eHealth Centre: rapidly deployable cloud enabled healthcare solution

eHealth Centre Instant-on Cloud Enabled Healthcare Infrastructure 

Micro Health Centre mitigates ground-level issues of delivering healthcare to villages in India and in other economies that are challenged by the inadequacy of health infrastructure

Commission on Macroeconomics and Health of the World Health Organisation (2001), have argued that better health care is the key to improving health as well as economic growth in poor countries.

However, healthcare delivery at the village level is constrained by lack of basic healthcare infrastructure including inadequate supply of electricity, lack of doctors, non-functional equipments, lack of supply-chain with no appropriate monitoring of the existing healthcare infrastructure and manpower.

The aim of the Micro Health Centre (µHC) is to mitigate these ground-level issues of delivering healthcare to villages in India and in other economies that are challenged by the inadequacy of health infrastructure.

The cloud enabled infrastructure of the “Micro Health Centre” solution by Hewlett Packard provides access to specialist medical consultation at affordable cost and provides support for disease surveillance by tracking disease patterns and risk factors. Given that µHC is a rapidly deployable infrastructure, it is also appropriate to support disaster relief operations.

The µHC proposes to provide preventive, curative and emergency services, also acting as a tool for creating public awareness.

Current Healthcare Scenario in India
India has nearly 741 million rural people (72 percent of the total population, source: census of India, 2001).The Tendulkar Committee report states that 42 per cent of rural people in India are below the poverty line.

In India, about 75 percent of health care infrastructure, medical manpower and other health resources are concentrated in urban areas where 27 percent of the population lives. Contagious, infectious waterborne diseases and reproductive tract infections dominate the morbidity pattern, especially in rural areas. Moreover, non-communicable diseases are also on the rise. The basic nature of rural health problems is attributed to poor maternal and child health services.

Every year, 1.8 million persons develop Tuberculosis in India, of which about 800,000 are infectious and until recently 370,000 die of it annually–1,000 every day.

However, the reach and quality of the Primary Health Centre (PHC) needs to be enhanced in order to cater to the healthcare requirements of the last mile.

The primary health care infrastructure in rural areas in India is based on the population norms of having one PHC for every 30,000 people and one sub-centre for every 5000 people. There are 24,375 doctors serving the PHCs, which imply a doctor population ratio of 1: 34,000 in the rural areas. This is much below the global standard set by the World Health Organisation (WHO) of 1: 250.

The timely availability of appropriate drugs and equipment is much needed in the existing PHC.  Efficient management of data is difficult in the currently existing manual system, and often involves duplication of efforts and wastage of time.

The existing physical infrastructure in PHC’s and the number of existing public health facilities needs to be enhanced to meet the health care demands in large remote areas of the country.

Concept of Micro Health Centre
The better reach and quality of the Primary Health Centre is much required to cater to the healthcare requirements of the huge population. This calls for a need of a rapidly deployable self sustainable infrastructure, backed by the robust healthcare services accessible from anywhere.

The solution is equipped with built in electricity, built in connectivity, medical equipment, telemedicine services and requires minimal training to operate.

In rural areas, a simple, correct and timely diagnosis of the fever could be a challenge, yet life saving. The difficulty of reaching a blood sample to a lab and getting the report back in a reasonable time frame for the villager, who may have already travelled long distances for medication, is a serious concern. Especially in case the patient is suffering from a disease like malaria.

The µHC acts as a solution in similar scenarios as it provisions the availability of laboratory facilities and specialist consultations through tele health services. The continuous remote monitoring of equipments, data, medical staff and the stock of medicine through techniques like biometric surveillance and “cloud enabled medical devices” ensures the availability of health services without interruption at all times.

The sms based services will act as an enabler to the vaccination camps of the government ensuring a higher volume of enrollment even in rural areas.

µHC can effectively address the challenge of health work force shortage in rural areas and the issues of quality and accountability in healthcare. Through a unique simple interface, it enables community ownership of the health care services being provided, thereby acting as a self sustainable solution.

Health Cloud – Linkage to Centralised Backend
Cloud computing provides tremendous opportunities for the health sector to improve the delivery of services and reduce the cost of operations. Using cloud technology in healthcare can aid in disease surveillance by tracking disease patterns and risk factors and disaster management.

