Amit Paranjape’s Blog

A Visit To GE India’s John F. Welch Technology Center – Watching Innovation In Action

Posted in Current Affairs, Science & Technology by Amit Paranjape on September 6, 2015

I visited the John F. Welch Technology Center of GE in Bangalore this weekend. They were celebrating the center’s 15th anniversary with a ‘Tech Mela’. Solutions from the various business units at GE were showcased. I have admired GE as a company, and their previous legendary chairman Jack Welch (I would highly recommend reading Jack Welch’s books about his management philosophy). This visit was a good opportunity for me the get a better understanding of their work.

The center (also referred to as GE ITC: GE India Technology Center) has over 5,000 R&D professionals working across healthcare, aircraft engines, transportation, energy and other GE verticals. This is the largest multi-disciplinary R&D center of GE in the world and more than 50% of the employees here have Masters or PhD degrees.  The GE ITC is involved in supporting GE globally, as well as focusing on local/regional solutions for India and the emerging market.

Good discussion with Munesh Makhija (Head of GE, ITC)

Good discussion with Munesh Makhija (Head of GE, ITC)

I got a chance to interact with the head of GE ITC, Munesh Makhija (Managing Director, GE India Technology Centre Chief Technology Officer, GE South Asia). Here is a video of our interesting discussion (https://www.facebook.com/ge.tech.india/videos/vb.480156825343034/1075515979140446/?type=2&theater). It was good to hear about the overall focus and vision for the center, as well as their day to day activities and challenges. Hiring top talent is a challenge for every company and GE ITC is no different. Today, many top engineers want to work in software (and in startups), and this is a big hiring challenge. Along with their presence in Bangalore and Hyderabad, GE ITC is also trying to tap into the advanced manufacturing talent in Pune where they have a brand new state-of-the-art multi-modal manufacturing plant (inaugurated earlier this year). I suggested to Munesh that GE should seriously consider expanding their R&D activities in Pune. Pune is the biggest center for manufacturing in India and hosts many advanced manufacturing capabilities across large and SME companies, including a large talent pool.

Healthcare is one of the biggest groups at the GE ITC and is involved in developing solutions across imaging, maternal health, critical care, surgery and other areas. Solutions for the global market, as well as India/Emerging Market are developed here. We got an overview of these solutions from Shyam Rajan, CTO, GE Healthcare India.

A new latest PET/MRI scanner was on display (IMAGE). This scanner can simultaneously carry out the PET and MRI scans of a patient. A low-cost, award winning CT scanner was also showcased, specifically targeted for the developing markets, where cost and space are big issues.

PET/MRI scanner

PET/MRI scanner

Portable (Tablet) Ultrasound

Portable (Tablet) Ultrasound

Evolution of the Jet Engine

Evolution of the Jet Engine

GE Jet Engines

GE Jet Engines

Some of the other technology areas on display included:

Transportation – Diesel Locomotives, Fleet Management, Marine Engines

Energy – Oil & Gas, Wind Power

Gas Turbine Power Generation, Electricity Distribution, Smart Grids

Aircraft Engines
It is very interesting to note the diverse engineering and technology areas that GE is involved in. They are addressing the core problems in energy, transportation and healthcare. It was good visiting these various solution areas and learning more about the solutions and tech challenges involved. The kinds of problems being addressed include machine design, modeling & simulation, advanced materials, hi-tech manufacturing, data analytics, big-data, software programming, signal/image processing, structural design, electronics control systems, and many more.

I would have liked to see more of the aircraft engine technology on display. Unfortunately (I guess due to IP/competitive restrictions) couldn’t see a lot in this area.
I also got a chance to interact with Sukla Chandra General Manager, GE Global Research, Bangalore Director-Legal, Patents & Analytics Centre of Excellence. Patents are a big focus area for GE, and Sukla’s team is responsible for providing strategic IP support to GE Global Research and several other GE businesses. In addition the patents center, Sukla also co-leads the GE Women’s Network Initiatives for India.  The patents legacy of GE goes all the way back to the founder, Thomas Edison (who is credited with more than 1000 patents).

Top GE Inventors - includes Thomas Edison (1000+ patents

Top GE Inventors – includes Thomas Edison (1000+ patents

As part of the Tech Mela Event, GE released an info-graphic on their work in India (good summary): http://www.slideshare.net/GE_India/ge-reiterates-its-commitment-to-design-make-in-india-52449008

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“The Emperor of All Maladies: A Biography of Cancer” – Brief Book Review

Posted in Healthcare & Medicine, Science & Technology by Amit Paranjape on March 17, 2014

Recently finished reading this brilliant, fascinating, (and at times) depressing book. Highly recommended. This book won the Pulitzer Prize in 2011.

#Cancer is a tough topic, across many dimensions. The author Oncologist Siddhartha Mukherjee presents a detailed journey of our understanding of this disease (or a collection of diseases), going back 4000 years. There is good amount of technical details about cancer, its diagnosis and treatment…but explained beautifully so that a non-medical professional can understand it quite well.

The first few chapters read like an interesting history novel. The concluding chapters delve into genetics and core understanding of what is going on internally, inside the cell, inside the DNA.

It is amazing how our understanding has changed and improved over the past few decades. But there is a long way to go. The sobering truth is that we still don’t understand many things in this area.

Fascinating story of how Lipitor almost didn’t make it; but eventually became world’s biggest blockbuster drug

Posted in Current Affairs, Healthcare & Medicine by Amit Paranjape on December 28, 2011

Lipitor has been the biggest blockbuster drug till date with sales of over $120 Billion over the past 14 years. It recently came off patent.

