Archive for April, 2012


Telehealth (continued)

April 29, 2012

Labas Señor Arvydas Sabonis.  It turns out that Deep Foods has started a line of frozen food called Healthy Tiffin.  We picked up a couple of boxes, but haven’t tried them yet, so I can’t say if they are both tasty and healthy. I don’t know if they represent smarter food.

There’s about a day left to donate to Global Health Bridge via In this post, I’m going to finish up recounting the brainstorming with Chacha, starting with a potential mechanism for service delivery. 

The key to the whole thing, as is being widely touted, is the ubiquity of mobile devices in India.  After the patient’s condition has been diagnosed and managed through face-to-face consultation, let us say that the patient requires testing every three months to adjust treatment dosage.  The patient gets the test performed close to home, as is typically done at present.  The medical technician enters the results directly into a secure portal of Navjeevan Hospital.  Chacha, at his convenience when he can get in a groove and punch out lots of adjustments, logs in to his view of the portal and does so.  The system then automatically sends a text message from Chacha directly to the patient with the new treatment dose.  The patient then takes his or her phone to the medicine shop, shows the message to the shop-keep, and receives the correct treatment dose (a literate patient is not required). 

In terms of payment, the patient pays the medical technician directly for the test as normal.  The patient pays Navjeevan Hospital electronically via mobile phone.  Navjeevan Hospital pays the medical technician electronically.  From what I understand, electronic payment is happening, and quite successfully.

The main thing to find out about, perhaps through a survey, is whether patients would buy in.  Is the trip to Aligarh a burden or a beautiful day in the big city?  How much would they pay for the remote consultation in comparison with an in-person consultation.  Will they believe that it is really Chacha ordering the treatment adjustment or non-adjustment?

There are of course initiatives underway that utilize mobile technology for rural health care in India, e.g. E Health Points and Global Health Bridge.  In the Navjeevan Hospital case, the proposed delivery mechanism banks on the reputation of the doctor, hopefully allows everyone to profit, does not cut anyone out of the so-called pie, and does not require any new physical infrastructure. But who knows if it will work.



April 6, 2012

Good Friday Señor Nerlens Noel’s High Top Fade. Did you mean to say “Commodore Perry” instead of “Commode Perry”?  Interesting slip, considering how technologically advanced the toilets are in Japan.  Some of them even have a volume control for the loudness of the flushing sound. 

In Kyoto, we toured Nijō Castle, the place where the Tokugawa shogun signed over power to the Emperor: the Meiji Restoration. I think the tutorial went well.  I was happy with the experience, both putting the presentation together and delivering it at ICASSP.  Exclusively for the readers of the blog, here are the slides from the tutorial.

After coming back from Japan, I took the Westchester Express up to Ossining with a gregarious Jamaican driver.  Among the many topics we talked about, one, related to your “food binge,” was about tasty food, healthy food, and getting ‘sugar.’  He recalled once during his bucolic childhood getting invited to a wealthier girl’s house for dinner, being served lots of vegetables, and being miffed at why these rich people weren’t eating tasty food like fried chicken and rice.  Now that he is obese and diabetic, he is starting to change his diet to include more vegetables.  If there could be someone who does to dually healthy and tasty food what Lender did to bagels (cheap and accessible everywhere), I think he or she could disrupt the world populace and economy even more than potatoes did.

But in its absence, let us turn to diabetes.  In February, Chacha (a physician and proprietor of Navjeevan Hospital in Aligarh) and I had a discussion on using technology to better serve his rural patients who are being treated for chronic diseases such as diabetes and hypertension.  Primarily due to his reputation and quality, some patients travel more than fifty kilometers from rural outposts to consult with him.  He is overloaded with patients and has no time to sit in peace.

By his estimate, approximately 80% of his time is spent in patient consultations and 60% of those consultations are regarding those two chronic conditions. He also says that once such a patient is in a holding pattern, in-person consultations are overkill; treatment dose adjustments can be made by the physician just based on numerical values from test results remotely with very little or no degradation in patient outcome.  If technologically implemented in a good way, the physician can crank out such adjustments in less than a minute per patient as opposed to four or five minutes required per patient for an in-person consultation. If done remotely, the patient saves the significant time and monetary expenditure of traveling to Aligarh and the physician saves time, allowing him to serve more patients.  Doing so could be disruptive just like Lender’s Bagels.

For any human system to work, everyone involved needs to have some incentive.  Let’s start with the patients. 

