Sustainable preventive-care for Diabetes for bottom of the pyramid


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Non Communicable Diseases are like Tsunamis hitting the developing economies and killing the demographic dividend. Costly and financially devastating Curative care is not the solution. Preventive care designed on a different model with sustainability is the path to travel

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Sustainable preventive-care for Diabetes for bottom of the pyramid

  1. 1. The Context Healthcare in India And beyond 1 c: Rtn. Srihari Boregowda, CONFIDENTIAL +91 98441 19490 25/04/13
  2. 2. On a Saturday Morning at a Rotary convention Why? 2 c: Rtn. Srihari Boregowda, CONFIDENTIAL +91 98441 19490 25/04/13
  3. 3. 3 25/04/13
  4. 4. The Problem: Tsunami of Non Communicable Diseases (NCD) Diabetes, Cardiovascular, Hypertension, Cancer, Pulmonary 180 million at Risk from NCDs, 55% of deaths are due to NCDs and can be prevented or at fraction of cost India Diabetes affecting young population, (40s) can be a nullify the “demographic dividend of India” 4 . ©Srihari Boregowda +91 98441 19490 CONFIDENTIAL Diabetes leads to other NCDs > Half of the population is undiagnosed > 20% of 30+ are at pre diabetes Impact of Diabetes is 3 times more on BoP, leading to economic Ruin of the entire family V8:04-Aug-13
  5. 5. Why Diabetes to begin with?: Silent Destroyer, leader of NCDs Diabetes : 1.Holistically Addressing Diabetes, you are addressing all the triggers for other NonCommunicableDiseases, like Hypertension, Cardiac, Kidney etc., 2. General awareness of the “Sweet Disease” Madhu Meha is high even among rural folks 5 . ©Srihari Boregowda +91 98441 19490 CONFIDENTIAL V8:04-Aug-13
  6. 6. Acceleration due to Causes(Lifestyle) 6 c: Rtn. Srihari Boregowda, CONFIDENTIAL +91 98441 19490 25/04/13
  7. 7. NCDs are easily preventable by Lifestyle modification Chronic Stages Stage#1 Stage#2 Stage#3 Stage#4 ß cell mass IBSAPG Evidence of Insulites (IVGTT) Glucose Intolerance, Environmental l Modifiersà Auto antibodis to Insulin IA-2 47% Financial Model of Diabetes as a Preventable disease 7 Loss of first phase Insulin Response (IV Glucose) Addressed by Preventive care Genetic Predisposition Of population 7% Beta cell Pathology PreDiabetes Healthcare Cost V/s Age-,Risk factors in population 35% 22% 18% 10% Healthy-Risk Clinical Model of Diabetes as a Preventable disease At-Risk Chronic Loss of Glucose Tolerance (Oral Glucose) Diabetes 48% 17% Acute Years Health Expenses Beta cell Function 100%
  8. 8. Proposal for Year 2013-2014 Presentation for Rotarians 8 c: Rtn. Srihari Boregowda, CONFIDENTIAL +91 98441 19490 25/04/13
  9. 9. Target segment : BoP under S-E-G Just economic criteria (e.g. earning $4 -$8/ day)alone will not suffice to fit the product into the space. The suitable criteria for selecting India target segment are Socio Economic classification and further tune with Geographic i.e. Towns that have population between 1 and 5 hundred thousand, having > 100 villages in Cluster Economic Socio-Economic Geographic City Population Tier-1 Tier-2 Tier-3 Tier-4 Tier-5 Tier-6 < 500,00 Tier-7 >100,000 Annual Household Income in 000s 9 . ©Srihari Boregowda CONFIDENTIAL 25/04/13
