Monday, April 1, 2019

The need and lack of healthcare information in India

This article was first published in my Times of India Blog Staying Wired.

In my previous post I had mentioned about the importance of Artificial Intelligence and Machine Learning in healthcare specially for countries like India where the population is large and availability of skilled medical professionals is scarce. But is the healthcare infrastructure of India in a state from where it can take this great leap forward.

The primary requirement to be met for being able to utilize the fruits of AI and ML, is the availability of data which can be fed into the systems to make them learn. As we humans learn by reading so do these machines. They can gobble up volume of medical data, sift through them, learn, and generate more meaningful output during diagnoses.

However, there must be context to the data. We cannot train an algorithm by feeding it medical data from Europe and expect them to yield meaningful results in a tropical country like India. With different environmental and weather conditions, there is difference in the nature of diseases and the agents which cause them.

However, the question is whether India is well equipped with the health data of its citizens which can be used for the purpose of training these models. The answer would be a resounding ‘no’. Apart from a few top tier public sector hospitals like AIIMS basic IT infrastructure is lacking in most places. In private sector though some of the big names have provisions for Electronic Medical Records (EMR) the same cannot be said for other small nursing homes and hospitals operating throughout the country.

From personal experience even in a leading private hospital in Kolkata I never got to access EMRs online. They seemed to have an online portal, but no one in the hospital knew how, from whom and where to get access.

Moreover, an EMR in most cases doesn’t translate in to a meaningful Electronic Health Record (EHR). In retail a well-used term is the ‘One Customer View’ through which a retailer knows his customer holistically; what he buys, which brand he likes, how much he spends, what are his/her dislikes and most of the other relevant preferences.

EHR should be able to provide healthcare agencies similar holistic view of a patient’s entire health history, so that in time of need or emergency there is no scrambling around looking for allergies etc. Transparent sharing of EHR across hospitals would also make it easier for patients to continue the correct course of treatment while shifting from one city to another.

Worldwide the adoption of EHR has been rapidly progressing. In most of the developed European nations the adoption rate is more than 90%. In USA as of 2014, 76% of hospitals and 97% of acute care hospitals had adopted for EHR. For India no certified figures could be found, some resources point the adoption to be in the region of 20-30% only.

Despite some recent advances with public healthcare spending in India below 1.5% of GDP not much change can be expected to take place. Globally most countries have understood the important part IT is to play in the healthcare domain. By 2020, the global healthcare expenditure is expected to reach $9 trillion out of which $1.7 trillion will be in technology; almost reaching one-fifth of the total.

It is quite a contradiction that India being home to some of most prominent names in information technology industry, is lagging poorly in revamping its own healthcare. There are multiple healthcare schemes launched by successive governments but all this while the allocation for health never reached 2% of the GDP. Even considering the emerging countries of the BRICS group, India stands out at the bottom when it comes per capita healthcare expenditure; just $75 for India as against $947 for Brazil at the top.

None of the fruits of new age technologies could be availed till this apathy towards healthcare is corrected to the core. Having a comprehensive EHR for all citizens would be a goldmine which is to be protected with an equivalent zeal. The data so far available is scant, scattered and localized.

About 72% of the rural and 79% of the urban residents today avail private sector services for healthcare. But over reliance on private sector would make it hard to realize the requirements of an integrated EHR framework. Government needs step in with the initial necessary capital investment, policy formulation and provide the necessary governance framework; since it is necessary that the information is not put to rogue use. Once the integration is achieved the benefits would just be exponential.

Artificial Intelligence and the future of healthcare

This article was first published in my Times of India Blog Staying Wired.

Anyone reading this post would know how predominant has been the terms ‘Artificial Intelligence’ and ‘Machine Learning’ in this millennium. Though these fields have been under the research radar of scientists from a much earlier period, it is only in the last few decades that AI and ML have matured out of the test-tubes to face real-world challenges. And healthcare is one field which stands to gain from that.

It would not be too far-fetched to predict that the advances in medical science like vaccination and genetics which helped to further human longevity, Artificial Intelligence would bring about the next quantum leap. And as we discuss multiple instances of applications of AI and ML have already started coming to the forefront.