  • Another topic of conversation with my Jamaican driver was when he was growing up there was no television, listening to the radio was a big thing, and hearing stories from someone who had just returned from the big city was an even bigger thing.
  • Clearly, not traveling to Aligarh saves the patient a day or two of lost earnings and also the travel expense.
  • As written by Bhaduri in the most recent issue of OR/MS Today, “According to WHO regional advisor Kathleen A. Halloway, a majority of Indians spend about 70 percent of their income on medicines and healthcare.” “More than 40 percent of low-income families in India have to borrow money from outside the family to meet their healthcare costs. Almost 16 percent of families had been pushed below the poverty line by this trend.”
  • The physician can offer a reduced fee for remote dosage adjustment as compared to in-person consultation.

Now the physician: Chacha’s objective is to serve more patients at more-or-less current levels of outcomes, stay sane, not decrease bottom line monetary profit, and not decrease his reputation.  Other physicians may have differing motivations, but some fraction will share Chacha’s.

There’s a third type of individual involved in the system as well: the medical laboratory technician.  When Chacha’s rural patients come to him, they bring paper reports with the results of blood tests administered close to their homes.  Sites for medical tests are much more ubiquitous than physicians of repute.  For remote dosage adjustment to work, especially if many patients are illiterate, the medical technician will have to transmit the results to the physician.  If there is very little effort involved for the technician, then simple monetary compensation should suffice.

I’m going to continue with this later.  In the meantime, I encourage readers to donate to Global Health Bridge by going here, just as you did earlier this week.


Disruption, Dissociation, and Acting Crazy

April 1, 2012

Konnichiwa Commode Perry.  Hope you had a good time at ICASSP and that your tutorial and John‘s presentation went well.  I believe your tutorial was based in part on your recent magazine article, which starts off by talking about the Tokugawa Shogunate.  Of course, one of the causes for the Meiji restoration is said to be the technological prowess demonstrated by Perry, driven in some part by the steam engine revolution in technology.  In your two previous posts, you’ve talked about gamification and interactive open data as two big sociotechnical trends afoot.  Do you think they are big enough disruptions to cause regime change like the steam engine or social media (as some claim)?

Since I’ve mentioned disruption and technology, I feel compelled to write about the notion of disruptive innovation due to Christensen.  It seems most people talk about things like computer memory systems or technologies like that, but since I am on a food binge, let me talk about bagels.  I don’t know if you heard, but Murray Lender, the leader of Lender’s Bagels recently passed away.  There was a great article by Matthew Yglesias that talked about the invention of frozen bagels and how it allowed a complete revolution in the national bagel market.  For example, this revolution allowed one to get bagels in Urbana-Champaign in the 1970s.   Let me quote from it:

Innovation is often thought of as coming with better products. But sometimes the most successful innovations involve coming up with inferior products, but making them cheaper and more convenient.

and further:

But the main way Lender’s changed the world was by arriving on the supermarket shelf. Frozen, the bagel became an exploratory food. Fresh-baked products can only be sold in places where you know for sure that demand is high—otherwise they go stale. Baked goods thus tend to be conservative and intensely regional. The freezer changes all that. A frozen product can venture out into uncertain waters and survive as a niche product even if volume isn’t enormous.

and in closing:

The fundamental story of Lender’s Frozen Bagels is that the winning product isn’t always the best one. Like Ikea for furniture, H&M for clothing, or the Olive Garden for Italian food, Lender’s innovated by finding a way to compromise on quality and reap huge gains in other spheres. To an extent, it’s thankless work. Nobody wants to stand up and proudly proclaim, “I changed the world with my inferior products.” But often this is how the world changes. And if you look at the health care and higher education corners of the American economy where spiraling costs are bankrupting the middle class, you see sectors that are largely untouched by this kind of low-end innovation. The world could probably use a few more Murray Lenders.

So in many ways, exactly as Christensen describes it.

Dissociation has been a long-running theme of this blog, and it seems that dissociative technologies can be particularly disruptive to extant social systems.  The Supreme Court has of course been busy with other things recently, but they also listened to arguments about legal questions that essentially arise due to the dissociation of time and space in life.  Very interesting indeed.

Finally, returning to food, I was reading this article about pizza in New York.  It is such a great example of acting crazy to try to preserve market  power.  If Ramanlal Patel really wants to claim market power, I think he needs to come up with a disruptive pizza.  Pav bhaji khakra pizza anyone?  Claudette von Jurgens?