Category: Healthcare

20 Jul 2020

How real is Virtual/Augmented Reality in healthcare? (Exponential Tech Part 4)

We have so many immersive experiences today that transport us to a reality that existed in dreams and fantasies earlier. Welcome to the world of Virtual Reality (VR). As the name suggests, it’s virtual and yet the experience is meant to feel real. A computer-simulated alternate world that you experience with sensory devices such as handsets and gloves.
Then there is Augmented Reality (AR), here the focus is the real world and there are digital elements superimposed. One of the best examples of this is in the Ikea Place app. If you wanted to see how an IKEA sofa looked in your living room, you just tap the product and use your phone camera to place the digital sofa in your living room to see how it looked.


So how does all of this fit into healthcare? Let’s check out some of the interesting applications in use.
In gastroenterology, the use of AR in the endoscopic unit helps improve the polyp detection rate, polyp classification, polyp size estimation, etc. Key to the AR technology is image processing and computer vision. Image processing allows the deconstruction of the image captured as a part of the input (camera) into a series of parameters and properties. The computer vision refers to the high-level image processing which allows the computer to interpret the image or series of images.
AED4EU is an app that uses AR to show all known Automated External Defibrillators in the location near you. AED4EU will also give you the phone number and address.
AccuVein uses augmented reality by using a handheld scanner over the skin and shows nurses and doctors where veins are in the patients’ bodies. It’s been used on more than 10 million patients, making finding a vein on the first stick 3.5x more likely.
These are just a few applications putting AR to good use in healthcare. Let us round up the overall benefits of AR and VR in medicine as it potentially promises to revolutionize treatment, therapy, training, and education.
1. Surgical Simulation, Training, and Education
Virtual Reality transports you directly inside the human body to access in 3D view even the tiniest of veins that otherwise would be impossible to see. Currently, medical students learn on cadavers, which are difficult to source and do not react as live patients would. In VR however, you can view minute details of the body in a 360° CGI (Computer-generated imagery) reconstruction & create training scenarios that could substitute common surgical procedures.
Case Western Reserve University and the Cleveland Clinic have partnered with Microsoft to develop a HoloLens app called HoloAnatomy to visualize the human body in an easy and spectacular way.
With Microsoft’s HoloLens Headset, app users are able to see everything from muscles to veins before their eyes through a holographic model. This has the potential to revolutionize medical education.


Specialized training simulators can be created to improve surgeons’ skills in various scenarios. Simulated models help many surgeons, plan, and rehearse before the actual surgery, as a part of preoperative planning. These virtual models of the patients’ bodies can be made using the MRI, CT, and Ultrasound scans.
Such simulators can also be used by trainee residents and students in developing intuition and decision-making abilities.
AR enables experienced surgeons to remotely assist residents by using an Internet connection and therefore opens the way of excellent distant teaching. Compared to virtual reality (VR) simulators, where the whole simulation takes part in a CG (Computer-generated) environment, the main advantage of AR simulators is the ability to combine real-life objects with CG images, resulting in satisfactory tactile feedback.
By monitoring and transmitting the image of a surgical site between two distant stations, remote virtual collaboration is possible between two surgeons. This concept is sometimes referred to as “telepresence”. A VIPAR ( Virtual Interactive Presence Augmented Reality) system was used in an effort to allow communication between Vietnam and the USA.
Another interesting example of immersive training experience is the HumanSim system which enables doctors, nurses, and other medical personnel to interact with patients in an interactive virtual training environment. This measures the participant’s emotions via a series of sensors. Helps the medical professionals to develop more empathy for patients among other things.
2. Virtual reality diagnostics
Virtual reality is often used as a diagnostic tool in that it enables doctors to arrive at a diagnosis in conjunction with other methods such as MRI scans. This removes the need for invasive procedures or surgery.
3. Virtual robotic surgery
A popular use of VR is in robotic surgery. This is where surgery is performed by means of a robotic device that is controlled by a human surgeon, which reduces the time and risk of complications. The robotic device is accurate, meaning smaller incisions, reduced blood loss, and faster recovery.
Robotic-assisted surgery with Da Vinci surgical systems are cleared by applicable regulatory agencies for use in a number of different procedures such as colorectal, cardiac, urology, general surgery, gynecological, head and neck, and thoracic.
4. Treatment of phobias, anxiety disorders, and addiction
Combined with biosensors that monitor physiological reactions like heart rate and perspiration, therapists can assess how patients react to stressful situations in a safe, virtual environment. This is applied to the treatment of post-traumatic stress disorders and patients with various phobias.
VR can also be a useful tool to treat addicts and prevent a relapse from occurring by exposing them to the right stimuli.
VR can help people with autism develop social and communication skills. It can also diagnose patients with visual or cognitive disabilities, by tracking eye movement.
5. Patient Education
The ability to view the inside of the human body in Virtual Reality is not only useful for doctors, but also for patients. VR allows patients to be taken through their surgical plan by virtually stepping into a patient-specific 360° VR reconstruction of their bodily anatomy. This helps them in the understanding of the treatment.
6. Pain Management & Physical Therapy
VR’s healing capabilities are used in physical therapy and pain management too. UW Harborview Burn Centre uses the VR game, Snow World, to alleviate the pain for burn victims during wound care. VR distracts the mind from the source of pain and immerses the patients in an alternate world of snowmen, snowballs, and penguins.
VR for physical therapy has also been shown to be effective in speeding recovery. Allowing the patient to do their prescribed daily exercises in a virtual environment makes the activity more fun, keeps them in high spirits during a long recovery period. Today, we also have the option of having a digital physiotherapist at home by means of a VR avatar.
Future Trends and Challenges
The adoption of AR and VR in healthcare is forecast to grow even more quickly, with the value of the market increasing by 38% annually until 2025.
However, there are challenges in the mainstream adoption of these technologies.
► Cost is definitely one of the factors. These technologies are expensive. A lot of big investors like Google and Facebook have pumped billions into the VR market, allowing for some very powerful hardware like the Oculus Quest to hit the market. The total cost of ownership of the technology solutions will need to be contained if it is to be adopted widely.
► Mobility is another challenge. One of the biggest limiting factors with current technology is the need for restricting headsets, display units, and all the cords used to connect them. However, hardware devices have started to trend towards being “untethered”. Facebook’s Oculus headset that initially needed to be connected to a powerful PC, became available as the self-contained Oculus Quest version.
► VR requires higher bandwidths and superfast networks. 5G will open up new possibilities for these technologies. Data transfer speed of 3 gigabytes per second (as opposed to 100mbps for home broadband) would be required to stream data from the cloud. Rather than needing to be connected to PCs, viewing devices will upload tracking data to data centers on the cloud where the heavy processing will be done. The rendered images can be delivered back to the user in real-time thanks to the speed of 5G and other advanced networks.
► Lack of knowledge and research around AR/VR in health care. A quick search of research studies shows over 3,536 publications with “virtual reality” or “augmented reality” or “mixed reality” in the title since 1991. Unless there is more knowledge and useful research available, mainstream adoption will be slow.
► Regulatory/Policy/Insurance issues. As with anything new in healthcare, unless there is wide adoption of this technology, regulatory and insurance challenges will be a given.
As Facebook, Google, Oculus, Samsung, and Sony continue to aggressively market VR/AR experiences for consumers, more people will be exposed to it and interest will grow. That said, patient demand and pull will have a powerful influence on administrative and clinical decision-makers.
Healthcare facilities from across the globe are now utilizing immersive applications such as vein visualization, surgical visualization, etc. Development-driven healthcare professionals are researching areas that could potentially benefit both customers and businesses. While some of the hospitals are not equipped to handle these technological advances, many of them (including third party companies) are choosing to invest in the same.
A lot of the VR and AR applications mentioned above are still in their infancy. However, the potential for VR in the healthcare sector is huge, limited only by the imagination and insight of those creating and applying the technology.