  10. 10. 6-Step Process: Value focused delivery across the care cycle Critical Success Factor: Financial efficiency / throughput, keeping value high Value= Value&'&Strategy&Map& ΣHealth Outcomes Cost of delivery Traveling ASHA worker Care at Doorstep, Relation build Culture sensitivity, Awareness creation Mobile Health enabled, Empowerment Protocol based seeding for max coverage 10" 9" 8" 7" 6" 5" 4" 3" 2" 1" 0" 9" 10 9" 9" Integrated PHC TRAYEE" NRHMENCD" 9" 8" 7" High throughput 5" 5" 5" 4" Outcome Tracked Postponement Quality of life 3" 2" Reachout" 1 Integrated PHC Lowest cost of screening All data in digital form Evidence based, Customer Affinity Camps" 2" 2" Screening" 2 Scientific, Measurable Back-office connect EMR Expertise access , multi domain Risk (Prediction) quantification Evidence based . ©Srihari Boregowda +91 98441 19490 Prognosis" 3 1" 1" Advice" 4 0" 0" Management" Preven@on" 5 Holistic, Integrated AYUSH and integrative medicine Patient centric, Wellbeing: Physical, emotional, Social & Spiritual CONFIDENTIAL 6 Care Pathways Behavior Modification SMS Alerts, Coaching Community creation V8:04-Aug-13
  11. 11. Affordability and Access Driven by Technology Value&'&Strategy&Map& Reachout" Sensor as Service Anywhere, Anytime Access Screening" SENSOR NETWORK Advice" 1" 1" Management" MOBILE HEALTH . ©Srihari Boregowda +91 98441 19490 BIG DATA / ANALYTICS CONFIDENTIAL N I A M 5" 0" 0" Preven@on" Behavior Modification & Reachout Cloud Infrastructure: Device, Protocol, Telemedicine, Delivery, EMR/PHR D4D:Data for Development 11 Prognosis" 2" 2" 8" O 3" Outcome D 2" 4" 5" 5" 9" Disease Surveillance, Predictive Care V8:04-Aug-13 Te c h n o l o g y 7" 9" Advice 9" Prognosis Reachout 9" Screening 10" 9" 8" 7" 6" 5" 4" 3" 2" 1" 0" Management M o d u l a r I m p l e m e n t a t i o n : Camps" r tNRHMENCD" n yTRAYEE" t i c a l Sta with a ver
  12. 12. 1-Reach out: Protocol driven, Risk stratification at Family level In  the  first  2  months,  Artoo  helped  ICTPH: Artoo  brings  to  life  technical  expertise,  coupled  with   the  ability  to  collaboratively  adapt,  be  it  healthcare,   education  or  financial  inclusion.  Their  entrepreneurial  spirit   and  close  attention  to  every  engagement  makes  it  an   even  more  fulfilling  experience. Coverage of Chronic NCDS 1.  Diabetes, 2.  Cardio Vascular, 3. Hypertension, 4.Acute Lower Respiratory Illness 12 . ©Srihari Boregowda +91 98441 19490 CONFIDENTIAL V8:04-Aug-13
  13. 13. 1Reachout: ICT enabling mobile Health workers 13 Src: Artoo . ©Srihari Boregowda CONFIDENTIAL 25/04/13
  14. 14. 14 c: Rtn. Srihari Boregowda, CONFIDENTIAL +91 98441 19490 25/04/13
  15. 15. Step-2 Screening: Integrated PHC for Diabetes: Diabetes has multiple problem attributes: It is primarily Endocrinology but, it is also renal problem, It is also vascular problem, Retinal problem and so on. Need to Integrate care delivery around patient and not federated around clinical specialty Integrating 3 Components Measurement,  Diagnosis,  Forecastà Decision Points   Platform assisted Medical    /  Surgical Specialists   Medical   Generalists   Paramedics Patient   “At home /PHC” healthcare       “CCC” Telemedicine “Secondary /Tertiary” healthcare Common Healthcare Platform   Multi-­‐loop   Value  Creation   ß  Therapy,  feedback,  Prescription 15 . ©Srihari Boregowda +91 98441 19490 CONFIDENTIAL #1 Knowledge component #2 Technology Component #3 Operational Component Care Protocol Disease Management Integrated Medicine Nutrition Partnerships EHR/PHR/ DHIS Sensor Kits Telemedicine NW BigData, analytics Mobile Apps Model Clinic: Low cost medecine, Telemedecine center, Screening Center, Microlab Local Resources: Councellors, ASHAS, Hygenists, Nutritionist, Local Doctor V8:04-Aug-13
  16. 16. 2-Screening: Coverage across the Disease manifestation Sample Process: Src: Karnataka Institute of Diabetology Conducted by Trained Paramedics: Opportunity for Rural employment Test Glucose 40 Paisa Lipid Profile 15 Rs. Kidney function test 16 Cost 12 Rs. . ©Srihari Boregowda CONFIDENTIAL 25/04/13