The cloud enabled µHC infrastructure can help solve some of the most pressing issues facing the health care industry today such as dismal quality of health care provided, shortage of drugs, equipments, trained personnel and specialist medical care in remote areas.

A health data base gets generated by electronic reporting of data using rapid and reliable diagnostic tools and remote sensing for the collection, storage and analysis of health data. Services provided in µHC are OPD services, tele health services: real-time support to physicians, tele consultation, information dissemination, research, video conferencing, availability of essential drugs, mother and Child healthcare services including family planning services, referral services, in-patient services, education about prevention and control of locally endemic diseases, Health Education and Behavior Change Communication (BCC) and laboratory services such as all general tests, including blood, urine and sputum tests, record of vital events and reporting and disease screening for diabetes, hypertension and COPD (chronic obstructive pulmonary disease) and ambulance on call.

The µHC will increase the reach of healthcare and will lead to improved communications between healthcare providers separated by distance through Tele consultation and video conferencing. It will address basic health issues and deliver preventive healthcare such as immunisation to the rural masses. It can act as a tool for public awareness and disaster management and provide accurate reporting of health indicators of the community.

Components of a cloud connected µHC infrastructure: •    Equipped with Cloud based network architecture •    Web based EMR with CPOE (computerized physician order entry), •    CDSS (clinical decision support system) •    Data storage and transfer to expert centre •    Video conferencing with medical experts •    Medical Equipment Connectivity: Equipments with sensors •    Automated reminder of vaccination and TB drug administration •    Monitoring of the patient visit, doctor and medical staff attendance. •    Centralised health record management •    Training and health awareness program

Conclusion
Thus, µHC presents an affordable solution proposed by HP (Hewlett Packard). It is an intelligent Telemedicine Health Centre, designed to meet the local needs and conditions without any infrastructural constraints.

It proposes to provide essential health care services with Health Cloud connectivity services, thus providing invaluable data for research and can act as a tool for disaster management, disease surveillance and public awareness.

Thus µHC can dramatically increase the reach of healthcare with the following benefits rapid deployment of nation-wide healthcare, remote monitoring of functioning of the micro-PHC and its equipment through transducers, improved ante-natal and post-natal care, addressing basic health issues and delivering preventive healthcare such as immunisation, invaluable data for research on better drugs, reduced mortality and enhanced quality of life for patients, reduced IMR and MMR, easy access to primary  healthcare facility and better quality of care, affordable healthcare, enable citizens to avoid unnecessary travel for health care needs, access to family welfare services and laboratory services, low cost diagnostics tools and methods for diseases requiring immediate attention, patient data available in EHR and counselling and teaching for preventive healthcare.

Note: Co-authored with Ritu Ghosh and Anjali Nanda

Technological Sovereignty

http://egov.eletsonline.com/2012/12/technological-sovereignty/

Dr Jaijit Bhattacharya
President, Centre for Digital Economy Policy Research;
Director, South Asia, Hewlett Packard

Sovereignty is one of the cornerstones for ensuring the security of the country and ensures that India as a nation can stand up to pressures from other nations. Sovereignty is critical to ensure our economic independence. As India moves into occupying the space of an IT superpower, the ability of the ICT industry to provide the requisite technologies reliably to the military, needs to be significantly enhanced. The issue is compounded with the fact that India has a feeble presence at the high stake tables of IT standards. IT standards have become one of the preferred tools of developed economies to extract undue economic benefit from emerging economies. Given that India, as of now, appears to have limited presence presence at the global forums on international IT standards, we appear to be abdicating our responsibility to secure our IT industry as well as IT usage. This situation has very deep implications on our defence preparedness.

The Strategic Implications With the lack of control over the technological layers, defense institutions will be challenged to protect the nation from Cyberwarfare. More importantly, military hardware itself could be subject to intrusions and control by adversaries, thanks to the increased “intelligence” of the equipment.

Given that tactical thrusts on the ground need to be backed up with complex supply chain which are increasingly dependent on critical information infrastructure such as Railways Signaling, telecommunications network etc, the entire Military strategy could be threatened by compromising the critical information infrastructure which has non-authenticated ICT components.