Originally published on LinkedIn, by Suzette Sugathan, Director, NextServices
Image Credit:



COVID-19: The Way Forward for Gastroenterology Practices
COVID-19 is a double whammy of both clinical and business disruption. This ebook will help you explore possible scenarios and be a guide in your plans for the future.
01 Jul 2020

Looking for a post-COVID health-tech idea? Find it in 3D printing (Exponential Tech – Part 3)

From printing food to organs, 3D printing is a fascinating exponential tech industry in the making. This week we shall delve into its application in healthcare.
In this article, you’ll understand where the opportunities are in this upcoming field.
• What is 3D printing?
• Bioprinting and its uses in regenerative medicine 
• Other applications of 3D printing in healthcare
Current challenges and future of this promising technology
To put it simply, 3D printing is a process of making 3D solid objects from a digital file. It’s an additive process, wherein an object is created by adding layer after layer of material. Until finally the desired object takes shape.
3D printing in healthcare: Four core areas
As per the report published by Allied Market Research, the global 3D printing healthcare market accounted for $972.6 million in 2018. It is expected to reach $3.69 billion by 2026, growing at a CAGR of 18.2% from 2019 to 2026. Here are the four major areas.
1. Bioprinting tissues and organoids (grow from stem cells)
2. Manufacturing customized medical and dental devices
3. Manufacturing surgical tools
4. Producing patient-specific anatomical models
► 1. Bioprinting tissues and organs
Bioprinters are 3D printers with one key difference. Instead of using materials such as plastic or metal, these printers deposit layers of biomaterial. That means these printers use cells to build living tissues. That eventually become blood vessels, bones, heart, or skin.
In the early 2000s, researchers discovered that living cells could be sprayed through the nozzles of inkjet printers. That didn’t damage the cells. But the problem was cells need a nurturing environment to stay alive: food, water, and oxygen. Such an environment is made possible by a micro gel that has vitamins, proteins, and other nourishing compounds. Researchers plant the cells around 3-D printed scaffolds made of biodegradable polymers or collagen so they can grow into a fully functional tissue.
For example, this method could be used to “print” a bladder, a simple organ consisting of only two types of cells. Here are the steps:
a) Scan a patient’s organ to determine size and shape
b) Create a 3D model from the scans
c) Using degradable polymer, print scaffolds to help cells grow in 3D
d) Place the organ in the patient’s body
e) Watch the scaffold slowly disappear after surgery
Isn’t it fascinating? There’s more.
In a landmark achievement, Tel Aviv University has 3D printed a small heart using human tissue. While the organ itself is smaller than one would need in a transplant, it is a massive step forward for bioprinting. Here the bio-inks used were “personalized hydrogel”, extracted from the fatty tissues of the human test patients.


