This is a quick write-up I produced a while back when someone asked me what's the innovative thing you've done. I thought I'd share this story with you all (of course with a revision) now that the impact of this invention is tangible and public. Welcome the feedback and look forward to hearing your inputs on how this invention can be democratized globally. The link to Linkedin article is - https://www.linkedin.com/pulse/what-most-inventive-innovative-thing-youve-done-melachervu/

1. Venkateswar Reddy Melachervu 1
29th Oct 2017Most Inventive or Innovative Thing I’ve Done
What is The Most Inventive or Innovative Thing You’ve Done?
THE INNOVATION
“Creativity is thinking up new things; Innovation is doing new things” said Theodore Levitt, American economist
and Harvard Business School professor of mid-20th
century. My fascination for technology comes from my
unflinching belief that technology that appears as a magic, is a logical democratized tool that can be leveraged to
create innovations transforming lives and society for a better and safer tomorrow.
One of the most innovative things I’ve done, of late, is the transformational output I’ve achieved out of an
endeavor that I embarked on to build an eco-system to prevent medication errors and enhance patient safety
during my stint at Apollo Hospitals. The outcome was world’s first cloud-based, SOA1
-centric, webscale2
Medication Safety Solution – from concept to commissioning.
CONTEXT
When I started working at Apollo Hospitals group in 2009 heading technology and solutions for their newly
incubated group start-up HealthNet Global, the now joint-MD of the group had said that drug interactions – the
chemical interactions manifested on human body when patient takes multiple drugs (as part of therapy) or when a
patient has pre-existing illness – especially negative interactions arising from wrong or mis-spelled or mis-
interpreted drug names from prescriptions (LASA3
, SALSA4
), could harm patient’s health jeopardizing patient safety
and had asked me to create a database of drug interactions that doctors and other healthcare professionals could
refer to while treating a patient.
Being a victim of negative drug interactions during my childhood, I could correlate instantly and clearly to what she
was looking at solving – preventing medication errors. I was treated timely and saved fortunately from the brink of
being dead when a doctor of a community hospital in Gadwal district of Telangana state (Mahabub Nagar district
of undivided Andhra Pradesh), the only town whose weaved silk (zari) saree adornment kicks off Lord
Venkateswara’s Brahmosthavams at Tirumala annually , nearby the village where I grew up, injected two drugs in a
gap of 30 minutes, un-aware of their negative interactions, for treating fever and abdominal pain I was suffering
with. Additionally, she had asked me to leverage a database that was created some ten years back by the
group/partner which was not in use then.
DEEP DIVE
Racing ahead, I did a quick research to understand the enormity of the problem on global scale, medication safety
eco-system, global medication error scenario, medication pathways, where and why errors occur, challenges,
current global practices, solutions etc.
What I found in my research was startling and spine-chilling!
• As per American Institute of Medicine in 2006, at least 1.5 million Americans are sickened, injured or
killed annually by errors in prescribing, dispensing and taking medications of which 7,000 are deaths
• Of 3 billion prescriptions filled each year in US, 5% are incorrect and the extra expenses of treating drug-
related injuries in US hospitals alone is estimated at $3.5 billion annually
• In India, healthcare fraternity feels that 10-15% of prescriptions may lead to some kind of drug
interactions
I figured out from WHO India representative’s 2011 press meet that the medication safety scenario in India could
be at least 10 times worse than that of US.
1
SOA – Service Oriented Architecture
2
Webscale – Highly Scalable, Available, Web Architecture
3
LASA – Look Alike, Spell Alike
4
SALSA – Spell Alike, Look Alike, Sound Alike

2. Venkateswar Reddy Melachervu 2
29th Oct 2017Most Inventive or Innovative Thing I’ve Done
I gathered from my research that the root causes for the medication errors were improper or lack of drug
information and human errors in medication pathway. While it was a bit of surprise to find that practices like 7-
Rights Framework (a manual practice) that providers have been practicing for some time did not produce any
significant improvement in preventing these errors.
While, undoubtedly, the damage is enormously grave and characteristically historic, what I arrived at based on my
research findings got me hooked, obsessed and pushed me into thinking deep into exploring a seamless solution
leveraging technology.