With the same “ICT intrusions”, the Financial Infrastructure of the country can be brought down, impacting the ability of the military to sustain a conventional warfare.

The impact on Network Centric Warfare is also obvious.

Thus it is imperative that we move towards an ICT & Electronics and Cyber (ICT&CE) ecosystem profile which provides greater control over the ICT layers to the military strategists.

The Tactical Implications
The tactical implication of lack of Technological Sovereignty on ICT is even more severe. The saying that “but for a nail, the war was lost” holds absolutely true for role of ICT in tactical engagements.

Compromising the supply-chain, command and control systems, financial systems, Operational Control systems will have devastating tactical implications, arising out of not having control over the ICT layers.

Industrial Ecosystem
A military can be as strong as the industrial ecosystem that backs it up.

In the modern warfare, ICT industrial ecosystem plays a critical role to ensure continuous supply of the latest ICT tools to support defense preparedness.

It is quite questionable whether India’s ICT Industrial Ecosystem has the wherewithal to provide uncompromised ICT tools to the military. This issues needs to be addressed through systematic policymaking and through carefully crafted institutional mechanisms.

Way Forward
India is growing as an economy and as an IT superpower. However, from a defense pre-paredness perspective, one is suspect of the layers of ICT&EC going into the ecosystem and the purposes for which these layers are actually operating.

India has limited sovereignty over these layers of ICT&EC that are going into defense preparedness. It is imperative to address this lacuna. India has the potential to develop the critical technologies and provide the technological sovereignty required to have credible defense preparedness.

One of the policies that may be leveraged to develop Technological Sovereignty is the defence offset clause. Under the current procurement
norms, India has a policy for 30% offset on defence procurement. This creates an immense opportunity for domestic manufacturers and service providers. More importantly, this also creates an opportunity for developing domestic IPR to take benefit of the 30% defence offset policy. However, in order to do so, it is critical to identify the roadblocks that prevent domestic manufacturers from tapping this enormous market, which also includes a fickle tax regime that prevents having a long-term view of the market. It would also involve identification of institutional mechanisms to facilitate partnerships of global military ICT providers with domestics manufacturers to enable the procurement process The first step in this process would be the identification of institutional mechanisms to facilitate domestic entrepreneurship.

However, such a step would require conceptualization of facilitating policies and institutional mechanisms to accelerate the process of Technological Sovereignty in ICT&EC for Strategic purposes.

Launch of the First of its Kind eHealth Centre

Launch of eHealth Centre - a Two year effort of Technological and Social Engineering

Issues in Public Procurement – The Public Procurement Bill 2012

The prime objective of any government procurement is getting the right product or service, at the right price and quality and at the right time. Government Procurement accounts for approximately 20% of India’s GDP. However, public procurement processes, which are governed at the Centre by the General Financial Rules, 2005, are widely perceived to be vulnerable to corruption, collusion, fraud and manipulation. Therefore, there is a need for a single set of robust guidelines for public procurement in India which would mitigate the current situation.

In order to strengthen the public procurement process, the Government of India has already taken a stand to streamline all public procurement. As a first step, the government, through the Ministry of Finance, has formulated a draft Public Procurement Bill 2012 which will govern the procurement process for all central government and PSUs in the country.

The Draft Procurement bill 2012 however faces the challenge of aligning all other regulations and legislations that impact Public Procurement in India. This includes alignment in the areas of ‘green’ procurement, support to innovation, appropriate penalties for both vendor and procuring entity alike, vendor development programmes for SMEs and a mechanism for procurement based on lifecycle costs.

Green Procurement

As advised by the Prime Minister’s Climate Change Council, all government procurement in India is scheduled to go ‘green’ by mid 2013. Under the PMO’s directions, the Planning Commission has set up a core group comprising senior representatives from government departments, including BEE, DGS&D, MoEF, CPCB, Defence, Railways, and select industry associations like CII. 

As a part of the move towards green procurement, BEE has sent a proposal to DGS&D today for procurement of energy efficient goods. Should this be accepted by DGS&D, then for future procurement DGS&D would either give a ‘preferred vendor’ status to suppliers who comply with the BEE labeled products (laptops and Office Automation equipment for now) or the next Rate Contract could be only for products which are energy efficient as per the India specific requirement, which is BEE labeled.

