What is Twitter? And why should one start using it?

Many of my professional and social contacts are already using Twitter, and yet many more are still not fully aware of it.  I am writing this brief article to introduce this great new medium to those who are not on board. If you are already familiar with Twitter, but are not actively using it – please, get onboard….you are missing out on a lot! If you are already a regular Twitter user, that’s great! Feel free to skip this article.

 

Just 6 months back, if someone had mentioned ‘Twitter’ outside the confines of some Silicon Valley coffee shops and offices, chances are they would have received a blank stare. Further more, many ‘techies’ who understood the concept would have dismissed it as another one of those Web 2.0 websites. How much difference 6 months can make! Today people from all walks of life are entering the ‘Twitter-o-sphere’! Twitter already has more than 6 Million users.

 

Initially, these new users start off with a few tentative steps to test the water. Like any new communication medium, there is some acclimatization (learning) curve. However, in Twitter this is typically very short. Many Celebrities, Politicians, CEOs, Authors, Business Gurus have started ‘tweeting’ (sending messages via Twitter). When geeky words and phrases such as ‘Google It’ and ‘Reboot’ enter out lexicon, that’s a clear signal of mainstream adoption of the technology. ‘Tweeting’ is almost there!

 

Almost all major news organizations (TV/Print Media/Blogs) are also leveraging this new medium. President Barack Obama used Twitter quite effectively in his election campaign; and in this week’s State of The Union Address Session, it was reported that a congressman was sending live updates of the President’s speech on Twitter.

 

Twitter is as fundamental a medium as ‘Email’. You can use it the way you want it. Unlike a social networking site, or a professional networking site – it doesn’t compartmentalize the user into a specific domain. Like email, you can use twitter for catching up with friends, for personal networking, for business connections, for marketing, for following news & sports, etc.

 

Twitter user base is growing exponentially and has started rivaling some of the most popular sites on the web.  As the number of users grows, so does the reach and the types in which it used. Whether it was the Mumbai Terror Attacks or the Hudson River emergency landing of a passenger airliner, breaking news was being actively disbursed via Twitter, before any of the conventional media. One primary reason for this popularity is Twitter’s cornerstone design of limiting message length to 140 characters (something that can be sent through a SMS protocol on cell phones). This forces the user to write brief and crisp messages, and enables readers to focus on the real topic quickly.

 

So what exactly is Twitter? And how does one start using it? Instead of re-inventing the wheel, I am simply going to point the reader to a great overview article & presentation “Why you should be on Twitter – and how best to use it” that was compiled by Navin Kabra, the founder of PuneTech. After going through this presentation, I hope that you can start ‘tweeting’ soon! My twitter id is ‘aparanjape’ – look forward to connecting with you there!

  

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Electronic Medical Records (EMR): A Practical Solution

Messaging, Social Networking, Photo Albums, Filing Taxes, Stock Market Investments, Banking, Paying Bills and many other activities are moving online and are being converted to an ‘electronic form’. The internet user base in India (especially in the Metros and Tier-1 cities) is growing at a very fast rate.

 

Yet, something that is very critical, something that is very personal – Medical Health Record, is still stuck with that ‘nearly 2000 year old ancient Chinese invention – Paper’! Why aren’t medical records being stored in an easy to use electronic format? As in any big change, there are multiple reasons ranging from the availability of appropriate technology, stakeholder education, standards, and process changes.

 

Today, core technology is not a bottleneck. Having appropriate technology systems for the Indian environment is important. Stakeholder education and requisite process changes at hospitals and clinics are more critical. Let us try and explore the advantages of Electronic Medical Records, and their adoption. Let us begin with the definition of Electronic Medical Records (also referred to as ‘EMRs’) – Wikipedia defines Electronic Medical Records as medical records in a digital format.

 

In the past, detailed medical records were often only generated during surgical/other critical procedures or during treatment of a serious illness. Advances in medical sciences have meant that today, we undergo a lot more preventive tests and procedures. There is a great deal of focus on improved diagnostics and preventive care. This has resulted in a dramatic increase in the number of medical records an individual would typically maintain.

 

Rapid and easy accessibility of these medical records can help save time and effort, and can potentially be a life-saving aid in case of an emergency. Paper records by their very nature are difficult to manage, copy, carry, and forward to others.

 

Benefits of Electronic Medical Records

 

Electronic Medical Records can deliver multiple benefits to the various stakeholders in the healthcare process. For patients, they simplify management of their medical history – across multiple doctors, hospitals and other facilities. They also enable quick access and retrieval in case of an emergency. Risk of loss of valuable data is greatly reduced.  For hospitals and other healthcare providers – EMRs simplify the overall records management process. For doctors, EMRs enable quick review of past history of a patient and aid in rapid diagnosis. They also enable a doctor to quickly forward and discuss a patient’s condition with a colleague or a specialist.

