Tuesday, October 16, 2007

ICT in Healthcare for Rural and Urban areas: Telemedicine

This could be an good idea for people who want to start a business which serves a noble cause too, specifically in the domain of Healthcare. So the basic idea is to provide an asynchronus clinical diagnostic decision support system (CDSS) to healthcare professional on a hand-held device like (tablet/pda/notbook) or a desktop . The way CDSS works is, we have a very big number of cases and expert opinions combined to form rules for diagnosing what disease the next patient (case) has an the basis of symptoms seen. Most systems use bayesian algorithms to formulate these rules. When a new case comes, on the basis of information on symptoms observed and other relevant personal entered, system suggests what diseases could possible be there with probabilities for each of these and explanations for why that disease could be present. It would also suggest what tests should be done to make a diagnosis and in what sequence. Finally the healthcare professional (most often a doctor) makes a decision or diagnosis and treats the patient for that disease. Ideally each new case with final test results and the diagnosis decision should be updated in the system so that rules also get updated for treating the next set of patients better.

Additional support for treatment guidance and sending reminders for taking the medication or check-ups etc can also be provided. Use of Information and Communication Technologies (ICT) in healthcare is increasing but has not been fast enough to catch up with the pace at which technologies are developing. Technically, building such a system is really not a big deal but there is a lack of effective delivery mechanisms which gets adopted well into the healthcare community which apparently is normally not well-versed in use of ICTs. Right now such systems come along with hospital information systems and are thought of as something big, complicated and expensive. What I think is, we can just use Google Gears (http://gears.google.com ) as a platform application to build up our own asynchronus application which can run on any client and updates the rules by periodically sending the information/data about the cases treated in the last unconnected period and also downloading the information about updates in the diagnosis rules. This way we can provide a good product at affordable prices to the users. Google provides APIs for using its applications to anyone, and that is a great resource which many entrepreneurs may want to exploit for delivering their services.

The amount of information being generated in healthcare is so huge that it is almost impossible for professionals to keep up with all the latest information in the field. Such systems are an answer to it, as such this is something people have known since long but now is the best timing for launching such systems as healthcare professional are increasingly adopting ICT based systems into their practice. Points mentioned so far hold true for the urban and developed areas around the world and for the underdeveloped areas too. But for underdeveloped and remote (rural) areas where doctors are rarely available this application is going to be far more beneficial, if we can provide healtcare advice through telemedicine using such decision support systems. It is an emerging area and a huge market around the globe. Small entrepreneurs can also start such a system, and if such small entrepreneurs can become the part of a bigger network (something like a cooperative) for sharing the data collected, then it would definitely be called as a great innovation. I believe one group trying to something very similar thing is www.d-tree.org and I am certain that there would be many more small businesses or non-profits working on this idea.

The first part of such a business would be to collect the information or cases and develop a system which lies on the server. This is possible with some investment of time and money and many firms can do it so to being with an alliance can also be formed. There are numerous initiatives at different universities which have already have a lot of data with them, and I believe one can either partner with them or just buy the data from them. The second and most crucial part would be to efficiently provide such a decision support to the practitioners or telemedicine providers in user friendly way. Direct diagnostic advice to consumers is out of question right now because of the legal issues involved but as some legal barriers fall in future due to increased trust in technology, major players would be able to take advantage of those new laws too. Existing APIs of Google Gears can provide the web in a condensed form asynchronously to client devices, and hence have most of the features which would be required to implement a health decision support in the form proposed above.

Another orthogonal but important aspect here is that governments and insurance providers have a huge interest in reducing healthcare costs and increase efficiency of the healthcare in general. With support of such a system a lot of spurious diagnosis testing could be avoided, because that happens due to either some personal interests of doctors, hospitals and testing labs, or because of the over cautious approach towards diagnosis adopted by the doctors and healthcare providers. These spurious tests account for about a third of total lab tests done specially in the developed economies. So we have stakeholders in the market who have a strong interest in promoting such products and may be making these mandatory in future. New breed of healthcare professionals are receptive to the idea of using ICTs for providing better healthcare and other complementary products, systems or ideas like electronic health records for individuals are also getting acceptance into the market. On the whole use of ICTs in healthcare is gaining momentum and this kind of product/service to deliver diagnosis support would be one of the pillars to provide healthcare in a networked manner.

I believe, it is a good idea for anyone who wants to make money and also do something meaningful. Also, everyone is aware of the humongous size of healthcare market. If anyone would like to discuss more details on this then I would be more than glad to so :-)

Saturday, October 06, 2007

Why competition is a local phenomenon?

In the early days of college, I used to wonder (rather I still wonder!) about this phenomenon. However good, strong or competitive people may be at anything for any level higher to their current level of action, but they get hurt most when someone at their current level of competition beats them. I will try to use a small exercise to illustrate what I mean: try to recall of one activity in which you were really strong in high school and you continued it later also and managed to reach heights which were far bigger than what others in your high school thought you would ever be able to achieve.

Now recall your strongest competitor back from high school in the same activity. It may have happened many or at least some times that due to any reason whatsoever, this other person would have beaten you. Each time this happened, your heart would have burnt to ashes in a second and the next few days were hell :-) Remember how hard it was then to accept that you lost to such a sucker :D Now it doesn't matter but just try to think what or who matters to you now? :-) I am yet to find someone who is able to separate her/himself from the present competition they face. It is the present and the competitors in the neighborhood or physical proximity which makes the adrenaline rush when you are competing, and if it doesn't then you are not in a competition. Either you are a sure winner or you have already accepted that you can't win. But we never get bothered by the far better or stronger competitors whom we know but with whom we are not competing at that point of time, though we will definitely hate them or feel jealous of them when in future we are running the race with them .

The point here is, it is primarily the local competition which drives your growth. It holds true for organizations, groups and countries or any other form of an entity as well. Constructive competition has always been local in time and location. You will find this point being emphasized by many smart people in the history. In fact, in the recent times when one of the most famous business thinkers, Prof. Michael Porter of Harvard had proposed his claim to fame theories on competition, he used this phenomenon a lot. I have read his work in the field of economic development where he just took the same concepts to a higher or macro scale. He says that very strong domestic competition in an industry for a country has historically been the pre-cursor to that country's global dominance in that industry. He also says that we will always observe some very adverse conditions and some pre-existing strengths or support structures which make this path to global dominance possible. So in a nutshell, adverse conditions and pre-existing support structures make the local competition fierce and hence competitors very strong in the long run.

So coming to the level of our everyday life, however bad things people say about the dark human emotions like jealousy and anger (for revenge), smart people have been able to use these to their advantage and win the game. How sustainable this method could be in the long run is really debatable (I personally don't believe it is very sustainable in the long run) but in the short run it is definitely the way to follow, if one wants to progress or grow. I guess if we just take this debate to a very high level then we can say that it is the classic debate about capitalism or socialism :-) So I obviously am a non-existent speck of dust in front of the intellectual giants who are advocating both sides of this big debate. But I do believe that wherever healthy and fair competition exists, it definitely is the engine of growth. Also we should not forget that when the gap between the strength of competitors is very large then it never remains a fair competition unless the strongest is a benevolent person/entity/country.

Again, I still wonder why it so happens that we are always jealous of the person running next to us in the race. Is there something which nature wants to tell us through this?

By the way, an interesting aspect of internet which is worth another posting is how it changes these fundamental or natural law of competition :-)