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Cisco's HealthPresence in India and beyond

July 12, 2010 | Chris Payatagool
Healthpresence_india.jpgThy hand, great doctor

Created at its second global headquarters, in Bangalore, a tech giant's flawless illusion takes doctors to places where they are not. Welcome to the next Internet

By Seema Singh
From: The Wall Street Journal via LiveMint

Bangalore: Outside, in the lobby, the flags of several countries seek to signify the boundary-less nature of the work that goes on here.

Inside, true-to-life TelePresence (a video conference on steroids kind of thing) screens emphasize this point further, and create a flawless illusion of being where one is not.

This is Cisco Systems Inc.'s Globalization Center in Bangalore, ground zero of the company's efforts to get this technology to work in the area of healthcare.

In India, where most people in remote rural areas have no access to doctors, the benefits of this effort are easy to see; still, the advantages of HealthPresence, as Cisco calls it, can travel easily across borders, to other developing countries, even to the developed world.

That's just the kind of work the Cisco Globalization Center was set up to do. In 2006, chief executive John Chambers decided that to become a truly global company, Cisco would have to do more than merely invest in a development centre in India--until then, the preferred India strategy of technology firms. Chambers decided that Cisco would create a globalization centre, a sort of second global headquarters for the firm, and one where some of its best and most senior executives would work. And chief globalization officer Wim Elfrink moved to India, becoming the first direct report of Chambers to be based outside California.

Interestingly, Cisco's TelePresence (TP) technology debuted the same year, in 2006. (Hewlett-Packard Co. has a similar technology that was launched the previous year.) At the time, few visualized that technologies which create images so sharp and real that even a mole on the face doesn't escape the camera could leap into healthcare as rapidly as they have done since.

Here's how Cisco's HealthPresence works:
The patient sits before the TP unit. Facing him on the screen is a doctor who could be sitting before another TP unit anywhere--in the same building, elsewhere in the same city, or somewhere in the world. A host of medical devices, besides the general examination camera, stethoscope and vital signs monitor, are connected to the TP unit and help the doctor examine the patient. The patient-doctor interaction is immersive and dynamic and the diagnosis is in real time. That's classic HealthPresence. Cisco has been piloting this in a few places around the world and is now working with hospital chains to roll it out.

What a team of 10 people at Cisco's Globalization Center has done is to take HealthPresence and develop, on top of it, a new health delivery solution that the company calls HealthPresence Extended Reach, or HPER.

True to its name, this circumvents technology and network challenges common in countries such as India to extend healthcare delivery to a larger audience. "The whole solution is conceptualized, designed and created here and is now being installed in Africa, Latin America, China, and Australia. Once we get the US Food and Drug Administration's (FDA) approval, we will install in the US as well," said Vishal Gupta, vice-president, global services practice and healthcare practice at Cisco.

In March, when Chambers was in India, Cisco announced a new memorandum of understanding with the Indian government for speedy delivery of education and healthcare solutions that would include HPER.

So what can HPER do? All that the classic HealthPresence does, and more, but at a lower cost and with less bandwidth. And it will do so using laptops which consume little power or desktops, not high-end TP units.

The team did this even as it kept local medical practices in mind, says Hemant Mahishi, a doctor-turned technology wiz, who goes by the title "solutions consultant" at Cisco. One such innovation: an ePen, a mobile e-notes taker; doctors in India don't like to pound their keyboards for prescribing drugs.

Mahishi demonstrates the technology by playing doctor again to a dummy patient. Through his desktop computer, and using Neurosynaptic ReMeDi, a medical data acquisition unit with thermometer, blood pressure, heart rate, stethoscope and electrocardiogram machine, he examines the patient. As he prescribes drugs on the e-notepad, signing off with a practitioner's flourish, a PDF of that prescription is created in real time on the screen; this can be viewed and printed by the patient on the other side. All medical records in the system can be stored and retrieved when desired.

Interestingly, HPER can work with cost-effective medical devices that are available widely, unlike the classic HealthPresence unit that can work only with US FDA-approved devices. And it is interoperable with whatever technology infrastructure exists in public and private hospitals. Many hospitals don't even have a hospital information system, says Gupta. HPER can integrate with existing ones, create its own if none exists and store and analyse data. "It can help a doctor ask: why am I getting so many TB cases in this area," adds Gupta.

HPER has already been tested in hospitals in India, including some run by the Apollo group. Gupta sees classic HealthPresence as being deployed in large hospitals and HPER in remote clinics, enabling healthcare providers to enhance their efficiencies, including a much-in-demand star doctor's time.

"Cisco HealthPresence and HPER are part of their Smart Connected Communities vision. I think it takes the TelePresence concept to the next level and applies it to specific use cases," says Usman Sindhu, researcher at technology market research firm Forrester Research. "HealthPresence is not one single piece of technology, it offers a lot more potential. Just imagine the entire medical toolkit...becoming IP (Internet protocol)-enabled and sending information in real time to any location instantly."

This is "smart" healthcare, snugly fitting into Cisco's larger "smart connected community" vision where the infrastructure across various sectors is Internet Protocol (IP)-enabled, using Cisco's core technology innovation: Unified Communications, which allows businesses to connect anyone to anything, anywhere.

Cisco sees this as the next great leap in technology--the industrialization of the Internet.
In buildings, for instance, Cisco's smart technology provides IP-based management of heating, ventilation, air conditioning, electricity, water, telephony, water and data. Similarly, transport, police services, and financial centres are some sectors in India that are buying into the Cisco "connected" vision.

Devi Prasad Shetty, chairman of the hospital group Narayana Hrudayalaya, who pioneered telemedicine in India in collaboration with the Indian Space Research Organisation, is willing to switch to HPER because being dependent on satellites for healthcare delivery to remote locations has some limitations.

But Cisco needs to figure out the economics of these solutions. There are fundamental questions such as who will fund these initiatives, says Sindhu.

Gupta isn't disregarding this, and indicates that Cisco has somewhat sorted out the thorny delivery chain issues. "We are working with partners...they could be companies like Bharti Airtel (as network service providers), technology system integrators and large hospitals."
To be sure, healthcare needs a platform like HPER but is there policy in place to unleash its true potential?

Maybe not. There are currently no medical record or data exchange standards in India, in the absence of which there is no interoperability among institutions, public and private sector alike. Bandwidth--even though HPER works on 512 kilobits per second of data transfer rate--is still a scarce resource. Just as electricity today has the generation, distribution and retail use ecosystem in place, says Gupta, transformational healthcare needs a similar environment.

Practitioners feel no less constrained. "Technology should be able to convert a doctor's activity into data to be stored, transmitted and exchanged, but in the present hospital setting, this doesn't happen," says Shetty.

There is enough money in the National Rural Health Mission and in the 11th Plan for telemedicine, so money isn't an issue, says Gupta. But changing mindsets could be. "Sometimes change is hard, but it is needed."

YES WE CAN

Cisco Systems Inc
Started operations in India: 1995
Made in India: HealthPresence, developed at the company's globalization centre in Bangalore, marks a significant milestone in what Cisco considers the next big technology leap: the industrialization of the Internet.







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