Bioprinted bones are made with a durable and regenerative biomaterial capable of fusing with a patient’s natural bones over time. Eventually being replaced by them.
Researchers in South Korea developed 3D printed artificial corneas. Meanwhile, an Australian bio fabrication center called BioFAB3D built a handheld cartilage printing device called the BioPen. The BioPen is filled with stem cells derived from a patient’s fat. That helps in creating and implanting custom scaffolds of living material into failing joints.
Wake Forest School of Medicine has designed a printer that can print skin cells directly on to a burn wound.
Bioprinting also has its uses in clinical trials. It can use 3D printed tissues and organs without conducting trials on animals. Loreal, the French cosmetics major, partnered with 3D bioprinting company Organovo to 3D print human skin. This helps test their products before they get to market.
As this amazing area evolves, organ donations will be a thing of the past. The space of regenerative medicine will bring hope to many people around the globe.
You could even be printing your own personalized medicines soon. The possibilities are truly exciting.
► 2. Manufacturing customized medical and dental devices
3D printing has made manufacturing of medical devices less complex, much faster, more cost-effective, more customized, and easier to sterilize.
Prosthetics – 3D printing has completely transformed the prosthetics industry. Now you have perfectly fitted devices that are more cost-effective as well as functional.


Surgical guides – Both dental and medical surgeries require precision. A 3D printed surgical guide can help a surgeon line up holes, incisions, and implants as per the patient’s anatomy. Now with 3D printing, these guides can be produced rapidly to specifications.


Implants – 3D printing produces fine mesh structures at no additional cost. The organic structure of the device reduces the risk of rejection after the surgery is complete. These customizable implants are usually manufactured with 3D metal printing. This makes them strong, sterile, and matched to the patient’s needs.This is a test done on a sample of blood. It looks for cancer cells from a tumor that are circulating in the blood or for proteins in the blood due to the response of the immune system to the cancer. This will help in detecting cancer at an early stage.
► 3. 3D printing surgical tools
Sterile surgical instruments, such as forceps, hemostats, scalpel handles, and clamps, can be produced using 3D printers.
Not only does 3D printing produce sterile tools, but some printers based on origami, allow for the printing of tools that are precise and small in size. These instruments can be used to operate on tiny areas without causing unnecessary extra damage to the patient.
► 4. Preparing patient-specific surgical models
Creating 3D anatomical models from CT scans or MRIs is becoming increasingly useful for both doctors and patients. While these models help doctors prepare for their complex surgeries, they serve to educate patients about procedures. This helps not just reduce patient anxiety and recovery times but improves pre-operative planning and operating room efficiency. 
In the words of Dr. Alexis Dang, an orthopedic surgeon at the University of California San Francisco (UCSF) and the San Francisco Veteran’s Affairs Medical Center:
“Every one of our full-time orthopedic surgeons and nearly all of our part-time surgeons have utilized 3D printed models for care of patients at the San Francisco VA. We’ve all seen that 3D printing improves performance on game day.”
These 3D printed models are also widely used for training. For example, 3D printed endoscopic biopsy simulators are practical and useful tools in endoscopic training.
Three challenges before 3D printing goes mainstream in healthcare
As you can imagine, a regulatory and legal framework is still in the works. The scope for 3D printing is vast – from drugs and biologics to implants and prosthetics.
Beyond regulatory challenges, there are several technical challenges to overcome. These include costs of equipment, biocompatible materials, and interoperability between software and hardware.
Finally, there’s the economic hurdle of getting paid from insurance companies. While an FDA-approved 3D-printed joint implant may be reimbursed, 3D models of a patient’s anatomy and professional fees often are not.
Crossing these hurdles paves the way for the future.
3D printing in healthcare: At the cusp of an exponential curve
Consider these areas where 3D printing can be a gamechanger.
◘ A typical kidney transplant can cost more than $300,000. 3D printing has the potential to reduce that number to less than $100,000.
◘ Almost 114,000 people in the U.S. are on the waiting list for a life-saving organ donation. 3D printed organs can eliminate these queues forever.
◘ There are nearly 2 million people in the United States with amputations. 3D printed prosthetics can get people back in motion faster than ever before.
◘ The average price of a set of surgical instruments today is more than $3,000. This cost can reduce dramatically with 3D printing.
A multihospital organization can have more than 25,000 pieces of equipment. 3D printing has a big role to play here.
Emerging opportunities for business and impacting people’s lives are aplenty here. Add the power of customization and precision, you can see the power of this exponential technology.
If you are in healthcare and be a part of this transformation, the time to experiment is now.