While this effort is laudable in itself, it throws up two distinct challenges for procurement which are (a) there is need for a crisper definition of ‘green’ and (b) there is a need to have clear processes for managing the labelling on imported products such as office automation products, such that when their packaging are opened locally for inserting the required labels, such products should not treated as second hand products.

Support to Innovation

DGS&D procurement rules follow a process whereby unless there are a minimum of three bidders who can supply to the specifications in the Rate Contract, the RC stands cancelled. By definition, an innovative product will be the only product in the market in the initial stages. The current process prevents the innovative company the chance to bid, thus inadvertently discouraging procurement of innovative products. While the PPB 2012 allows single vendor procurement under specific conditions, there needs to be a clear connect between the Bill and the DGS&D rules in this respect.

The matter is further compounded by the fact that the procurement processes prevent product upgradations midcourse through a rate contract. This raises challenges for the IT industry, as rate contracts are typically for one year, while there are component upgradations every quarter. Under the current norms, each upgradation would necessitate a revision in the specifications outlined in the rate contract. The OEMs are thus in a position where they may have to stock up a year’s supply to provide obsolete products to the government. It is a lose-lose situation. The PPB should allow for product upgradations as and when industry moves forward, as long as there is no upwards price revision.

Disproportionate penalties for vendors and procurement agencies

As per PPB 2012, it is mandatory for all potential vendors to inform the procuring entity on any blacklisting of the vendor by any government agency across the world in the previous three years. Based on that information, the Indian government reserves the right to debar the vendor for a period of two years from bidding for any rate contracts. Given the complexities of doing business with various kinds of government agencies globally, the above clause would essentially debar almost all multinational vendors. This clause requires rationalization in order to strengthen the procurement process.

Public Procurement is a challenging issue. Besides the above challenges, Public Procurement also need to address issues of vendor development programmes for SMEs and a mechanism for procurement based on lifecycle costs. The PPB 2012 is a step in the right direction that needs to be further strengthened with the above guidelines/clauses.

Cloud Computing: The Potential Next Generation Export of IT Services

Cloud computing is fast changing the paradigm of computing and of compute consumption. Rightfully, India is enthusiastically adopting Cloud Computing to solve its compute infrastructure issues. Cloud computing is considered as a disruptive IT delivery model that allows software/hardware services to be delivered remotely through the Internet. The public cloud computing market in India is expected to grow tremendously in the coming years.

However, India and Indian policymakers are viewing Cloud Computing primarily as a mechanism to solve the compute infrastructure issues. Cloud Computing services could also become a significant IT services export from India.

As India is uniquely positioned to become a low cost, high quality provider of Cloud Computing in all its forms, including IAAS, PAAS, SAAS and its myriad other iterations. The primary constituents for setting up a Cloud Computing infrastructure are readily available in India, such as (a) hardware infrastructure, (b) infrastructure software, (c) cloud enabled application software, (d) connectivity, (e) skilled manpower (f) electricity and (g) cooling.

Given the focus on local manufacturing in hardware, India is soon going to become the hub of IT manufacturing, thus leading to reduced cost of setting up of hardware infrastructure. Also, setting up of cloud infrastructure would also increase the market demand for the associated computing equipment, thus making it lucrative to increase IT manufacturing in the country, thus forming a virtuous cycle of increasing market and reducing prices.

India is already a global powerhouse in software, both infrastructure software and application software. Hence, India would have the competitive advantage of providing Cloud Computing because of its software prowess. Exporters of Cloud computing service, would also provide a platform to application developers to tap international markets which otherwise involves significant cost of sales through alternate sales channels. So again, a virtuous cycle will be formed with Cloud computing service exports attracting application developers to access larger global markets which in turn would reduce the cost of providing applications from India.

Thanks to the aggressive rolling out of broadband and connectivity under the programs of the Government, India would in the near future be one of the most well-connected economies in the world. This would enable India to be highly competitive in providing Cloud Computing.