  17. 17. PHAR   MACY   REGISTRATION   Wai:ng  /  Interac:on   Area   ..   1.6m  x  1.5m   (Op:onal)     Storage   UPS   17 1   Educa:on  Posters   Low  cost  medicine   leverageGenerics   Re:nopathy   Neuropathy   Vasculopathy     Spectacles   Educa:on  Posters  /  LCD  panels   Educa:on  Posters   5   Educa:on  Posters   Step-2 Screening: Integrated PHC for Diabetes: Model Layout Teleconsult   With  specialty  care   •  Diet   •  AYUSH   •  Physical  Ac:vity   6   3   One2One   counseling   2   . ©Srihari Boregowda +91 98441 19490 4   Lab  +   Inves:ga:on   2.5  x  1.5m     CONFIDENTIAL Creating Consumer Experience: India has moved on from traditional to Modern retail format. Ini:al  consult   3.0m  x3.0m     The PHC is integrated to screen, refer and manage and deliver under one roof as a Convenient Daycare clinic to give differentiated consumer experience V8:04-Aug-13
  18. 18. 3-Prognosis: Tele Expert advice, EMR, Sensor data, Questionnaire Screening Hosted Archived data Prognosis EMR, Care Pathway Video / Audio conference Expert-in loop i2i telesolutions 18 . ©Srihari Boregowda +91 98441 19490 CONFIDENTIAL V8:04-Aug-13
  19. 19. Step-4 Advice Advice is generated from Expert’s inputs and care pathways. It is generated to be Patient centric based on Sex, Age, Culture, lifestyle, economic status. It is calendar of action in the daily life of the patient. The orientation is not absence of Disease but overall wellbeing Value 4.1: Diet Advice: Fit to Local, enjoyable, Cuisine Value 4.2: 1 to 1 counseling, Eliminate chronic stress TOMATO DOSAFor 1 serving (3 Dosas): Calories 319 kCal Carbohydrate 55.3 gm Protein 10.5 gm Fat 6.8gm Value 4.3: Exercise to fit daily routine, monitored Value 4.4: Medication using Generics reduce cost:1/3rd to 1/10th Sample Exercise Plan: Schedule # Branded Rate 15151 3 X ₹&&&&& 0.55 05051 1 Y ₹&&18.00 05051 1 Z ₹&&&&& 4.50 Total;cost;per;day Price Locost ₹&&&&&&&&&&1.65 Metformin ₹&&&&&&&& 18.00 Atorrastitin ₹&&&&&&&&&&4.50 Atemol ₹;;;;;;;; 24.15 Cost;Per;Month55> ₹&&724.50 19 . ©Srihari Boregowda +91 98441 19490 CONFIDENTIAL Rate ₹&&0.39 ₹&&2.20 ₹&&0.28 5&times&Saving&@@> V8:04-Aug-13 Price ₹&&&&&&&&&&1.17 ₹&&&&&&&&&&2.20 ₹&&&&&&&&&&0.28 ₹;;;;;;;;;;3.65 ₹&&109.50
  20. 20. Wellbeing = Health W.H.O. Definition Of Health Step-5 Wellness Management (Spiritual) Emotional Mental Physical Health is a state of complete physical, mental and social wellbeing and not merely the absence of disease or infirmity. Wellness is an active process of becoming aware of and making choices toward a more successful existence Treatment Compliance Green New/Un-­‐Familiar Dot Is  done  one   time Span Has  duration   such  as  40   days Path   Is  a   permanent   change 20 Install  Solar   Panels in  house GREEN  DOT Car pool  to  work   for  3  weeks Blue Old/  Familiar Tell  a  Friend   about  eco   friendly   Purple Increase Plant  more  trees   and  local  plants MOBILE BLUE  DOT Bike  to  work  for   a  month GREEN  SPAN BLUE  SPAN Start  growing   own  vegetables Turn  off  lights   while  leaving   room GREEN  PATH BLUE  PATH PURPLE  DOT GRAY  DOT Take  public  bus   for  one  month Take  shorter   showers  this   week PURPLE  SPAN Purchase  more local  produce Behaviour   PURPLE   ModificationPATH . ©Srihari Boregowda +91 98441 19490 Gray Decrease Buy  fewer     bottled  water GRAY  SPAN Eat  less  meat from  now  on GRAY  PATH Black Stop Turn  off  space   heater  for  one   night PURPLE  DOT Don’t  water   lawn  during   summer PURPLE  SPAN Never  litter   again PURPLE  PATH CONFIDENTIAL Value 5.1: Addressing through Holistic and integrative (Alternative) medicine Value 5.2:Treatment Compliance and wellness management through behavior modification V8:04-Aug-13