Originally published on LinkedIn, by Suzette Sugathan, Director, NextServices
Image Credit:, Rob Wingate



COVID-19: The Way Forward for Gastroenterology Practices
COVID-19 is a double whammy of both clinical and business disruption. This ebook will help you explore possible scenarios and be a guide in your plans for the future.
18 Jun 2020

Exponential Tech: DNA testing in cancer screening (Part 2)

In last week’s post, we cruised through a primer on exponential technologies and how it can disrupt business and life as we know it. Moving on, this week we’ll attempt to understand how this applies to cancer screening in healthcare. We’ll do so from the lens of gastroenterology (GI).
Here’s what you’ll take away from this article:
• Present DNA testing methods of colon cancer screening (stool DNA testing)
• Upcoming DNA testing methods such as liquid biopsy (using a blood draw to detect not one but many types of cancers)
• Implications of exponential technologies in cancer screening
Colorectal cancer screening 101
For those of us in the GI world, colonoscopy is not new. Using the procedure, a gastroenterologist examines the colon and rectum for abnormalities. It is a key colorectal cancer (CRC) screening method and helps in detecting or removing small polyps in the colon. Larger polyps or tumours need a biopsy and further tests.
Colonoscopy is the gold standard in CRC screening. It detects and removes precancerous polyps well before they become malignant. If you test negative, you may not need to test yourself for the next 10 years.
Almost all insurances in the US cover this procedure. The cost of a colonoscopy could vary from $500 to $3,000 depending on it happens. It contributes to a significant portion of a gastroenterologist’s income. As you’ll soon find out, this revenue stream is at risk.
Colonoscopies have certain downsides. It’s invasive and inconvenient. An endoscopist inserts a scope (5-6ft narrow tube with a camera at the end) through the anus to examine the colon. The procedure requires sedation and a bowel prep.
Exponential Tech makes its way into cancer screening
The gastroenterology circuit is buzzing with newer alternate CRC screening methods. Though not as reliable a screening tool as colonoscopy is, these methods may pick up momentum soon. As you know from my previous article, exponential technologies scale up quickly after a point.
Extremely well funded startups and established players are working on stool DNA testing and liquid biopsy. These are not small forces.
Stool DNA testing
There are “old-fashioned” GI stool tests, fecal immunochemical tests (labeled FIT) or the guaic-based fecal occult blood tests (gFOBT). These detect blood in stools.
With DNA testing of stool, however, you check for not just microscopic blood but also altered DNA. Cologuard (a product from Exact Sciences) leads in this testing method. It was approved by FDA in 2014. The company sends a kit home. You can leave it at the doorstep for UPS to pickup! There are no trips to doctors or scopes poking around the posterior. Completely contactless – it seems to have a new upside in COVID times.
Cologuard vs. Colonoscopy
► Colonoscopy detects 95% of CRC and advanced precancerous polyps. If tested negative, you don’t need another test for the next decade.
► Cologuard has a 92% sensitivity rate and a 87% specificity rate overall, in a clinical study of 10,000 patients aged between 50-84 years at an average risk of CRC. False positives and false negative results can occur, which is still a high risk to patients. This indicates that once you have your readings, you still need to consult with your provider. In case the result is positive, diagnostic colonoscopy will follow. If negative, you will have to screen again in three years because the test is unable to detect high risk precancerous polyps definitively.
Cologuard has its benefits as a more convenient and comfortable screening method. The Cologuard kit costs US$ 649 and it takes two weeks to get the test results. Medicare and most of the insurances in the US cover it.
Cologuard has covered ample ground since it got FDA approval in 2014. More than 3.5 million people have been screened for colorectal cancer. It has captured less than 6% of the large addressable market of people over 50 years old. It’s long term goal is to reach 40% of the market.
Cologuard has competition. Liquid biopsy is trying to detect not one, but many cancers
This is a test done on a sample of blood. It looks for cancer cells from a tumor that are circulating in the blood or for proteins in the blood due to the response of the immune system to the cancer. This will help in detecting cancer at an early stage.
FreenomeCellmaxGrailThrive and Guardant Health are some of the players using a blood draw for their CRC screening tests.
► Freenome. Set up in 2014, the company has received a total funding of $237.6 million. It uses molecular biology and machine learning to detect cancer. According to the company, they are pioneering the Multiomics platform that decodes cell free biomarker patterns to detect cancer at its earliest stages. It analyzes a blood sample not just for DNA shed by cancer cells but also for proteins. Any of the biological molecules Freenome detects could originate in tumor cells, or could come from the person’s immune system responding to the onset of cancer. Their focus is on colorectal cancer and the final study for FDA approval is underway.
► GRAIL. Founded in 2015, this startup also working in the diagnostics space has raised $2 billion for its technology that screens for multiple cancers. It received the FDA Breakthrough Device Designation status in May 2019. The Pathfinder Study initiated in early 2020 is evaluating the implementation of GRAIL’s multi-cancer early detection test in clinical practice.
Using a single blood draw, GRAIL’s still-in-development test can detect more than 50 cancer types across all stages. It has very low false-positive rate of less than 1%.
► Thrive Earlier Detection. The startup spun out of John Hopkins in May 2019. It’s backed by $110 million in venture funding. This is another company looking at multiple cancer screens through a liquid biopsy test.
► Cellmax and Guardant Health.These are other players betting on liquid biopsy with their cancer screening tests pending FDA approval. Guardant is a public company that’s frequently loved by Wall Street.
Liquid biopsy = autonomous cars?
Are these new screening methods like the autonomous cars we analysed last week? They may still be evolving in performance now, but, given the efforts going into product enhancement and cost reduction, they may emerge as reliable screening tools in future. Will the power of exponentials start playing out in CRC screening too?
Liquid biopsy for early cancer detection is still years away from being a reliable screening tool. Its noninvasive nature, quick turnaround times, low cost, real time monitoring etc. makes it an attractive option. However, the true power of this will unleash when the sensitivity and specificity of these tests improve as does our understanding of the biology of tumours and what can be found in the blood. Experts state it is still a few years away from effective implementation.
But wait…what about colonoscopy for screening?
Payers, patients, and physicians – all have a role to play in the choice of the screening tool.
In today’s consumer-driven healthcare, the best test for colorectal cancer screening is the one that the patients demands. A colonoscopy may be a gold standard but a patient may be unwilling to undergo the procedure.
Cologuard also invests heavily in TV advertising that influences patient demand.
Primary care doctors are now more willing to prescribe such noninvasive screening tools to cater to patient requests. As more DNA testing occurs, companies like Exact Sciences will get more data on DNA of cancers. With more data, sensitivity and specificity will improve.
Meanwhile, payers are continuing to cut reimbursements of screening colonoscopy.
The technology that we use for colorectal cancer screening will continue to evolve. The demand for less invasive, cheaper tests with faster turn-around times will continue to rise.
As with the rest of the healthcare industry, gastroenterology is bracing itself for massive change. The underlying reason for that change is exponential technologies in action.