 

Further benefits of Electronic Medical Records can be achieved if they are made available over the internet. This enables ‘pervasive’ accessibility of an individual’s complete health picture at anytime, anywhere in the world. Adequate processes need to be taken to provide a secure login and password to maintain privacy and confidentiality of the data. A comprehensive and user-friendly categorization, storage, search and retrieval workflow needs to be enabled.

 

Similarly, intelligent offline availability of these EMRs is also critical (especially in India) where internet adoption (especially amongst senior citizens) is not that high, and where internet availability is not reliable. Offline availability can be enabled through storage devices such as CDs, USB drives, etc. It is important that the offline usage scenario has the same user-friendly search and retrieval capability of the EMRs.

 

 

Stages of Electronic Medical Records Evolution

 

EMRs are evolving through the following 4 stages (as described in Wikipedia):

 

1. Non-Electronic Data (Paper Documents)

2. Machine Transportable Data (Email, Fax, Scanned Documents)

3. Machine Organizable Data (Scanned Documents with metadata descriptors)

4. Machine Interpretable Data (Fully digitized documents with metadata descriptors)

 

[Note – ‘Metadata’ is defined in the subsequent paragraph].

 

Presently a majority of the hospitals and clinics in India are still stuck at Stage-1.

 

Stage-2 can be easily implemented but has limited value when it comes to cataloging, organization and searching of records. Stage-3 has tremendous value and relatively low cost of implementation (we will discuss this further). Note, ‘metadata’ means the ‘description of data’ and can include various organization information around a medical record such as ‘Type of document’, ‘Doctor’, ‘Date’, ‘Category of document’, ‘Importance’, etc. Stage-4 can deliver the ultimate value, but is quite expensive and complicated to implement.

 

Adoption of Electronic Medical Records – A Roadmap

 

Clearly, Stage-4 signifies the ‘utopia’ of EMRs adoption. However, what is the cost-benefit scenario? Let us explore this further.

 

Stage-4 needs the complete data (i.e. each and every row, column and field in a document) to be stored as a computer interpretable entity. Essentially, this entails a computer model (or dictionary) of each and every conceivable field (health condition (e.g. ‘Blood Pressure’, diagnostic parameter (e.g. Systolic/Diastolic), their values (e.g. 120/80), acceptable ranges (High: 100-140, Low 60-100), etc.) in any type of medical record needs to be created and stored. This is easier said than done! Such a data dictionary could run into tens of thousands of items. Free form text, such as doctor notes are even more difficult for a computer to interpret. For many hospitals and other data sources, where data is not generated electronically at source – this entails an additional manual process for keying in the data into the data dictionary format. Even if data is available electronically, lack of standards implies that different doctors and hospitals maintain different formats (in other words, each hospital has its own data model/dictionary!) – And a big mapping and data conversion exercise is essential. This predicament is a big reality in US today where every major hospital chain has implemented their own versions of such data dictionaries. As a result, they are not interoperable. In the real world, a patient visits multiple doctors/hospitals across cities and hence electronic data in one hospital’s format is meaningless during his next visit!

 

Lack of standards is one of the biggest reasons why Stage-4 EMRs haven’t been successfully deployed in US and in many other developed countries.

 

In India, we are long way off from such a common standard.  Stage-3 simplifies all the implementation issues in Stage-4 by directly storing a scanned the paper document, the diagnostic image, or an electronic document in its native format (e.g. ‘.pdf’, ‘.doc’). There is no conversion into a ‘standard format’. The only limitation here is that such records cannot be machine readable. However, that is a small price to pay to achieve comprehensive cataloging and archiving of medical information. As described earlier, these documents carry a complete digital description (metadata) and can be stored, cataloged, searched and retrieved electronically with ease.

 

As can be seen from above, a good medium balanced approach is Step-3; especially for a developing country like India. Quick benefits can be derived through a lower relative investment, and the time for implementation is also very fast.

 

‘Practical’ Solution for Electronic Medical Records

 

 

 

 

A practical solution for Electronic Medical Records in the Indian context can be based on ‘Stage-3’ described above. In future, this can be migrated to Stage-4. The basic building blocks of such a solution are described below. Pune based ‘ArogyaDarpan.Com’ offers such a practical approach to Electronic Medical Health Records.