THINKING BIG
I realized from my research findings that preventing medication errors requires an integrated, seamless, systems-
based approach with zero human dependency in order to control the conditions that contributed towards errors. I
also opined that a database of mere drug interactions as a reference will not have any significant adoption and
scalable impact. I could foresee that it was increasingly becoming humanly impossible for doctors to remember all
mesh-connected interactions across myriad of brands with ever growing brands and generics, nor was it
operationally feasible for them to manually refer while treating in a large-scale care setting.
It dawned on me that such a system should not embrace manual intervention and address not merely drug
interactions, but offer a pluggable framework for many other dimensions of patient safety – dosage, age, existing
illnesses, lab etc. interactions – a total of 26 dimensions that I defined later and should scale elastically across care
settings of differing sizes.
It was quite a revealing moment for me.
While I could find many free or commercial drug interactions database applications in the global market that
required a healthcare professional to manually refer to these to find the interactions, I could not find any solution
that screened a prescription automatically for possible drug interactions avoiding manual reference.
I could visualize that such an integrated and automated solution for Error Free Medication Eco-system should entail
body of drug knowledge, massive search capabilities a la google, demanding response time (less than few
seconds), SaaS-driven integration architecture for HIS5
at the point of use for faster adoption and democratization
of the benefits across the industry.
It was a eureka moment for me!
BUDGETARY BUY-IN
While I was thrilled and excited by this innovative and first-of-its kind cloud-based patient safety solution, I knew
I’d increased the scope and budget of the project considerably and needed buy-in from the executive
management.
I’d presented my research findings, Error Free Medication Eco-system that I’d designed, multiplied benefits in the
context of new vision - faster adoption across the group, dynamic and seamless scaling across the networked
hospitals, transformative impact and enhanced patient safety with an incremental but not multiplied budget – to
the executive management team (Joint-MD, CEO, COO et al) and was able to convince them and get the budgetary
approval.
FRUGAL EXECUTION
I embraced agile development methodology with multiple sprints, dividing the solution into 3 primary functional
components – drug content, drug content administration framework and live prescription validation engine with
first iteration targeting 4 dimensional interactions – a minimum viable product. Team structure I’d instituted
5
HIS – Hospital Information Systems – Admission, Billing, ePrescription etc. integrated capabilities for Healthcare
Providers

3. Venkateswar Reddy Melachervu 3
29th Oct 2017Most Inventive or Innovative Thing I’ve Done
comprised of a product manager shouldered by myself, content team lead by Apollo central region pharmacology
head with 10+ senior pharmacists, lean software engineering team of 5 members and a user acceptance team of 2
members.
I chose to apply a unique product development framework that I created, practiced and evolved over two plus
decades of my global product development experience across industries - Disruptive Frugal Innovation Engineering
dFINE™ - that provided a fusion engineering execution platform embracing globally well accepted and respected
notions of Disruptive Innovation, Blue Ocean Strategy and Lean Start-up helping me achieve product utility,
shortened development cycle time and amazing user experience.
STAKEHOLDER MANAGEMENT AND EVANGELIZATION
As we started on the first sprint, I learnt to my dismay, from interactions with senior doctors, surgeons,
pharmacists etc. across the groups, that the legacy drug database content I was asked to leverage was rejected in
the past by Apollo’s Drug and Therapeutic Committee – an internal doctor fraternity – primarily because of content
errors.
While I was suspecting that the legacy database content was much less in scope and quantity with non-scalable
data entity relationships - this came as big surprise rather shocking news. I knew if this rejection is not reversed
soon, the new solution we were investing in and creating was not going to have any takers hitting fundamentally at
the confidence and integrity of the solution jeopardizing the targeted benefits of patient safety.
I knew addressing this hurdle had to be of high priority and immediately devised a multi-pronged strategy along
with the content head addressing - cleansing the legacy content for errors, automating and auditing content
creation process with multiple tiers and re-designing the data entity relationships. I’d also instituted a clinical
governance team drawing clinical pharmacology and practicing experts from across the group to vet, audit and
approve content sources, content scope, quality and quantity. I pushed forward executing this strategy with
surgical precision in the next few weeks during the first sprint and got the approval by the very team that rejected
the content and gained the content acceptance across the group before new content was added for the beta run
in Hyderabad.
Though Apollo had fully digitized medical reports, records, prescriptions etc. and automated IP6
processes for
around 50% of its 10K IP beds across India in the past, the end-user acceptability of these deployed HIS systems for
their usability was at the lowest – reasons being non-responsiveness of interface, cluttered and heavy user
interfaces, non-optimal key-board interventional design et cetera.