Originally published on LinkedIn, by Suzette Sugathan, Director, NextServices
Image Credit: Pixabay



COVID-19: The Way Forward for Gastroenterology Practices
COVID-19 is a double whammy of both clinical and business disruption. This ebook will help you explore possible scenarios and be a guide in your plans for the future.
13 Jun 2020

Exponential Tech from a GenX perspective – Part 1

Until recently, if anyone mentioned anything too technical – be it digital transformation or the myriad exponential technologies hitting us today – I had a standard reflex response. I’d dig my feet in and quietly withdraw from the conversation. I belong to the GenX cluster used to the brick and mortar of things.
However, we don’t live in a world anymore where we can blindspot the digital invasion that is part of everyday living.
With Covid-19, life has assumed a momentum that no one imagined possible. Do I have a choice now but to dive in to stay relevant? 
My next series of posts will be focused on exponential technologies and its application in healthcare – gastroenterology (GI) in particular, a focus area at our company. This article is a primer on exponential technologies. In my upcoming post, we’ll dig deeper into its application in healthcare.
The rice and chessboard tale
For the uninitiated, this story exposes the power of exponentials. It’s an old tale of the king and the creator of the chessboard game.
The king wanted to reward the creator of chess and asked him to name his reward. The clever creator asked for rice. He wanted one grain placed on the first square of the chess-board and doubled with every square and wanted the total of all grains that would sit on the entire chess board with 64 squares. So now we have series of grains equaling the exponentiation of 2…1, 2, 4, 8, 16, 32…all the way upto 2^63 grains on the 64th square of the chess board. We add all these grains up and get a whopping 18,446,744,073,709,551,615 grains. Approximately over 300 billion tons of rice, which is about 400 times the global production of rice.
What started as one grain became an unthinkably large number. One to many, that is exponential power.
What in the world are exponential technologies?
We have all heard of Moore’s Law that states that the computer processing power doubles every two years. What does this point to in essence? Growth of technology with computing at its core will always grow exponentially, it’s never linear growth.
Postulated by Ray Kurzweil in 1999, the Law of Accelerating Returns states that the rate of progress in an evolutionary learning environment increases exponentially.
The more advanced such a system becomes, the faster its rate of progress grows.
Combining these laws, here’s what we understand about exponential technologies.
1. It’s exponential. At set intervals, it doubles in capability or performance and halves in cost.
2. It’s a technology with a price-performance ratio that’s solves business problems in a way that was unthinkable previously. It’s disruptive and can have a positive impact both in social and economic terms.
What are the examples of exponential technologies you’re already experiencing in everyday life? Artificial intelligence (AI), additive manufacturing, augmented and virtual reality (AR, VR), digital biology and biotech, data science, medical tech, nanotech, robotics, autonomous vehicles, etc.
Self driving cars are a reality because of exponential technologies
Let us take Autonomous vehicles (AV) to understand this further. If you’d have mentioned the idea of AVs replacing Human Driven (HD) cars to me even as far as five years ago, I would’ve laughed and scorned at the suggestion. But not anymore. 
When a Toyota Prius was remodeled with Google’s driverless technology in 2012 the price tag of owning a self driven car was over US$150k. Today, while you still can’t own a self driving car (why would you when there are self-driving cabs?), almost autonomous driving options cost between US$ 25k-35k.
Autonomous vehicles need sensors that serve as the eye of these vehicles. They need AI systems that help the vehicle to think and take decisions. There are a combination of sensors used – camera sensors, radar sensors, and LIDAR sensors. The sensors allow the car to see all the objects in short range and long range. They help determine speed and distances relative to the AV. This allows the car to travel without colliding into nearby cars or objects.
LIDAR sensors, the more advanced of the sensors, use laser light to provide 3D images of objects and surroundings with a 360 degree span. The LIDAR system that the Toyota Prius used in 2012 cost $75k. Today the performance of these sensors are way better and the cost of sensors has dropped drastically. It costs between a few thousand dollars to $100 depending on the performance required.
Artificial Intelligence (AI) software in the car is connected to all the sensors and collects input from Google Street View and video cameras inside the car. The AI simulates human perceptual and decision-making processes using deep learning. It controls driving actions, such as steering and brakes.
AI systems need to be trained with loads of data. The more the system drives, the more data can be fed to the neural network algorithms for more nuanced decision making, improving the safety of these vehicles.
Disrupt or be disrupted
So there you have it. These cars will only continue to see a drastic drop in cost and an exponential improvement in performance as we have more driving data available. They are slated to be far more safer than regular cars in a few years. Cornell professor, Bart Selman, has predicted driverless cars would be 10 times safer than those driven by humans within three years. Within a decade, they’ll be 100 times safer. According to a University of Texas report, if 90 per cent of the cars in the US were replaced by AVs, the savings across industries could reach as high as $450 billion.
If you were in the auto space and not invested in this exponential technology, you may risk extinction. You either disrupt or get disrupted.
So how does all this fit into healthcare and gastroenterology? Find out next week in the Part 2 of this series.