 

1. Online Web-Service to Upload, Describe (add metadata), Save and Search/Retrieve Documents in different formats.

 

2. Offline software capability to search and retrieve previously saved EMRs

 

3. Offline service capability to collect, scan and process documents, obtain other electronic documents directly from legacy systems. This can be further extended to automatically source and integrate medical documents from various legacy systems at different doctors/hospitals.

Can Pune Emulate The Silicon Valley Technology Startup Ecosystem?

I have always wondered about the parallels between Silicon Valley and Pune. Some might call this farfetched, but there are some really interesting and some coincidental similarities. Pune (as does any other Indian City) has a long way to go to even get closer, but that should not stop us from brainstorming on leveraging these similarities as building blocks, and strive towards emulating the leader. Silicon Valley is unique. Maybe one day, we can indeed see a vibrant Pune Technology Startup Ecosystem, thriving and prospering – on the lines of the Great Technology Entrepreneurship Capital of the World!

 

I started this self-brainstorming exercise by simply listing those Pune characteristics that parallel Silicon Valley (The degrees of similarities might vary …):

 

·        Good quality of life (Compared to other Indian Metros).

·        Temperate Weather.

·        Technology Entrepreneurship Culture.

·        Fledgling Startup Ecosystem.

·        Education Hub:

o       Many Good Colleges

o       Leading Research Institutes

·        Magnet for people from all over India/World:

o       Pune has the highest number of foreign students (amongst Indian cities)

o       Large number of foreign expats, and visiting researchers

o       Recently, Pune has also benefited from the ‘Reverse Brain Drain’: Many highly qualified professionals and successful entrepreneurs (of Indian origin) from the US/Silicon Valley have moved back to Pune.

·        Proximity to a Financial Capital.

·        Large IT talent pool (Thanks to the many IT Outsourcing Companies).

·        Leading ‘Green’ Technology Hub in India. (Headquarters of companies like Praj and Suzlon).

·        Hub of Hi-tech manufacturing (Note: San Francisco Bay Area has quite a few high-end manufacturing companies as well).

 

And some coincidental ones …

 

·        Leading Wine Producing Region in India.

·        Developing into a key hub for specialty fruits, vegetables and Flori-culture.

·        Open (and tolerant) culture.

 

Some of the obvious things that are lacking in Pune include – Infrastructure and Sustainable Development. The other ones include greater focus on pure research, and venture funding. [I will discuss these and more in further detail in following articles in this series.]

 

As I was continuing with this brainstorming and gap-analysis, I stumbled upon a great article written by the well-known Silicon Valley Venture Capitalist and Essayist, Paul Graham on ‘How To Be Silicon Valley’, in May 2006. He describes the key characteristics of the San Francisco Bay Area that led to the development of this amazing ecosystem over the past few decades. He also explores how similar Ecosystem Development could happen in other cities/towns anywhere in the world.

 

In my article, I make an attempt to use the key characteristics identified by Paul Graham, and try to map them to Pune. I believe that Pune is amongst the best places in India where a Silicon Valley like Ecosystem can take shape. Obviously, there are many challenges. I am not going to use sobriquets such as ‘Pune – The Silicon Valley of India’. Silicon Valley is unique – there can be only one.

 

I am also not doing a comparison (either/or) between different Indian cities here. Many writers routinely refer to Bangalore as the Silicon Valley of India. While to me, Bangalore is definitely not there at this point, it might very well be on the right track. To me, if places like Bangalore, Pune and others introspect and strive for the key characteristics that are described by Paul Graham, then all of them have a shot (tough, it might be!) at creating Silicon Valley like Ecosystems someday.

 

Note – I recommend that you do read Paul Graham’s article: “How To Be Silicon Valley”, before reading further. This will enable you to better relate to my observations below.

 

I am going to follow a format, similar to that used by Paul Graham. Listed below are the key characteristics and how Pune fares with respect to these.

 

Presence of Rich People who are not Bureaucrats

 

Paul Graham argues that a technology ecosystem needs rich people who can take risks, and invest the necessary seed capital. These investors shouldn’t be purely financial investors who don’t understand the domain that they are investing in. Nor should they be bureaucrats who simply evaluate short and medium term financial returns and are risk averse.

 

Paul Graham describes the example of how the money made on the risks taken in the 1980s (e.g. Sun Microsystems) was then re-invested again in the 1990s (e.g. Google, Amazon) and now being re-invested again. Essentially, startups create startups – this how this ecosystem starts and grows.

 

Does Pune have rich people, who are technocrats? The answer is yes. Maybe nowhere enough, but the successful technology entrepreneurs of the 1980s and 1990s have built up some good reserves and have started looking for interesting technology ideas to fund.