  21. 21. Implementation Model Financial and Business related Note: These are budgetary figures, Actual Numbers may vary while implementation 21 . ©Srihari Boregowda, CONFIDENTIAL +91 98441 19490 25/04/13
  22. 22. Even Philanthropy has changed Service above self: I sought my soul, my soul I could not see I sought my god, my god eluded me I sought my brother, I found all three 22 c: Rtn. Srihari Boregowda, CONFIDENTIAL +91 98441 19490 100% Result Driven Service 25/04/13
  23. 23. We need inclusive Revenue Models to Sustain 23 •  •  •  Membership Model (Subscription) Annual enrollment =X Monthly subscription = Y Base consultation charges=x Lab and diagnostic charges =y Generic Drugs = z Total fees F= x+y+z PPV+ Co-pay model Visit Charges •  •  •  •  Base consultation charges=x Lab and diagnostic charges =y Generic Drugs = z P=part or whole is reimbursed by a sponsor/NGO / Govt. Total fees F = x+y+z-P . ©Srihari Boregowda +91 98441 19490 CONFIDENTIAL Pre-Paid Based Post-Pay Based “Pay-per visit: PPV User fee based model •  Unlimited teleconsult •  N #, Free visit, Tests, consult •  Generic Drug, supplement Total fee F = X + (12 x Y) Micro Insurance for Health •  Annual Insurance=X’ à to Micro Insurance •  Society= Y’ à Co-op / SHG •  Co Pay = Z Micro Insurance pays part for Outpatient and takes care of catastrophic care as well Total fee = Formulated {x,y,z} V8:04-Aug-13
  24. 24. Revenue / working Model —  Procure Model —  Cap-ex led fixed cost of 1,200,000 (12L) one time procurement and operational costs of Rs 75,000 per month —  Operate Model —  Op-ex led Fixed cost of for 2 pilots totally subsidized by Sponsors and new ones will be charged 1,200,000 (12L) per center, operational costs recovered by charging patients and /or re imbursement from Govt. at Rs 250/ - per patient —  Build-Own-Operate model —  Hybrid capex of 600,000– 50 % upfront paid by Sponsor, remaining 600,000 of Capex and op-ex recovered by charging patient or Govt. re imbursement of Rs 500/- per patient till recovery period 24 . ©Srihari Boregowda +91 98441 19490 CONFIDENTIAL V8:04-Aug-13
  25. 25. Screening Workflow Model and costs ASHA workers go house to house 1.  1.  1.  2.  3.  4.  1.  5.  25 Blood Glucose, Lipid profile, HB, BMD and BP - Rs 50/Those found Diabetic go through target organ tests - Rs 250/If CKD +ve then go for CKD staging test - Rs 75/- (optional) Those who are hypertensive detailed ECG – Rs 100/- (optional) PHC Counseling 3.  4.  Counseling done, data collected using tablet, high risk population identified and eHealth Record created - Free PHC Screening 2.  One PHCenter for 40,000 Population Screenings Per Hour Screenings per month Screening Revenue per month Nott Expenses Retaining per month Breakeven.. (Subscription amount accelerates) 6 960 240,000 140,000 100,000 9 to 12 months Counseling by dietician is free All electronic records are maintained in the cloud and UID/ MRN number assigned for each patient for follow up and staging information. Disease management for Diabetes and Hypertension done by providing training material, timely SMS, telephonic calls with the councilor/ doctor in case of emergency regulated by councilor and periodic screening. . ©Srihari Boregowda +91 98441 19490 CONFIDENTIAL V8:04-Aug-13