Originally published on LinkedIn, by Suzette Sugathan, Director, NextServices
Image Credit: Karol D.



COVID-19: The Way Forward for Gastroenterology Practices
COVID-19 is a double whammy of both clinical and business disruption. This ebook will help you explore possible scenarios and be a guide in your plans for the future.
31 Dec 2018

Healthcare Technology Articles: Trends And Insights for 2019

Here are the most interesting healthcare technology articles focused on trends to watch out for during 2019 and beyond.

1. 4 Takeaways from Practice Fusion EHR’s $100M sale to Allscripts – by NextServices

2. Amazon In Healthcare: The E-Commerce Giant’s Strategy For A $3 Trillion Market – by CBInsights

3. Top 10 healthcare innovations for 2019 – by Healthcare Global

4. 4 Ways Blockchain Could Transform Healthcare – by HealthTech

5. Uber and Lyft ride into healthcare. What to expect (and what not to) – by NextServices

6. Top Three 2019 Healthcare Cybersecurity Trends – by Healthcare Informatics

7. Alexa for Doctors Claims 70 Percent Reduction in EHR Time – by Healthcare Analytics News

8. Three Acquisitions In 2018 To Impact 2019’s Tech Landscape  – by Forbes

9. How Google Cloud’s health care advisor thinks data and machine learning can transform health care, without privacy risks – by CNBC

10. 20 health IT thought leaders speak out: top trends affecting healthcare and what to expect in 2019  – Becker’s Health IT & CIO Report


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31 Dec 2018

Articles on 2019 Healthcare Industry Trends – All In One Place

Here are all the major healthcare industry trends by leading publications. All in one place so that you don’t have to spend time searching to stay on top of your game.

1. Top health industry issues of 2019 – by PwC

2. Top 8 Healthcare Predictions for 2019 – by Forbes

3. Amazon gets into health insurance — and more 2019 health-tech predictions from top experts – by CNBC

4. 10 Health Care Predictions for 2019 From a Pair of Venture Gurus – by Fortune

5. 2019 Healthcare Industry Outlook Infographic – by Capital One

6. Medical Billing, Patient Access Top Revenue Cycle Risks of 2019 – by

7. Healthcare Privacy and Security—Predictions for 2019 – by HITECH Answers

8. 12 trends that will dominate healthcare IT in 2019 – by Health Data Management

9. Five innovation trends that will impact the healthcare industry in 2019 – by MedCity News

10. Three Critical Patient Engagement Trends – by Accenture


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31 Dec 2018

Most Memorable Healthcare Industry Articles From 2018

As 2018 comes to a close, here’s a recap of healthcare industry articles that shaped our thinking.

1. 2018 Healthcare Year in Review – by Modern Healthcare

2. LinkedIn Top Voices 2018: Health Care – by Healthcare at LinkedIn

3. It’s time to talk about private equity in gastroenterology – by NextServices on KevinMD

4. Allscripts, athenahealth Acquisitions Head Top 10 Stories of 2018 – by

5. 10 key business trends for GI physicians and centers in 2018 & beyond – by Becker’s ASC

6. Our 10 most popular stories of 2018 – by American Medical Association

7. The Ten Biggest Private Equity Deals In Healthcare In 2018 – by Forbes

8. Private equity is piling into health care – by The Economist

9. Top Digital Health Stories of 2018: From Amazon And Google To Gene-Edited Babies – by The Medical Futurist

10. Year in review: The provider mergers that made headlines in 2018 – by FierceHealthcare


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13 Dec 2018

Healthcare: Disruption at a scale we haven’t seen before

Just like you, I’m trying to make sense of the world around me. But there are no templates for the bridge that healthcare’s building for its future.

All we can do is listen to weak signals and amplify them.

Last week, CVS finally bought Aetna for $69 billion (must we say almost bought because a judge is still questioning them). I spoke to someone closely familiar with the deal. He called it “vertical stacking” – to expand what CVS customers can get – from drugs to MinuteClinic consultations to now insurance.

But it seems more like CVS disrupting itself before Amazon does. Earlier in the year, Amazon bought PillPack, an online pharmacy (CVS and others lost $11 billion in market value on the day of the announcement).

Market is rife with speculation that Amazon is going to be biggest company in healthcare (fancy signing up for Amazon Prime Health?).

After such buzz, do you think other insurances or pharmacies will stay quiet? In the M&A world, more begets more.