Coming to the issue of electricity, it would be prudent to locate such cloud computing infrastructure close to cheap, inflation-proof sources of electricity. The areas close to Hydel power would be ideal for such infrastructure.

Given that India has large number of such locations in the Himalayan states such as Himachal Pradesh, Uttarakhand, J&K, Sikkim and the rest of North East, it would be a obvious to locate Cloud Computing parks in such locations.

These Himalayan locations also provide natural cooling, thanks to the perennial snow cover, thus further reducing the cost of operations for Cloud computing infrastructure.

Thus, to propel India into becoming an exporter of Cloud Computing services, it is imperative that appropriate policies are adopted to notify and create Cloud Computing Parks in the Himalayan States, with sufficient bandwidth. In addition, focus should be put on trans-border legislations that inhibit the export of Cloud Computing Services.

But what if after making considerable investments in setting up Cloud Computing parks, the exports don’t take off because of say trans-border legislations ? The investment into rolling out the internet bandwidth and the associated infrastructure for the cloud computing parks will not get used as they would immediately get re-purposed for delivering education, health and other social services to the local communities.

What is important to note, Cloud computing is a natural monopoly as it benefits from economies of scale. Thus, the first movers of Cloud computing and gain scale and thus reduce cost of delivering Cloud computing, making it difficult for late entrants to compete. Hence, if Government of India hesitates in setting up such Cloud Computing Parks, other nations will get into this space, with India missing this bus.

Encouraging IT Manufacturing in India

The current market for IT hardware and electronics in India is USD 36 billion per annum. This is expected to grow to USD 400 billion by 2020. As of now there is insignificant value add domestically for the IT hardware and electronics sold in India. As one of the policy measures to mitigate the above issue, Ministry of Communication and information Technology, Government of India has therefore recently come out with Preferential Market Access (PMA) notification. The Preferential Market Access policy provides for at least 30% of government IT market for domestically manufactured equipment as long as the equipment matches L1 (i.e. the least price bid for the tender) and Q1 (i.e. the best quality offered by any other entity for the tender). As per the PMA, products will be considered as domestically manufactured if they have at least 25 percent local value add. To implement PMA, the government has to construct detailed guideline and processes by which one can track the percentage of local value add for each kind of equipment. For example, if the equipment is a computer, then the government would need to validate how many components of the computer are domestically manufactured. In addition the government would need to define what constitutes a domestically manufactured component. For example, if the hard disk is imported into India and locally only casing is added to the hard disk, would this be considered to be a domestically manufactured component? Clearly, such processes would be cumbersome for the manufacturer to comply with and cumbersome for the government to monitor. Therefore the proposed rules will lead to significantly increased compliance costs and significantly  increased interference by lower levels of the government machinery as it would provide them with discretionary powers. The above process would also divert the attention of the manufacturer from manufacturing better product at lower cost to focusing on accounting procedures to prove larger domestic value add. The above regime would also lead to extremely complex processes to be adopted for allocating general expenses and common expenses such as sales and marketing, accounting, guest house expenses, ERP costs etc to each SKU manufactured. Such allocations will also get challenged by procuring agencies, leading to higher costs of litigation. The industry will get retarded as the industry will loathe moving to newer products since, for each new product, the entire process of demonstrating percentage of local content will have to be done from scratch. Even currently, government procurement, especially through DGS&D, inhibits newer products from being introduced as the rate contracts are for a year and does not factor in obsolescence and introduction of better products at same or lower prices. This is inimical to an industry where products get obsolete within three months. Moreover radically new products will have radically different architectures which will make it even more difficult for the innovators to prove the levels of domestic production to the government procuring agencies. The PMA policy also needs to be strengthened to ensure that it is able to accommodate radical innovations. The monitoring of PMA becomes more complex when one has to factor in and value domestic innovation and IPR as there is no watertight market based price discovery mechanism. MSME’s are the backbone of innovation. MSME’s already face significant challenges for manufacturing which is compounded by  manufacturing inspections and compliances which hold them back from innovation. It would be extremely challenging for MSME’s to face additional burden of having to prove domestic value add for their innovative products. Therefore, to promote innovation in domestic manufacturing the Government of India should consider updating its procurement processes to ensure that government can procure innovative products and thus promote innovation in  domestic manufacturing. In addition, the government should consider funding ICT manufacturing  research and development, adopt pro-manufacturing  tax rates and labour laws, and establish ICT manufacturing educational programs, and otherwise incentivize investment in the ICT manufacturing sector on a non-discriminatory basis. The government may also consider adopting labour laws that are specific to IT and electronic manufacturing industry to ensure an uninterrupted manufacturing environment. Specifically for the Greenfield and Brownfield clusters proposed to be developed under the Triad of IT policies should have all clearances and approvals a priori so that potential  manufacturers need not face the hassle of running from pillar to post to get clearances. In addition, these clusters should be declared as “Inspector- raj-free” zones. It is indeed a challenge to rapidly increase domestic content in electronic goods. Domestic Content can be increased in a phased manner with the development of component industry. A combination of good infrastructure, favourable tax regime, appropriate labour laws, conducive policies, capital at globally competitive costs, availability of skilled manpower and a proactive implementation of the manufacturing policy roadmap would go a long way in speeding up domestic manufacturing of IT hardware and electronics.