In the detection of cancer, metastasis pathologists are faced with the time-consuming task of reviewing slides of high-resolution images covering every tissue under investigation. The images are in the magnitude of 10 gigapixels and a pathologist must go through each pixel to ensure that he isn’t missing anything important.

AI algorithms reading the visual patterns are expected to be between 5-10% more accurate than pathologists with unlimited time studying the same images. And since being machines they are expected to be more consistent as well. This increased accuracy and consistency can strongly fight off misdiagnoses.

In another brilliant example, Madurai based Arvind Eye Hospital has started testing a Google AI based interface which can provide early against diabetic retinopathy, which if untreated can lead to permanent blindness. However, with just 11 ophthalmologists for 10 lakh people, not everyone is expected to undergo regular eye checkups in India. Such AI interfaces, providing preliminary examination results fast and at low cost, can go a long way to bridge the gap w.r.t availability and reach of doctors.

AI systems have found extensive usage in diagnoses of common ailments along with predicting how long a patient would stay in hospital or chances of readmission and even death.

In China studies conducted on a wide base of patients have shown amazing results. AI systems diagnosed asthma with 90% accuracy as against physicians whose accuracy ranged from 80% to 94%. For gastrointestinal diseases, AI systems were 87% accurate while physicians were in the 82-90% bracket. Thus AI systems can be overwhelmingly reliable in terms of generating a consistently accurate outcome. And hopefully, with further proliferation, it will be cheap and maybe even open source sometime in future.

But that doesn’t mean there are no pitfalls. Anyone with access can fudge the medical records to fool AI systems. And many scientists have already proved so my performing tricks with AI systems which made these machines fall flat. So it can be well said that the introduction of AI will no way reduce the importance of the work a physician or a pathologist does. It only shifts the nature of work.

Pathologists and doctors can let AI systems perform the preliminary investigation while they get look at exceptions and outliers. For the patients, especially in countries like India where competent doctors are scarce to be found, AI systems could be the first line of the interface at primary healthcare facilities where preliminary diagnoses can take place.

We should be aiming at an augmented Healthcare system where physicians and AI can work hand in hand providing the best possible outcome for the patient. With the growing population and ever new complications in diseases arising, the field where humanity needs to embrace the combined might of Machine Learning and Artificial Intelligence most are not self-driving cars or productivity enhancing robots but healthcare.

Friday, January 11, 2019

Book Review - The White Tiger by Aravind Adiga

Completed my first book of 2019. I had this book on my wish list for a long time but never attempted to read it. One reason was that I always thought all these books which have won literary awards may not turn out to be an interesting read. However that belief was proved completely wrong when I read this book.

First of all the author wrote the book in a tremendous lucid language which had a wonderful flow; I didn't find any word / information which would have needed me to open the wiki/dictionary. And that again surprises me since this book was a New York Times Bestseller apart from being a Booker Prize winner.

The book is about the two different countries forged into one country, India, through the life the protagonist named Balram Halwai who makes his transition from one to the other. Since the economy opened up in the 90s, India has steadily grown to be one of the largest economies in the country. We have urban centers which have grown in size along with the steady growth of billionaires and millionaires. But along the process of that development, we have left behind a chunk of our country (mostly rural) which still languish by the lack of education, health, nutrition and pulled by down by extreme poverty; author very aptly labelled this India as 'Darkness'.

The journey of Balram Halwai is an endearing one. The novel provides a brilliant depiction how in the age of globalization, a rigid caste system still controls the fate of most in the hinterland. Balram's travails with himself while undertaking the painful and risky process of making the transition is worth reading.

However one thing that really intrigues me whether the literary quality of the book is good enough to have won the Booker or is it just that a negative portrayal of Indian's growth story touched the right chord with our erstwhile colonial masters; or may be because it was published in UK. Frankly there have been multiple works which explores this same situation of inequality that exists in our country. But yes Indian poverty does sell well internationally as we have seen with the case of the movie Slumdog Millionaire which incidentally swept Oscars in the same year, 2008, in which this novel won the Booker.