In fact, the entire healthcare industry is in an M&A frenzy. As of June 2018, healthcare was only third in line (#1 is Energy, #2 is Media) in terms of size of deals. See below.

Zooming in and out. From the forest to the trees

Healthcare is so big ($8.7 trillion by 2020) that it nurtures mini-industries within itself. Like the space I’m most familiar with: gastroenterology, a medical specialty in high demand.

Long time ago, gastroenterologists (GIs) ran smaller solo or group practices. Despite the myriad challenges of running a medical business, doctors enjoyed the independence that private practices offered.

But over the years, everything got too complicated. From insurance reimbursements to regulatory compliance to even patient behavior. It just became tougher to stand alone. (Younger physicians hardly go solo today. Most join groups or hospitals.)

Smaller groups became bigger. Demand for colonoscopies (the main procedure that GIs perform) fueled the growth of free-standing ambulatory surgery centers.

Hospitals sensed the opportunity. And began luring gastroenterologists to gain access to their patients and bring home revenues from GI procedures. Under the thumbs of hospital administration doctors lost their independence. It didn’t help that they were forced to use monolithic hospital EHRs.

Well, the market’s now shifting again.

Private equity companies are fueling consolidation of GI groups. By providing capital for recruiting other groups, buying new medical equipment, removing administrative burdens and inefficiencies, streamlining technology and so on. They are courting doctors by offering them independence in a way that hospitals can’t.

Small groups (e.g. 4-8 doctors) and mid-size groups (e.g. 8-20 doctors) are merging to become large groups (e.g. 25-50+). Large groups are becoming super-sized groups (80-200+ gastroenterologists).

And the super groups? I learnt that the pipeline goes all the way to 1,000 GIs operating under a single entity.

Private equity (PE) companies refer to this as a “roll up” strategy. These roll ups will create a different kind of market dynamic that doesn’t exist today. A tailwind of ancillary opportunities (imaging, pathology labs, nutrition counseling, administrative consolidation, EHR and billing systems unification, analytics and so on).

There are approximately 12,000 GIs in the US today. Present consolidation trends indicate that these deals would cover at least half that number over the next few years. The rest might continue to operate like they do today – finding ways to not buckle under market pressure.

Depending on where they are in their career, gastroenterologists welcome this trend or are cynical about it. Older doctors see it as a way to capitalize on what they’ve built so far. Younger doctors see it as selling out too soon. And then there are doctors who are more entrepreneurial – they see it as a way to shape what’s to follow.

Gastroenterology offers an insightful window into other specialties such as dermatology (booming these days), orthopedics, ophthalmology and others.

Larger private equity companies will eventually want to combine super groups across specialties and regions. If that makes no sense, think “vertical stacking” that my friend said as a reason for the CVS and Aetna merger. Or even think of Kaiser Permanante – a non-profit with 22,000 doctors on staff – with a PE twist.

Welcome to the new world!

Where do we go from here?

Just the other day, a doctor reached out to us (after reading our monthly newsletter). Saying it’s confusing out there. He runs a solo private practice but owns a surgery center with other doctors.

He hates all these things that he’s had to do in order to stay in practice. Like EHRs and MACRA, he said. So he stopped doing those things. But worries that he can’t keep ignoring them forever. It’ll catch up with him and then it’ll be too late.

In the end, he wondered if he should find a way to merge with somebody. But then his operations weren’t so clean. Wouldn’t PE investors want a cleaner practice?

And so the conversation went.

The sooner you accept the new reality, the better positioned you’ll be to shape that reality. Before it begins to shape you.


Originally published on LinkedIn,  by Praveen Suthrum, President & Co-Founder, NextServices. 

Image Credit: Álvaro Reguly @ Flickr (

17 May 2018

Doc = Drop Out Club? 5 baffling things in healthcare

Say we met 10 years ago during the early stages of our business. And you asked me this: would healthcare delivery be more complicated in the future?

I would’ve shaken my head animatedly and said “no, it would be simpler!”.

I would’ve shown you technology trends. And told you that healthcare transactions will indeed become more automated, much simpler. Repeatable administrative tasks would be tech-enabled, algorithm driven.

As a company, we started life in billing claims for doctors. Back then I was quite sure billing would be way less complicated in the future. Insurances and hospitals would make sure that happens.

In fact, I would often urge our people to learn and upgrade their skills faster because their jobs would disappear soon.

I was wrong. Actually, very wrong.

I would’ve never guessed any of these things that baffle me about our industry today.

Baffling thing #1: It would cost more for doctors to make the same money

We never used to spend so much time obtaining prior authorizations (PA) before doctors perform procedures. Now we do. On an average, doctors today spend 16.4 hours per week or 853 hours every year on prior authorizations. Average wait time of response is 1-2 days.

I recently visited a hospital that houses some of the world’s best doctors. They can’t handle the PA burden. Their gastroenterology division spends 30+ days on average. Imagine what that means for a patient who urgently needs a procedure.

While PAs represent a bulk of the burden, there are many costs that add up. What’s worse is doctors are left with no choice but to meet these expenses. If they don’t, they don’t get paid.

Baffling thing #2: Healthcare law would get more and more complicated

On Jan 1st, 2017, a new law to track physician performance went into first gear. It’s called Medicare Access and CHIP Reauthorization Act of 2015 (or simply MACRA).