 

Not Just Buildings

 

Large buildings and nice campuses don’t make the Silicon Valley! The massive new IT Parks we see today in many Indian cities, don’t equate to Silicon Valley. We need the DNA of a startup that was founded here and grew.

 

Unfortunately, Pune doesn’t have many IT firms that became very big (like Infosys – though one could argue that Infosys in fact started in Pune, and moved on…). However, there are a few good examples of non-IT technology companies (Manufacturing, Industrial Automation, Green Energy, etc.) that made it big.

 

Universities & Research Institutions

 

Pune has a strong education culture and some excellent engineering and science & technology colleges, including the 2^nd oldest engineering college in India. A new Indian Institute of Science Campus is also being planned. Distance wise one can argue that IIT Bombay is less than 3 hours (150 km) from Pune.

 

In addition to the universities, Pune has many leading research institutions in a variety of technology areas – National Chemical Laboratory, Institute of Virology, Indian Meteorological Office, Inter-University Center for Astronomy & Astro-Physics, Agricultural Research Institute, Various Defense Research Organizations, etc.

 

Personality

 

Paul Graham talks about a city/town having a ‘personality’. He further states that you don’t build such a personality – you let it grow. I believe that Pune has grown a strong personality over the past many decades. In fact, this is one of the attributes that Pune is quite famous for. A ‘Punekar’ (resident of Pune) can be identified by many interesting traits!

 

Pune has a personality of a small city/town; a personality of knowledge & learning; a personality of creativity (not just in technology, but in other areas such as arts and music); a personality of a distinctive life-style; a personality of tolerance & openness to new ideas. Historically, it has embraced and assimilated people from different parts of India (and the world).

 

And while the new Pune is morphing into a cookie-cutter solution of suburban development seen in other metros, the old – new Pune combination still maintains a distinct identity.

 

Nerds

 

According to Paul Graham, ‘Nerds’ constitute one of the most critical building blocks of such an ecosystem. You can call them anything – But Pune is increasingly a preferred destination for many techies (or nerds, or whatever you want to call them!). Historically, Pune has always been a center of attraction for the learned – not only in technology areas, but in other areas such as History, Sociology, Arts, Music and Languages.

 

Many of these people find Mumbai and other Metros to be too big, too fast, and too glamorous. Pune is compact, liberal and relatively quiet in comparison to most Indian cities. These nerds don’t mind paying a lot more to live in such a place with it’s unique identity (see earlier section). Quality of life is important for them.  Note – Pune real estate is quite expensive, and the overall cost of living is amongst the highest in India.

 

Youth

 

Given Pune’s strong education ecosystem, Pune is a ‘young’ city. It is vibrant with fresh energy and drive. Culturally, it is less conservative/more liberal – whichever way you want to look at it. There are also quite a few people here who are ‘young at heart’.

 

Time

 

Even after having all the right mix of the above key characteristics, you need to provide ‘Time’ for a Silicon Valley to be built. While Pune has many of the desirable ingredients, it still needs more time. And it is critical that these characteristics don’t degrade/disintegrate over that time period. I will discuss this further in future articles in this series.

 

Competing with the ‘Original Silicon Valley’

 

Paul Graham’s last point relates to competing with the ‘original Silicon Valley’. Any new challenger will definitely face competition from the original one!

 

I do think that there is room for more challengers. Speaking about Pune/India, we have an advantage of having more generalists (engineers who are more application oriented that theory oriented; and can quickly span interdisciplinary boundaries). The costs in India have risen significantly this decade, but still remain low compared to the west. Thus, if planned and used correctly, the same capital can stretch longer here. Pune and India have a large and growing young population. Many innovative ideas are driven by young people – both as innovators, as well as consumers. It is here where India in general and Pune in particular has a strong credential.

 

In future articles in this series, I will explore specific steps that I think Pune needs to take towards its goal of emulating a Silicon Valley like technology ecosystem.

 

Please provide your feedback, other ideas and comments on this article. I will try to incorporate these in the future articles in this series.

 

This is a very important topic for all people interested in and/or working in the technology area in Pune!

 

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Restaurant Review – Stone Water Grill

For those of you, who are still not convinced about Pune’s entry into the big league of metros in India, take a look at the fine dining options, and the brand new five star hotels here!

 

As you continue past the Kalyani Nagar Bridge on North Main Road, Koregaon Park you will drive past a massive Westin Hotel that is nearing completion. I am sure, given Westin’s worldwide standards – this place will soon take over as Pune’s best Hotel. Continue further east, and you enter a complex that has Stone Water Grill and Hard Rock Cafe restaurants. Quite an exciting choice!