http://www.facebook.com/eGov2.0 

e-Politics

We are in the cusp of change when it comes to the manner in which politics is conducted

With the advent of Internet, there has been a significant democratization of the ability to distribute and consume information. The power to distribute information and the ability to reach out to the is not controlled by a few in the society. This has had disproportionate impact on all walks of life and society. However, this change in the asymmetry of power to distribute and consume information is only just beginning to impact the business of politics but growing at a rapid pace. In 2011, almost one-third of Internet users described the web as an important source of political information, compared with less than 15 percent in 2007 according to the Russian Public Opinion Research Center (VTsIOM).

We are in the cusp of change in the manner in which politics is conducted. Tweets from a twelve year old girl had galvanized the population of Seoul to converge at the Town Hall to protest against beef imports from US. A few years later, similar mobilization over the Internet had started toppling governments, starting with the Government of Egypt. Nearer home, civil society has effectively used the Internet to create one of the largest people’s movement since independence where people notwithstanding their geographical location joined the fight against corruption through the Internet. We have also seen how Internet is being used to run political campaigns and to also reduce the cost of campaigning. The presidential campaign run by Barack Obama in US was highly dependent on the Internet. Digital media gives any politician the "baseline" pulse thus knowing when people favor or disfavor the candidate and his/her policies. Thus, the internet allows trends of people’s expectations to be mined that would help politicians and policymakers to target people’s need more effectively.

Most importantly, we are witnessing the metamorphosis of democracy itself. Democracy is slowly morphing from being an Indirect Democracy to a Direct Democracy with people’s views being factored in for most policies that are being adopted by the government and for each legislation that is passed by the parliament. No longer do the elected representatives have the sole prerogative to unilaterally decide on what is the appropriate legislation and appropriate policies for the entire nation without any further consultation with the citizens. Thus politics is moving towards a more collaborative leadership model. Waves of ICT applications in politics have empowered groups of political neophytes (‘netizens’, ‘cyber-libertarians’), extending the power of people who are from the disadvantaged layers of society to shape and transform conventional politics into a stage of ‘virtual democracy’. This transformation is being expedited with the advents of Internet access over mobile phone which gives citizens new opportunities to mobilize and be heard.

Increasingly netsavy citizens share political content in real time. This can lead to phenomena such as the ability of the new-found tools for mass political mobilization. Internet was used as a tool in the Egyptian anti-government protests which further provoked a series of uprisings. In the case of Myanmar, where there are limited avenues to express dissent, the recent protests and their global impact were only possible through extensive use of mobile phones and the internet.

However, the disconcerting aspect of ePolitics is that in a society with an urban-rural digital divide, how do we ensure that we also do not have a divide over which sections of the population can express their opinion? What level of political dissent will be tolerated? In a world of government censorship crackdown, will citizens and smaller political parties succeed in finding alternative routes to safeguard their cherished freedom of expression? Such questions and the value of the internet to Politics will shape how politics will evolve with the power of Internet.

https://www.facebook.com/CenterforDigitalEconomyPolicyResearch 

Centre for Digital Economy Policy Research