I came across this great article by Linda A. Johnson in Associated Press – “Against odds, Lipitor became world’s top seller”, that chronicles the story of how this drug almost didn’t make it. It was not the first statin on the market. However, early trials showed results that were significantly better than the existing peers. The article also discusses the extensive use of marketing (targeted to the consumers and doctors).  To quote a line from the article: “The Lipitor promotion team set new standards for a marketing campaign.”

One wonders if the pharma industry would ever again see such a massive success. Do read the full article, click here.

Issues With America’s HealthCare System – A Patient’s Perspective

Posted in Current Affairs, Healthcare & Medicine by Amit Paranjape on April 14, 2009

I had the misfortune of suffering from an extended illness in America and experienced firsthand the many problems and issues with the American HealthCare system. In this brief article, I will try to list some of the major ones that I can recollect from my personal experience (See list below – points are in no particular order).

 

Please note that I still believe that the American HealthCare system is amongst the best in the world; especially when it comes to treating really tough medical conditions, and performing complicated surgical procedures and emergency medical services. It still retains some of the best doctors and other medical talent in the world.

 

My issues are more systemic and process related. In the end, one would expect a little more from world’s most advanced and expensive healthcare industry! Note these are my personal observations – whether some of these points can be generalized further needs more data points from other patients and consumers of this healthcare system.

 

1. Cost of HealthCare Insurance – The cost of healthcare has undergone a major increase over the last decade. The increasing insurance premiums have forced many private sector companies (that offer health insurance to their employees) to increasingly pass on a bigger chunk of these costs to the employee. This increase has been significantly more than the rate of inflation, and has resulted in no perceptible change in the service quality.

 

2. High costs for the un-insured, and the under-insured – This issue is extremely critical and has already been discussed ad nauseum in every media outlet, by numerous experts.

 

3. Insurance Claims Processing – Even for patients that have some of the best insurance coverage, the process of settling claims is far from perfect. Discrepancies and errors are common. In certain cases, interpretation of ‘what’s covered vs. what’s not’ is not clear. The 3-way communication across, Doctor’s Office – Insurance Company – Patient, further adds to the process complexity and mismatches. I personally had to deal with many of these claims related issues. To resolve these, often times you end up spending hours on the phone with the insurance company.

 

4. Impact of ‘medico-legal issues related complications’ on behavior? – I am not a legal expert and cannot pass explicit judgments here, but sometimes one gets a feeling that the entire medical staff’s (not just the Doctors, but also the Nurses and other support personnel) interactions with a patient are biased by a ‘medico-legal’ angle. Most answers are very generic, vague and filled with ‘disclaimers’. I understand that this is a big issue, but it is a bad trend if it affects the medical staff and patient communication. This communication channel needs to be one of those most ‘open’ ones!

 

5. Accessibility of a doctor – Most doctors work during the regular office hours and are not available on evenings and weekends. Hence seeing a doctor often times results in a forced half-day vacation during weekdays for many patients. Evenings and weekends are out of bounds and if you are in urgent need to see a doctor, in most cases an Emergency Room is your only option.

 

6. Difficulty in getting to a specialist – Often times it’s very difficult to schedule an appointment with a specialist. Many are booked out weeks into the future. And if you can’t see them right away, and are in some serious trouble, the standard answer that you might get is ‘Go to an Emergency Room!’

 

7. Difficulty in asking any simple follow-up questions to a doctor – If you have the most mundane follow-up question, it is still very difficult to directly ask your doctor. Even if you call during office hours, your call is routed to a nurse who often has no background about your particular case (except for some case-papers). Typically, the nurse is very busy and answers a simple – ‘I will get back to you’. If you call outside office hours, then your best bet is an answering service! I agree that many times it is not feasible for a busy doctor to directly talk to the patient. But some intermediate solution needs to be worked out. After all, I think that the most expensive healthcare system in the world should have at least some ‘personal touch’.

 

8. Information Technology in Healthcare – I get the impression that the Healthcare industry hasn’t leveraged IT to the fullest extent as compared to many other industry sectors. This can be seen in hospitals as well as in doctor clinics. From basic things like Electronic Medical Records (also referred to as Electronic Health Records), to a better integrated hospital management system (across billing, insurance, clinics and service providers) a lot of improvement is needed. Even today, there’s hardly any electronic data interchange of a patients reports, health records and doctor’s notes across practices and hospitals.

 

I have had to fill in volumes of paperwork every time I went to see a new doctor. Why can’t there be some automation of a patient’s insurance records and medical history? Why does a new patient have to arrive at a new doctor ’15 min early’ to fill out reams of paperwork, many times when he is not in a mental/physical condition to be dealing with this? A patient has to maintain an increasingly heavier load of files, and paper documents, and make it accessible to any new doctor that he might be seeing.

 

9. Difficulty in Scheduling Simple Procedures – Even simple diagnostic procedures (e.g. Ultra-Sound, Endscopy, etc.) can sometimes take days or even weeks to schedule. I don’t really know why this happens. Is this merely a scheduling problem or a supply scarcity of resources?

 

10. Newer patented drugs are regularly being introduced and are prescribed in many cases. Not sure if the incremental benefit that some of these provide over the existing older (and still under patent) or off patent/generic drugs can be weighed against their exorbitant costs. I am not an expert and cannot make this judgment, but do think that this is something that needs to be researched further. Again – since the US consumer is supposedly the ‘richest in the world’ he has to pay the highest (in most cases) for the patented drugs compared to other developed countries. This is another issue that has been a big point of contention, with lot of discussions in the media.

 

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Electronic Medical Records (EMR): A Practical Solution

Posted in Healthcare & Medicine, Information Technology by Amit Paranjape on February 19, 2009

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

 

 

Electronic Medical Records - A Practical Solution

 

 

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.

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