  

We got there a little before 8pm and were greeted by great music in their open air lounge bar. The setting and the ambience of this place is simply spectacular. The outdoor bar area uses a nice square design pattern and an interesting lighting. A small flight of stairs takes you to a lower level that is directly overlooking the river. The bar has a fabulous collection of wines and spirits, and a nice appetizer and snack menu. Stone Water Grill also has a slightly more formal (though by international standards, I would still classify it as ‘upscale casual dining’) restaurant.

 

The ambience inside the restaurant is simple and yet extremely well done. It’s definitely a contrast to the outside bar area. Other than some common menu items, you get a distinct feeling that the Stone Water Grill is really made up of two different constituents.

 

The restaurant has some of the best table settings I have seen in Pune. Complete with various different types of cutlery and wine glasses. One cannot think of too many places in Pune that have separate wine glasses- by wine types, and specialized cutlery for oysters and other seafood. The tables are very well spaced, and sitting is very comfortable. The menu has a nice international flavor with a slight concentration towards Mediterranean cuisine. The wine and cocktail selection is very nice.

 

They have added some interesting and yet simple concepts in their presentation. For example, the bread basket (which by the way, was simply terrific – a variety of different breads, hot and fresh from the oven) is served in a small well insulated ‘bag’ made of jute and cloth. The regular water is served from a bottle with basil leaves! Haven’t had ‘basil flavored water’ anywhere before.

 

Along with the drinks, we ordered one of our all-time favorites – Mezze Platter as an appetizer. It was very well done. The Caesar Salad and the Soups were also quite good. The bread basket literally fills you up. So if you want to do justice to your main-course, avoid the bread! For someone like me though, who loves various varieties of bread – this almost ended up being the main-course! We did try a Chicken dish, ‘Tequila Chicken Satay’, an interesting fusion dish that is served on a bed of mashed potatoes. It is worthwhile mentioning that the menu is a little light on choice as far as Chicken dishes are concerned.

 

This time around, we didn’t have any room for the desserts, though the menu looked quite good. Maybe next time!

 

Overall, I would say that Stone Water Grill’s ambience is their best asset. The service was prompt and excellent. The restaurant menu is quite interesting, with a tilt towards seafood. This probably is not surprising since I believe their sister concern in Mumbai – Salt Water Grill is quite well known for their seafood. 

 

The prices are comparatively a little on the higher side – but then you are paying for the ‘experience’. A dinner for two, with drinks could run into Rs. 1500-2000. While still new, the restaurant was nearly full; by the time we left around 10pm. Reservations are definitely recommended. Next time around, we do hope to try out the outdoor lounge bar.

 

Here is some general information about the restaurant:

 

Type of Restaurant: Casual Fine Dining Restaurant and Open-Air Lounge Bar.

Type of Cuisine: Predominantly Mediterranean with some focus on Sea-Food.

Phone: 20-41030303

Spot it on SadakMap : http://www.sadakmap.com/p/Stone-Water-Grill/

Location: Located on the River Front on North Main Road, Koregaon Park.

Directions: Continue past ABC Farms and Army Sports Institute on North Main Road and then take a left (there is a sign for the restaurant and Hard Rock Café. On the right hand side – you will notice a restaurant, ‘Chillies’). Common parking lot for Stone Water Grill and Hard Rock Café.

 

 

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Healthcare in US – Interesting New York Times Article about ‘Disruptive Innovation’

The US Economic Crisis has pushed two very critical issues off the front pages for now. These include: Healthcare System Re-haul and Alternative Green Energy. In the coming weeks, I am hoping to blog more about these topics.

 

Recently, I came across a terrific article on ‘Disruptive Innovation, Applied to Healthcare’ in the New York Times. The article written by Janet Rae-Dupree takes an interesting view of the present state of the health-care system in US, and the changes necessary to fix it. Here is a brief extract:

 

“THE health care system in America is on life support. It costs too much and saps economic vitality, achieves far too little return on investment and isn’t distributed equitably. As the Obama administration tries to diagnose and treat what ails the system, however, reformers shouldn’t be worried only about how to pay for it……” To access the complete article, please click here.

 

I have personally experienced the limitations, the bureaucracy, and the idiosyncrasies of the American health-care system first hand, during the course of a long illness. I cannot understand how the world’s richest country can have such a fundamental, basic human necessity; in such a bad shape.

 

The new Obama administration has committed to focusing on the health-care system. During the election campaign primaries, there was a lot of discussion around how Sen. Hillary Clinton could approach this whole issue, given her previous attempts at it in the 1990s. Unfortunately now, with the economy in front and center, it will be a while before fundamental changes are made to this system.

 

 

 

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