  26. 26. Risk Level Achieving Sustainability: Timeline for One center Inclusive Revenue model, builds up sustainability Infrastructure setup 3M Startup Operation Village Entrepreneur Management Transition Plant & Machinery capital Rs.1,200,000 18Months Market Risk Operational Risk Operational Capital Rs. 500,000 Rs. 75,000 x 6 months Spin-off one more Project With retained earnings Fully Sustainable operation 9Months 6Months Investment Risk Capex Project Cost 19 Lakhs 30 Months Results . ©Srihari Boregowda +91 98441 19490 BoP learns value of wellness Rural employment generation Education, Diet foods as spinoff Working Capital Intangible Rs. 200,000 Tangible Rolling Cash will be retained cost per test: Rs. 250 (600 tests pm – 20 ~ 30 a day) to cover opex 26 time CONFIDENTIAL Screen and mange 40,000 population Sustainable Project V8:04-Aug-13
  27. 27. Key Results for Rotary —  Sustainable Healthcare —  Take Care of Chronic conditions, Prevent Disease, Save lives o  Use of herbal medicine for minor ailment, Hygiene, maternal care —  Social Good: Following are broad benefits to the villagers —  Sociocare: ensure sustainability and scalability —  ASHA workers, aspirational goal.(micro entrepreneurs). Avoid mindless urban migration Empowering a housewife on health and socially has 3 times benefit to the family. (Micro Insurance) —  spiritual orientation and cultivation of human values to eradicate Caste and other social ailments. Leads to social inclusion, inculcating moral values, leadership —  —  Package Healthcare through Society:—  supplement other skills that can lead to better lifestyle —  e.g. apiculture, floriculture, financial literacy, food processing, tailoring Despite Governments' efforts and being signatory to Millennium Development Goal, It has not been able to take off on cracking NCD problem. Pnly Private-Public-NGO –Rural entrepreneur partnership can make difference 27 c: Rtn. Srihari Boregowda, CONFIDENTIAL +91 98441 19490 25/04/13
  28. 28. Proposal and way forward 28 Rtn. Balasubramanyam K S President RY-2013 Rtn. Srihari Boregowda Secretary RY-2013 25/04/13
  29. 29. Creating Revolutionary Wealth Through Social Business —  Which is the greatest gain? Health! —  Which wealth is the best? Education! —  Which treasure is the best? Skill! Yakshaprahna: an F.A.Q in 3000 BC. 29 . ©Srihari Boregowda +91 98441 19490 CONFIDENTIAL V8:04-Aug-13
  30. 30. ‘As On 30th Jan 2013 3800 Rotarians Section B RI District 3190 87 Clubs 55 from Bangalore, 32 from surrounding areas In the 4th decade of service
  31. 31. The Hospital is located in Ideally potential place. It blends the Rural (Uttarahalli cluster) and the Sprawling Urban location Rajarajeshwarinagar Rajarajeshwari Medical college & Hospital BGS Global Medical College and Hospital c: Rtn. Srihari Boregowda, CONFIDENTIAL +91 98441 19490 Rotary club of Bangalore, MOU with Rajarajeshwari hospital
  32. 32. Lab Registration Entrance Consultation The existing operations are mostly carried out in Ground floor. Mainly OPD consulting, LAB tests and Patient Stabilization. This can continue as is Medicine Ground Floor Footfall:15-20 Patients / day, Urban Poor 32 c: Rtn. Srihari Boregowda, CONFIDENTIAL +91 98441 19490 25/04/13
  33. 33. Changing Room Repurposing The existing Facility Gynec Free Space (Landing) Operation Theater Optholo mology 5 Bed Ward 33 c: Rtn. Srihari Boregowda, CONFIDENTIAL +91 98441 19490 —  First Floor This Area is underutilized. Can be re modeled for the Integrated Diabetes Clinic. The area and sections neatly fit for the purpose and also does not impact the existing operations 25/04/13