MACRA adds to the long list of regulatory mandates that practices already need to comply with. The law is applicable to roughly 55 million clinicians. It’s 2,398 pages long. Check it out here.

MACRA measures are converted to a point-based system. Using points, doctors are compared to other doctors. A score is derived based on what they could’ve done vs what they did. That finally determines how much someone makes.

We find doctors struggling to interpret the law, leave alone moving in the direction of incorporating the mandates.

Baffling thing #3: Technology, intended to simplify life, would end up making doctors miserable

Technology in the form of poorly designed EHRs adds to the burden of practicing medicine today. Some doctors feel it hurts their relationship with their patients. Some quit medicine altogether unable to deal with the technology.

My company recently completed the third stage of our Meaningful Use certification (now bucketed under the MACRA law) for our own EHR. It took our team us 6 weeks plus. The first stage took us a week. The second possibly 2-3 weeks. It’s reflective of how complicated the qualifying criteria have become.

Mandates require that doctors use certified technology to document their cases. If they don’t, they’ll lose money in the future.

Baffling thing #4: Coding would be so complicated. Creating another avenue for insurances to delay payments

When ICD-10 arrived, clinical codes exploded to 155,000 from an earlier set of 17,000. Insurances have begun to demand greater specificity for codes that doctors submit.

For example, earlier you’d use 530.11 as ICD-9 code for Reflux esophagitis (a digestive disease). Under ICD-10, you have to get specific and code say K21.0 – Gastro-esophageal reflux disease without esophagitis.

Doctors aren’t used to documenting this way. So specifically. The result is more avenues for insurances to deny or delay claims.

Baffling thing #5: In a world of desperate medical need, many doctors would actually give up medicine

It’s called the “Drop Out Club” – a networking site where doctors counsel one another to leave medicine. Burnout. Lack of enthusiasm. Depression. Long work hours. Increasing burden of bureaucratic tasks.

Read: In “Drop Out Club” Doctors Counsel One Another on Quitting the Field

To become a specialist doctor, you have to spend four years in medical school and nine more years to train under a specialty. Imagine the kind of frustration a doctor must face in order to give it all up.

Our long, messy path to the future

Of course, I’m excited about the future. As a business, we keep developing a service or product to address the problems that we see. We figured that’s the best way to move forward in healthcare. Be more useful by solving problems that our clients face.

But I worry about the kind of long, messy path we keep traversing as an industry. A path that only gets murkier.

If we met today and you asked me the same question. Would healthcare be more complicated in the future?

I’d still shake my head and say “no, it’ll be simpler!” I’ll point you to today’s technology trends in artificial intelligence and machine learning. Without question, healthcare delivery will be simpler and more automated.

Of course, I’ve no idea what I’m talking about.


Originally published on LinkedIn,  by Praveen Suthrum, President & Co-Founder, NextServices. 


04 May 2018

How do you get 5 star reviews from patients? Ask them

If you haven’t noticed already the popularity of doctor-review sites is on the rise. Healthgrades has over 3 million listed providers. Another review site Vitals claims to collect over 1.4 billion data points on doctors.

survey found 84% of patients use online reviews to evaluate physicians. 47% of them are willing to go out-of-network for a doctor with more favorable reviews.

Some doctors resist the trend. While some others take advantage of it.

Like Dr. M who seems to engage patients masterfully. Take a look.

Dr. M has over 5 pages of reviews of Vitals with an average rating of a stellar 4.8 on 5. Here’s a sample review.


If you took time to read the review, this patient’s problems aren’t “over” but s/he rated the doctor 5 stars.

Without question, Dr. M is a great doctor with sound clinical outcomes. Surely, patients must be treated compassionately. Possibly, the practice is also operationally efficient.

But there’s something more happening here. For patients to make the effort of going online and writing a review.

Making your best patients into powerful brand advocates

In today’s digital world, reviews have the power to significantly boost patient volume. Simply because patients trust other patients.

A high quality patient experience can instantly turn patients into powerful brand advocates.

The secret to making this work is this.

You ASK.

Yes it’s that simple. So obviously simple that I’m sure you wonder if there’s more to it.

But the reality is that it works.

Right after a patient receives great service and care, request a review. You’ll be surprised at the number of responses you’ll receive.

Getting patients to review you online. In 3 simple steps

Here’s everything you need to know.

1. Instruct your front-desk to capture the patient’s email address. Patients will be willing to share their email address if they know that they’ll be receiving their medical records digitally and securely.

2. Remind patients. At the end of the visit, remind patients that you’ll be sharing their medical records by email.

3. Use this email script when you share medical records. Setup your electronic health record (EHR) software to automatically send the following email when you share medical records.


The mindset of ASK

Most people (including patients) respond well to a request when asked. Here are 4 strategies that’ll help you and your staff get into the mindset of asking reviews.

1. Provide quality services, actually.

2. Even a few reviews matter. Start small

3. Don’t bribe patients. Feel clean

4. Make patient engagement a team effort.

The world of healthcare is changing. Transforming into a more customer-centric arena. Reviews play a crucial role in engaging patients online. With one review building over the other.

Now, over to you.


Originally published on LinkedIn,  by Praveen Suthrum, President & Co-Founder, NextServices. 


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