Overall I must say that my first of 2019, published back in 2008, was a satisfying read which I completed successfully; this I say because there have been some books in the past few months which I did start but didn't complete. I managed to get the book from the local library and have secured one of Aravind Adiga's other works as well. And then I have one from Shashi Tharoor along with few e-books to wrap up. Target is to read at least a dozen books in 2019; one for each month. Hoping for the best.

Friday, January 4, 2019

Towards a smart future #SmartHomeRevolution #GetFitWithFlipkart

  • You have left your house for a long drive and have been on the road for few hours. Then suddenly the thought strikes you whether you had switched off all the electrical devices before leaving.
  • You are out on vacation but was expecting an important package to arrive by mail. You wish if you could have spoken to the delivery guy and let him know where to put it lest it gets spoiled.
  • It's a hot and humid summer evening when you are on your way to home. If someone could have switch on the AC few minutes before you reach home, it would have been really nice.
These are all quite familiar cravings we have and would be part of many of our wish lists. The answer to these above requirements could be a smart light, a smart camera or in entirety a smart home.'

India today has the second highest smartphone using population in the world even ahead of the USA. However considering a penetration of less than 30%, it means there is still ample scope to increase the smartphone usage in the country.

Today smartphones are an integral part of our life. We remain connected with family and friends, pay our bills, keep track of finances, update social media and even do work through smart phones. The smartphone that we have in our hands today comes with immense computing power. It is said that the computing power we have in a high-end smartphone today would have been enough to blast off a rocket into outer space in the 1950s.
However the gap that not been bridged yet is that between the phone in our pocket and the other devices we use in daily life; our car, our watch or the electrical and electronic appliances in our house. It is to bridge this gap that smart devices have come into picture.

Smart wearables were the first smart devices that became of popular use. Today we can see enough people wearing a Fitbit or Apple Watch or Samsung Gear or any other smart watch to consider. With these wearables we can not only do things which we would have otherwise done using a smartphone like receive calls, text messages, check emails, listen to songs but these devices also act as a personal health monitor by keeping a tap on some vital body parameters like heart rate, pulse and also track calorie erosion when we engage in physical exercise.

The wearables help us to set personal health goals and help keep a track how far we progress on that; it helps us to live a bit more healthier life. Google Glass has opened a new frontier in the wearable technology field with widespread application starting from medicine to journalism. In India Google Glass should find application in the education field as well; when many of  the children are deprived of quality education, enabling live streaming using Google Glass has help students in far flung areas to have more accessibility to quality material

The Global Wearable Devices Market is expected to exceed more than US$ 51.50 Billion by 2022. Wearable devices are here to stay and penetrate our daily lives. In India the wearable device market is set to reach to a stage very close to $2 billion by 2023 while the penetration is not expected to change much from current levels.
Hopefully that will change soon as more Indians become health conscious and application of wearable is expanded beyond just the millennials. Wearable technology should be able to find wide scale used case among the elderly population where the devices can be used to trigger emergency response.


And when we talk of daily life, nothing is complete without an interaction with our home and it's appliances be it the oven, the air conditioner, lights or the security system. We now have smart thermostats which can be controlled remotely through apps in smartphones; thus we can now switch on the AC or heating before reaching home to have a more comfortable experience. Smart thermostats can also alert the owner in case of any abnormal changes like fire. We now have smart lighting solutions which can be controlled through apps.

Thus while on vacation you can still switch on and off the porch lights remotely or may be control the Diwali decoration lights. Smart cameras can help you keep an eye on your house remotely. There are also voice integrated smart security camera which can help the owner interact with any unknown person knocking at the front door or may be instruct the delivery guys to keep the parcels in the right place. And to integrate all these smart devices we can have a Google Home or Alexa; from playing the favorite song to opening the garage door these smart device integrators can do any task you just ask them to do. And that means no need to even use a smartphone app; you just say and Alexa does it.

