter but these schedules can really save your life.

3)      Reduce Stress- Diabetes is related to stress to great extent, higher stress higher sugar levels, and higher and lower the body’s ability to deal with the sugar let’s see where is it that is causing stress for you and how you can mitigate it, you might do yoga and meditation to manage the stress, but the ultimate aim should be eliminate the source of stress.

4)      Watch out for added sugar- Last but not the least, which is sugar intake added sugar is the biggest reason why insulin intolerance is happening in the body. So, it is important to figure out if there is added sugar that you are eating which you are not aware of, which could have been causing this problem.

5)      Exercise if your medicine- Workout in the open for 150 minutes a week. This could be a simple walk or cycling or swimming.

As always, it is important for you to stay healthy. Stay safe. Own your health. You have to do it; nobody else will take care of.

Sources: https://www.biospectrumindia.com/news/79/17555/average-hba1c-level-registers-marginal-improvement-in-india.html

Categories
Wellness

Sugar is the new health threat : Findings from Credit Suisse Study

Last week I had written a piece informing people about the dangers of sugar and given them 4 reasons to cut it out of the diet. I received a lot of criticism and some feedback on the piece. I do acknowledge that I am not an endocrinologist and have not conducted any independent study on this topic.

But last week while watching a documentary on sugar consumption from New Zealand, I came across references to a report from Credit Suisse “Sugar: Consumption at Crossroads”

Findings from the Credit Suisse report is more validation of my earlier article. The truth is that the processed food industry has been using sugar in large quantities. In addition to taste, sugar is also a good preservative. And last but not the least I feel Sugar is very addictive, more addictive than cigarettes or alcohol.

Sugar is the new threat to our health

There were three findings from the report that were eye openers. These were

  1. Global Consumption- The global per capita consumption of sugar is up 46% from 48 grams a day to 70 grams a day. This is the addition of 280 calories daily. 70 grams is around 16-18 teaspoons. While this is the average, the US leads the world with 40 teaspoons a day while China has the least which is around 7 teaspoons a day. Picture an American and a Chinese. Now you would know where obesity is coming from….need I say more.
  1. Sugar link with Obesity- While medical research has not been conclusive to link Sugar with Obesity, there are indications that the link will be established soon. Today we have enough indicators putting sugars and carbohydrates as creating a greater risk for Type 2 Diabetes and Heart Attacks. While Insulin resistance is genetically determined, it is established that more than 7 teaspoons for women and more than 9 for men is way above the insulin tolerance levels. This is the amount of sugar found in a single bottle of coca-cola.
  1. Medical Practitioners Agree- While a large scale trial or study keeping a control and a trial group across many years have not been organised as yet, the surveys across medical practitioners across the glove have agreed that sugar is the causative elements for the increase in hearts diseases. The concurrence was as high as 80%. Interestingly the consumption of sugar has declined in the upper strata of the society specially among educated individuals. But sugar finds a way to sneak in through processes food.

So what does all this mean for India?

Well in India the number of deaths in India due to heart diseases stood at 15% in 1990 and now it is up to 28%. The main factor for this has been diet. While factors like hypertension are a direct result of obesity, other factors like environmental pollution and tobacco usage also contributed to this number. In other words, our sugar consumption is killing us faster than we think.

What can we do ?

Here are three steps that I want all my readers to take immediately

  1. Educate yourself- There is enough literature available on the net and as well on research sites. Spend some time reading this and take charge of your health.
  2. Watch Documentaries- There are enough documentaries on channels like Discovery and Amazon Prime. This gives you a sense of the research and though process on this issue across the globe.
  3. Read Nutrition Facts- At the back of all food articles in India, there is a table that indicates the amount of sugar that have been added to the product. Read that carefully. Remember WHO prescribes only 9 teaspoons per male per day and 7 per female. Anything above that is very dangerous.

In conclusion, take charge of your health. If you don’t no one else will. As always comments and suggestions are welcome.