  34. 34. Global Grants —  Support the goals of one or more of the areas of focus —  Produce measurable outcomes in the benefiting community —  Achieve results that can be sustained after the grant funds have been expended —  Have been developed in conjunction with the benefiting community to address their most pressing needs —  Seek to address community needs in an integrated manner 34 c: Rtn. Srihari Boregowda, CONFIDENTIAL +91 98441 19490 25/04/13
  35. 35. Result based Project funding —  If results are not measurable Goals, you cannot tell success from failures —  If you cannot see Success, —  you cannot reward it. —  If you are not able to clearly reward success, then in all probability you are rewarding failure —  You cannot learn from it. —  If you cannot recognize failure, you cannot correct it. If you can demonstrate results you will obtain stakeholder support in large 35 c: Rtn. Srihari Boregowda, CONFIDENTIAL +91 98441 19490 25/04/13
  36. 36. Reachout: Integrated Rural Clusters Devara Hosahalli 1 of 135 Villages Population: 800 3 k.m.s NCD PHC PHC Location: e.g. Channapattana: Tier-6 city/ town. Population 95,000 55 KMs from Bangalore 36 . ©Srihari Boregowda CONFIDENTIAL 25/04/13
  37. 37. Results Results Framework Goal Reduced Mortality and Morbidity from Non-Communicable Diseases Outcome Value Focused Preventive care Delivered Implementation Delay / Prevention of disease {Measured} Improved Quality of life {Measured} Wellbeing {Assessed @ Physical, Mental Social, Spiritual. Quality of life} Output 37 •  •  •  •  •  •  10 Integrated PHCs rolled out, 10,000 people screened 50 Health professionals trained, deployed, 500 Volunteers enabled Sustainability ensured {Financial model established} Activities •  •  •  •  Conceptualize, design, Implement and operationalize through Pilot Interact with Govt., corporate and other agencies for reimbursement of costs Campaign, Brand build, Train with feedback Inputs •  •  •  Funds, Equipment, Expertise Volunteers, Trainers, Clinicians Place (PHCs), Mobile Vans
  38. 38. Service above self ü  Social Activism ü  Responsible Charity ü  Conscientious Citizenship 38 c: Rtn. Srihari Boregowda, CONFIDENTIAL +91 98441 19490 25/04/13
  39. 39. Community/ Need Assessment Tools —  Survey —  Asset inventory —  Community mapping —  Daily activities schedule Develop Community / Village Development Index with11 Points —  Seasonal calendar —  Community café —  Focus group —  Panel discussion 39 c: Rtn. Srihari Boregowda, CONFIDENTIAL +91 98441 19490 25/04/13
  40. 40. Exit to Sustain: STSTM framework Rotary is a an enabler. It is all about from community to community. Long term sustainability is to ensure that a model is built, operated and transferred to local community / resources 40 —  S.T.S.T.M —  Serve à Do it yourself and iron out —  Trainà Recruit and transfer knowledge —  Support à Handhold, Co-Operate —  Transfer à Assets and Operations —  Monitor à thro the KPI. Key performance Indicators It takes 18 to 36 months to achieve this. Involve the next 2 year’s team from beginning, let the learning happen continuously 25/04/13
  41. 41. PARTNER ECOSYSTEM network of organizations – including suppliers, distributors, customers, competitors, government agencies fostering “Open Innovation” 41 c: Rtn. Srihari Boregowda, CONFIDENTIAL +91 98441 19490 25/04/13