One of the areas I gave top priority during design was to create lean, clean and optimal key-board interventional
user interface design with interaction alerts organized visually and optimally by involving few senior end-user
community members. Knowing the usability resistance anecdotes of HIS from the past, I counteracted formation of
any pre-conceived usage resistance based on their historical experiences by organizing workshops, awareness
sessions about the solution, work-flow, how we arrived at the clean, lean and visual alerts design, benefits etc. to
end-users, drug and therapeutic committees, clinical administrators, resident doctors, senior stake-holders etc.
before the beta deployment, early in the game.
Spreading the solution socialization activities across all locations in India, I authored and published a white paper
War against Medication Errors: Creating an Error-free Medication Eco-system in the periodicals and grass-roots
reaching publications of corporate clinical quality group, presented in the annual Clinical Quality Excellence
workshop etc. which were well received and helped create a conducive environment for the faster adoption.
Post user acceptance test phase, I ran a beta for few weeks across select patient wards in one location and
presented beta run summary – interactions found (categorized) and prevented, details of the interacting
molecules, end-user experiences and feedback on usability – to all senor stake-holders and eco-system players,
6
IP – In-Patient

4. Venkateswar Reddy Melachervu 4
29th Oct 2017Most Inventive or Innovative Thing I’ve Done
achieved solution acceptance and defined enhancement roadmap for next iterations based on their feedback
before deploying the solution across AP and Telangana.
Evangelizing and spreading the importance of medication safety and benefits of this innovative solution outside
Apollo, I’d convened and presented in multiple plenary sessions with eminent personalities in the related field –
Drug Controller of AP, MCI7
board member etc. at global healthcare IT expos that had received overwhelmingly
positive response.
IMPACT
Deployed across southern region of Apollo Hospitals as of 2014, this solution is protecting 3K IP patients 24x7
against medication errors – creating technology driven invisible Patient Safety Shield for 5 interaction dimensions
(drug-drug, therapeutic duplication, drug-food etc.) at a run rate of around 2 million medication safety
transactions per month since deployment. This number would get tripled at a minimum as the solution gets
deployed across rest of the locations.
With over 1000+ clinical, brand and regulatory fields per drug for 75K brands across 26 dimensions of interactions
and 5K+ pharmaceutical manufacturers’ information in its fold, the content that my team had created is one of the
biggest Bodies of Drug Knowledge and probably the biggest in Asia.
The key differentiator for the utility and faster adoption of this solution was seamless integration (zero manual
intervention) of the prescription live screening into the legacy HIS leveraging SOA across multi-dimensional
interactions that alerted the healthcare professional visually and comprehensively in case of medication error right
at the point of prescription.
This innovation was showcased in many national and international expos. Talking about the solution after a
demonstration, Ms.Jacobson Ann, the then executive director of JCI – its accreditation is considered the gold
standard in global health care – said “This solution is a first such extensive clinical validation solution that I’d seen
for patient medication safety and would actively help the healthcare fraternity move towards a paperless
prescription seamlessly”.
Expressing the immense impact this innovation could create in clinical analytics, Dr Giridhar Gyani, the then
secretary general of QCI, said “The amount of clinical data this solution generates is immensely useful for
therapeutic clinical analytics, research and innovations”. This innovation has bagged national award for "Innovative
Use of Technology in Healthcare Delivery" at FICCI Heal 2014 Excellence Awards.
The transformational impact this solution has created and the potential for further innovations in clinical analytics,
research from the data generated by this platform were way beyond initial expectations – it pushed the
medication safety to the next historical level and raised the patient safety bar in Apollo.
Imagine preventing a fraction of reported number of 1000s of fatalities with this innovation which still runs into
few lives saved annually. Not many would be fortunate enough to be part of such transformational initiatives in
their life time. I feel fortunate and fulfilled for being able to contribute to raise the patient safety bar and
transform lives through technology through this pioneering endeavor which I am hoping would become (and
would work towards) ubiquitous in all care settings in not-so-distant future.
EPILOGUE
As of April 2016, this solution is running across majority of IP beds in Apollo with the below lifesaving outcomes
(refer to page 35 in this link for more details)
▪ 33 million live prescriptions (IP) screened for 26+ dimensional interactions and counting - in previous 2
years (as of April 2016)
▪ An average weekly run/safety rate of 5+ severe drug interactions & 10 therapeutic duplications prevented
7
MCI – Medical Council of India