Apart from convenience, smart devices add to the better management of energy by controlling the devices effectively as per need. Artificial Intelligence integrated with smart devices increases their utility many times more. Thus while we may witness a marginal increase in the initial installation cost, the effective savings on running cost over a longer time would weigh out the initial investment many times over.

In the US alone, smart home is expected to be a $40 billion plus business with a penetration into more than 50% households by 2023. Compared to that in India the penetration is expected to be less than 10% by 2023 generating a business of $7 billion. Thus India provides a far larger market in terms of opportunity.


One of my first interactions recently has been with smartness built in today's car. I had recently the experience of using a Bluelink enabled Hyundai Sonata. With this new technology you can now start you car remotely with the a smart phone app, lock or unlock the car, control the cooling and also technology will help send alerts and updates from the car. This is something very basic considering the world has moved into the realm of self-driving cars. However such smart connectivity is yet to come in cars which fall outside the premium segment in Indian. Hopefully in very near future that will no longer be the case. Connected car market and ecosystem is evolving across the globe. By 2023, connected car and related accessories will be a billion dollar market in India alone.


Smart devices are expected to have widespread use in the public space as well. Smart lights can help municipal bodies to more effectively control the city lighting and manage any wastage. Today's cities consumer more than 70% of the world energy production, thus effective management of resources can definitely help in the long run to create a sustainable ecosystem.
Chicago has undertaken an ambitious and largest (in USA) project to replace 270,000 city lights with smart lights resulting in an estimated savings of $10 million is energy costs annually.

Smart cameras can be used to monitor security and more effectively manage traffic in busy urban freeways. And the data from all these connected devices provides the as big an opportunity for analytics and machine learning to work more effectively. In Nairobi, Kenya Huawei has installation communication system that integrates 1800 smart cameras with 195 police bureaus and 7600 police officers providing a sense of national and economic security. India has also embarked on an ambitious journey of building 100 smart cities with an estimated funding of $14 billion. In India such smart solutions can also help to address to the problems related to women's safety.

That day is not far when on a long road trip while driving you can feed an instruction to the Alexa or Google integrated car to switch off the lights in you drawing room and the task will be done. And when you reach back home exhausted your car will communicate with the garage security system to open the gates and also ensure the hot water is ready for you to take a refreshing bath.
And the local police station become aware of a theft or burglary even before the owners actually dial the emergency response number.

The applications and opportunities are just endless. So get your first smart device from Flipkart which provides an amazing collection of Smart Wearable, Smart Home, Smart Camera and Smart Light solutions to choose from.

#GetFitWithFlipkart  #SmartHomeRevolution

References:
  • https://www.statista.com/outlook/279/119/smart-home/india
  • https://www.statista.com/outlook/279/109/smart-home/united-states 
  • https://www.forbes.com/sites/pikeresearch/2018/04/06/smart-cities/#5b8a459113c8 
  • http://www.bbc.com/future/bespoke/specials/connected-world/government.html
The images are sourced from Google Image search and the writer of the blog doesn't claim ownership of the same.

Thursday, January 3, 2019

Visit to Houston Museum of Natural Science - A Twitter thread


Featured post on IndiBlogger, the biggest community of Indian Bloggers

A very Happy Newfamily, went for a trip to Houston. Houston is a 4 hour drive from Dallas and is one of the largest metropolitan areas in the state of Texas. The city is named after Sam Houston who was the first President of the independent Texas Republic.

On the first day of our visit to Houston, we went for the Houston Museum of Natural Science. The institution is more than hundred years old having being established in 1909 and is one of the most popular museums in the United States.

During the visit I clicked a number of pictures of the exhibits for which I created a twitter thread. I created the twitter thread rather than a detailed blog post as I found it much easier to maintain and update the thread rather than a blog post. I can easily update the thread from my phone where I have all the pictures stored. Doing all that for a blog post is a bit cumbersome.

I am still in the process of updating the thread with pictures and information on new exhibits. Also during the trip I did visit few other places of great interest for which I will be creating separate threads. So please keep watching.

Wishing you all a very successful and Happy New Year.