  42. 42. Estimated Cost Schedule, Hybrid Capex-­‐1   Qty   Portable  Compact  Lab-­‐Accuster  (Basic)   Ophthalmic  Prescreener-­‐  3Netra   Neuropathy,  Vasculopathy  -­‐   Integrated  Vital  measurement  (ECG,  NIBP,..)   I2I  Tele  solu:on  (Telemedecine+  EMR)   Tablets-­‐  (Android/Windows)   Server+  Wi-­‐fi  network   Solar  with  UPS  (1.5  /  0.8  KVA)   1   ₹  2,00,000    ₹  2,00,000     1   ₹  4,50,000    ₹  4,50,000     1   ₹  1,20,000    ₹  1,20,000     1   ₹  25,000   ₹  25,000   1   ₹  1,05,315    ₹  1,05,315     4   ₹  15,000    ₹  60,000     1   ₹  1,20,000    ₹  1,20,000   1    ₹  1,20,000      ₹  1,20,000     Total  Capex  /  PHC    ₹  12,00,315     42 Price   Cost   Opex-­‐1   Paramedic  (Technician  &   Die:cian)   ASHA  Workers   House  Keeping  staff   Consumables   Remuner a:on      ₹  25,000      ₹  10,000      ₹  2,000      ₹  3,000     #   Cost  P.M.   2   2   1   5    ₹  50,000      ₹  20,000      ₹  2,000      ₹  3,000      ₹  75,000     1.Hb, fasting and PP sugar, lipids, LFT      Rs 50/1.b creatinine( with eGFR) Rs 75/- (opt only if CKD +ve) Test 2.HbA1c                                                                                            Rs 40/Cost 3.Ophthalmic examination(3Nethra)                                              Rs 90/Breakup 4.Foot neuropathy/Vasculopathy evaluation                                      Rs 40/5.Microalbuminuria                                                                            Rs 20/6. BP, 5 lead ECG, BMD Rs 10/                                                                                                   ----------------------. ©Srihari Boregowda                                                                                                    Total      Rs 250/25/04/13 CONFIDENTIAL                                                                                                     -----------------------
  43. 43. BMI àMetabolic Station
  44. 44. Accuster: Low cost Lab Test BMI Free Glucose 40 Paisa Hb 30 Paisa Lipid Profile 15 Rs. ECG 25 Rs. Kidney function test 12 Rs. Liver function Test Incubator: 25 samples 37 deg.c Free Blood pressure Biochemistry analyzer 23 Parameters Consumable Cost 12 Rs. President Of India: Recognition Centrifuge: 8 samples 600 RPM Semi-automatic in which 23 blood parameters can be done, an open system type based on colorimetric principle), a micro centrifuge (6000 rpm), a small incubator, a power back up (battery operated, on simple battery it can work for 7 days continuous), micro pipette, micro tips stand, cuvette stand and all other small accessories 44 . ©Srihari Boregowda, CONFIDENTIAL +91 98441 19490 25/04/13
  45. 45. Forus Health diabetic retina screening ( Screened over 450,000 people with 110+ installations in Forus Health & 8 other countries ) India 3nethra  ,  Awards  &  Recognition                                                                  Thank  you…. 45
  46. 46. Step-5.3 Diabetic Retinopathy, Nephropathy IP being created 1 Device: Optimized attenuation and size components to create innovative and affordable pre-screening devices 2 Automatic Capture: Software identifies optimal focus length for image capture 3 Retina Image Enhancement: Image is enhanced by highlighting the areas of interest 4 Intraocular Pressure: The device uses a proprietary Mobile Enabled Diagnosis method to measure intraocular pressure The following patents that have been filed: 1. OPHTHALMIC IMAGING DEVICE: An apparatus to optimize attenuation, size, components and power consumption in low power ophthalmic Imaging devices using Multicolor LED (Light Emitting Diode) based light sources. 2. AUTOMATIC CAPTURE: Method of detecting and capture of optimally focused image in digital fundus camera 3nethra forRETINA IMAGE ENHANCEMENT: Enhancement technique for low light conditioned fundus or retinal image 3. Neurology (MUMC+ Holland) 3nethra for Nephrology (RenalyX) 4. Pediatric (Rebiscan PRESSURE: A method and system to measure intraocular pressure of the human eye 3nethra forINTRAOCULAR - Boston) 3nethra forRoP camera: Device design and associated algorithms 5. Women's Health (PESMC) Ultra Low Power Laser (Rowe - DC) 6. Diabetic Foot: Device design and associated algorithms Handheld Fundus camera (NTU) 7. Method and tools for Photo refracto meter Early Detection Referral Evaluation Monitor Patient for prevention 10 46 c: Rtn. Srihari Boregowda, CONFIDENTIAL +91 98441 19490 25/04/13
  47. 47. THERMOSCAN A Device for detection of Inflammatory Pain, Vascular Disorders and Breast Cancer. 47 c: Rtn. Srihari Boregowda, CONFIDENTIAL +91 98441 19490 25/04/13
  48. 48. Step-5.2 Diabetic Vasculopathy, Neuropathy Infrared thermo scaning or other techniques can be used Stage 1: Inflammatory Phase Stage 2: Proliferative Phase Stage 3: Epithelisation Phase Stage 4: Remodeling inflammation in diabetic foot callus 48 c: Rtn. Srihari Boregowda, CONFIDENTIAL +91 98441 19490 classification system of the plantar thermo graphic patterns based on the vascular anatomy 25/04/13
  49. 49. Sensors, Cloud, Big-data (Mobile) Can this Address Societal Problems? 49 c: Rtn. Srihari Boregowda, CONFIDENTIAL +91 98441 19490 25/04/13
  50. 50. The Invisible Descent into Poverty Hard-to-track erosive effects of slow-onset crises The Crisis Information Gap (vast oversimplification) Crisis •  Reduce Expenses •  Get Help from Friends & Family Economize •  Seek Additional Income Deplete •  Spend Savings •  Sell Property •  Go into Debt Sacrifice •  Give up Meals •  Give up School •  Give up Healthcare Irreversible Harm Permanent Damage
  51. 51. Mobile Services as Human Sensor Networks When our lives change, we change how we use services Flashing Health hotlines Voice Calling Agriculture hotlines SMS Texting Educational services SIM Top-offs Employment services Mobile banking Social networking Money transfers SMS Search Microloan repayments Citizen reporting Tower hopping Food vouchers Health hotlines
  52. 52. Addressing the Information Gap with Sensors, Cloud, Bigdata 52 With Hunchworks
  53. 53. Data For Development Orange Telecom’s Initiative: The Orange “Data for Development" (D4D) challenge is an open data challenge on anonymous call patterns of Orange's mobile phone users in Ivory Coast. The goal : To help address society development questions in novel ways by contributing to the socio-economic development and well-being of the Ivory Coast population by analyzing the anonymized call records provided by Orange Telecom and cross-compare it with other types of data to find useful insights. 53 SJB Research Foundation Tuesday, 3 September 13
  54. 54. Pilot implementation Data Parsing: •  Hadoop HDFS •  Hive Query Language •  Map Reduce Data Visualization: •  Data Driven Documents •  ( •  Google API •  Open Maps 54 SJB Research Foundation Sentiment Analysis: Analyze and visualize number of calls made on public holidays between the given period from the data Analyze and visualize important antennas and subprefecture based on: Number of Calls, Duration of Calls, Users around the antenna and in the subprefecture Obtain number of calls made everyday and aggregate it monthly: Visualize this data and correlate it with activities happening in the particular month so as to come to an inference yielding to substantial change in the future Correlate the above fetched data with data available from other sources to bring about Inputs to Participatory development of society Tuesday, 3 September 13
  55. 55. Results (Visualization: No. of calls per hour – map) 55 SJB Research Foundation Tuesday, 3 September 13
  56. 56. Results (Visualization: Top hundred calls) 56 SJB Research Foundation Tuesday, 3 September 13